In order to effectively treat tinea capitis, oral antifungal drugs are necessary. As an additional therapy, topical antifungal shampoos like ketoconazole 2% shampoo or products containing selenium sulfide or salicylic acid are recommended. Prior evidence suggests that topical antifungal monotherapies have limited efficacy in the complete resolution of the lesions. The objective of this open study was to evaluate the effectiveness of ketoconazole 2% shampoo as a standalone treatment for tinea capitis.

The study involved 16 Black children, aged 3 to 6, all diagnosed with tinea capitis caused by Trichophyton tonsurans. They were treated daily with 2% ketoconazole shampoo for a total of 8 weeks, resulting in 56 treatments. Clinical and mycologic examinations were conducted every 2 weeks and again 4 weeks after the treatment. The number of colonies was counted on each culture plate during each visit. Patients who still had positive cultures after 8 weeks were given oral griseofulvin, while those with negative cultures were monitored monthly with additional 12 months of culture testing. 

The results showed significant clinical improvement in all patients within 2 weeks, and patients reported relief from itching as early as 2 to 6 days. After 8 weeks of shampoo treatment, 14 out of 15 (93%) children were clinically healed. Mycologically, the cultures demonstrated a reduction in T. tonsurans growth from a confluent state to less than 100 colonies within 2 weeks, fewer than 50 colonies at week 4 and 20 colonies or less after week 6. The number of colonies remained at 20 or fewer after 8 weeks of treatment. Six out of 15 children (40%) had negative cultures after 2, 4 and 6 weeks. One child experienced a relapse at the first 4-week follow-up visit. Five out of 15 children (33%) remained culture-negative for 12 months after treatment.

From the findings, it was inferred that ketoconazole 2% shampoo alone effectively reduces the number of viable arthroconidia in children with tinea capitis, thereby reducing the contagiousness of the disease. Unexpectedly, a complete cure was achieved in 5 out of 15 children, and they remained free of clinical symptoms and mycologic evidence of infection for up to 1-year post-treatment.

Source: Greer DL. Successful treatment of tinea capitis with 2% ketoconazole shampoo. Int J Dermatol. 2000;39(4):302-4.