# Tinea capitis (scalp ringworm) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary, antimicrobial 2023, griseofulvin monograph (printed p. 43) · Griseofulvin 125 mg Tablets SmPC sections 4.2-4.6 (eMC product 12894) · Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) · Tinea Capitis - disease-level clinical article (tinea-capitis-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary, antimicrobial 2023, griseofulvin monograph (printed p. 43) - Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) - Tinea Capitis - disease-level clinical article (tinea-capitis-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 - Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) ## Treatment metadata - Griseofulvin — oral.solid - Referral & safety-netting (no drug therapy) - Fluconazole — 150 mg — oral.solid - Ketoconazole — topical - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text TINEA CAPITIS (SCALP RINGWORM) Sources: Egyptian National Drug Formulary, antimicrobial 2023, griseofulvin monograph (printed p. 43) · Griseofulvin 125 mg Tablets SmPC sections 4.2-4.6 (eMC product 12894) · Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) · Tinea Capitis - disease-level clinical article (tinea-capitis-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Infection typically starts as small red bumps that grow larger and can spread across the whole scalp - Common symptoms are scalp redness, itching, flaking, and hair loss [hair loss · itching · redness · scaling] - The inflammatory kerion type discharges pus and can cause permanent hair loss [hair loss · pus] - Infection can extend to involve the eyelashes and eyebrows - An id reaction can cause intensely itchy blisters at a distant site, usually the feet, often triggered by antifungal treatment [blisters · itching] SIGNS - what you find (5) - The center of the round patch can look normal while the edges appear red and inflamed - Presentation varies by organism - it can resemble severe dandruff or present as patchy hair loss [hair loss] - Neck lymph node swelling is common in patients with the kerion form [lymphadenopathy] - The classic black-dot form shows hairs broken off at the scalp surface - Favus presents as a boggy, inflamed scalp with deep oozing nodules, abscesses, crusting, or scutula [crusting] TESTS (3) - A fungal culture can identify the specific causative organism - A scalp scraping treated with 20% KOH and viewed under the microscope shows fungal hyphae and spores - Wood's lamp shows green to yellow-green fluorescence for several Microsporum species, blue for T schoenleinii, and usually no fluorescence for T tonsurans IF NOT THIS - what else fits (12) - Dissecting folliculitis (folliculitis decalvans) - Cellulitis - Bacterial folliculitis - Secondary syphilis - Skin abscess - Infected eczema - Pyoderma - Pustular psoriasis - Syphilis - Seborrheic dermatitis - Systemic lupus erythematosus - Drug eruption reaction Source StatPearls "Tinea Capitis" - disease-level clinical article Status traced to the source above 1. GRISEOFULVIN [1st line] Adult Microsize: 500 mg/day in single or divided doses; for more widespread lesions initial doses of 750 to 1,000 mg/day in single or divided doses may be needed Peds 20-25 mg/kg/day [child max 1000 mg] (Children >2 years and Adolescents: Microsize: Oral: 20 to 25 mg/kg/day in single or 2 divided doses; maximum daily dose: 1,000 mg/day) 3kg -> 60-75 mg/day 4kg -> 80-100 mg/day 5kg -> 100-125 mg/day 6kg -> 120-150 mg/day 7kg -> 140-175 mg/day 8kg -> 160-200 mg/day 9kg -> 180-225 mg/day 10kg -> 200-250 mg/day 11kg -> 220-275 mg/day 12kg -> 240-300 mg/day 13kg -> 260-325 mg/day 14kg -> 280-350 mg/day 15kg -> 300-375 mg/day 16kg -> 320-400 mg/day 17kg -> 340-425 mg/day 18kg -> 360-450 mg/day 19kg -> 380-475 mg/day 20kg -> 400-500 mg/day 21kg -> 420-525 mg/day 22kg -> 440-550 mg/day 23kg -> 460-575 mg/day 24kg -> 480-600 mg/day 25kg -> 500-625 mg/day 26kg -> 520-650 mg/day 27kg -> 540-675 mg/day 28kg -> 560-700 mg/day 29kg -> 580-725 mg/day 30kg -> 600-750 mg/day 31kg -> 620-775 mg/day 32kg -> 640-800 mg/day 33kg -> 660-825 mg/day 34kg -> 680-850 mg/day 35kg -> 700-875 mg/day 36kg -> 720-900 mg/day 37kg -> 740-925 mg/day 38kg -> 760-950 mg/day 39kg -> 780-975 mg/day 40kg -> 800-1000 mg/day 41kg -> 820-1000 mg/day (upper capped) 42kg -> 840-1000 mg/day (upper capped) 43kg -> 860-1000 mg/day (upper capped) 44kg -> 880-1000 mg/day (upper capped) 45kg -> 900-1000 mg/day (upper capped) 46kg -> 920-1000 mg/day (upper capped) 47kg -> 940-1000 mg/day (upper capped) 48kg -> 960-1000 mg/day (upper capped) 49kg -> 980-1000 mg/day (upper capped) 50kg -> 1000 mg/day (capped) Source Egyptian National Drug Formulary, antimicrobial 2023, griseofulvin monograph (printed p. 43) Why The only route that reaches the fungus. Tinea capitis lives inside the hair shaft and down in the follicle, where no cream can follow it - oral treatment is not an escalation here, it is the treatment. Caution Microsize and ultramicrosize are NOT the same dose. The formulary's 20-25 mg/kg is microsize; ultramicrosize runs about a third lower, and the UK label for its tablets gives 10 mg/kg. Two Egyptian brands are called ULTRAFULVIN and ULTRAGRISEOFULVIN. Read which one is in your hand before you calculate, because guessing here either poisons a child or wastes six weeks. The label's paediatric figure is 10 mg/kg/day and the Egyptian formulary's is 20-25. The higher one is used here because it is the tinea-capitis-specific dose; 10 mg/kg is the general minimum for any griseofulvin indication. Scalp infection needs the higher figure. After food, and fatty food - whole milk, ice cream, peanut butter. On an empty stomach barely any of it is absorbed, and a failed course is usually a food problem rather than a resistant fungus. Shake the suspension. Not in pregnancy, and not in a woman who might conceive within a month of finishing. Men must not father a child for six months after the course. It weakens oral contraceptives. Additional precautions throughout and for a month afterwards. It photosensitises - keep off intense sun. Monitor liver function; jaundice or rising enzymes can be serious and means stop. Rarely leukopenia: stop if granulocytes fall. Watch warfarin and ciclosporin levels alongside it. Breastfeeding is not recommended during treatment. Contraindicated in hypersensitivity, hepatic failure, porphyria, and pregnancy. Use with caution in lupus erythematosus (risk of exacerbation). Egypt ULTRAFULVIN 125MG 25 TAB. MEMPHIS 5.00 EGP (0.20/unit) ULTRAGRISEOFULVIN 125 MG 20 TABS. KAHIRA 5.50 EGP (0.28/unit) ULTRAGRISEOFULVIN 2.5% SUSP. 100ML KAHIRA 6.50 EGP -> ? strength differs, ? different route - not oral solid GRISEOVIN 2.5% SUSP. 120ML DELTA PHARMA 7.25 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Tinea Capitis - disease-level clinical article (tinea-capitis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Monitor liver enzymes before, during, and after oral antifungal therapy. 3. FLUCONAZOLE [2nd line] Adult 150 to 300 mg once weekly Peds 3-12 mg/kg/dose (Children: initial 6 to 12 mg/kg/dose, then 3 to 12 mg/kg/dose once daily (general dosing; no specific paediatric tinea dose in the monograph; limiting dose 600 mg/dose).) 3kg -> 9-36 mg/dose 4kg -> 12-48 mg/dose 5kg -> 15-60 mg/dose 6kg -> 18-72 mg/dose 7kg -> 21-84 mg/dose 8kg -> 24-96 mg/dose 9kg -> 27-108 mg/dose 10kg -> 30-120 mg/dose 11kg -> 33-132 mg/dose 12kg -> 36-144 mg/dose 13kg -> 39-156 mg/dose 14kg -> 42-168 mg/dose 15kg -> 45-180 mg/dose 16kg -> 48-192 mg/dose 17kg -> 51-204 mg/dose 18kg -> 54-216 mg/dose 19kg -> 57-228 mg/dose 20kg -> 60-240 mg/dose 21kg -> 63-252 mg/dose 22kg -> 66-264 mg/dose 23kg -> 69-276 mg/dose 24kg -> 72-288 mg/dose 25kg -> 75-300 mg/dose 26kg -> 78-312 mg/dose 27kg -> 81-324 mg/dose 28kg -> 84-336 mg/dose 29kg -> 87-348 mg/dose 30kg -> 90-360 mg/dose 31kg -> 93-372 mg/dose 32kg -> 96-384 mg/dose 33kg -> 99-396 mg/dose 34kg -> 102-408 mg/dose 35kg -> 105-420 mg/dose 36kg -> 108-432 mg/dose 37kg -> 111-444 mg/dose 38kg -> 114-456 mg/dose 39kg -> 117-468 mg/dose 40kg -> 120-480 mg/dose 41kg -> 123-492 mg/dose 42kg -> 126-504 mg/dose 43kg -> 129-516 mg/dose 44kg -> 132-528 mg/dose 45kg -> 135-540 mg/dose 46kg -> 138-552 mg/dose 47kg -> 141-564 mg/dose 48kg -> 144-576 mg/dose 49kg -> 147-588 mg/dose 50kg -> 150-600 mg/dose Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Fluconazole is named by the article as an alternative oral antifungal for tinea capitis; the formulary gives a general tinea dose of 150 to 300 mg once weekly. No duration is stated in the formulary for this dosing entry. Caution Hypersensitivity to fluconazole or any component of the formulation Cases of QTc prolongation and torsade de pointes are associated with fluconazole use. Egypt JENFUNGA 150 MG 1 CAPS. EGPI > JENIKO... 4.50 EGP (4.50/unit) AMRIFLUCAN 150 MG 2 CAPS. AMRIYA 11.00 EGP (5.50/unit) FLUDCONRIZOLE 150 MG 1 CAPS. RIVA PHARMA S... 6.00 EGP (6.00/unit) FLUCORAL 150 MG 4 CAPS. SEDICO 60.00 EGP (15.00/unit) TRICONAL 150 MG 1 CAPS. T3A PHARMA > ... 26.50 EGP (26.50/unit) NAVILUCA 150 MG 2 CAPS. INTERNATIONAL... 69.00 EGP (34.50/unit) NAZOWELL 150 MG 3 CAPS. EGPI > HEALTH... 108.00 EGP (36.00/unit) DIFLUCAN 150 MG 1 CAPS. PFIZER 111.00 EGP (111.00/unit) DIFLUNAZOLE 25MG/5ML SYRUP 70ML CID 28.80 EGP -> ? strength differs, ? different route - not oral solid FLUCAZONIL 25MG/5ML SYRUP 70 ML EL NILE. 28.80 EGP -> ? strength differs, ? different route - not oral solid 4. KETOCONAZOLE [add-on - not a substitute] Adult 2% shampoo twice weekly, left on 3-5 minutes before rinsing, alongside the oral treatment - The first 2-4 weeks, while the oral drug works Peds Ketoconazole shampoo 2% is for use in adolescents and adults: Source Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) Why Cuts the spores shed onto pillows, combs and other children. It shortens nobody's infection - it limits who catches it next. Caution Off-label. The shampoo is licensed for dandruff, seborrhoeic dermatitis and tinea versicolor - not for tinea capitis. It is used here to cut spore shedding and reduce spread, which is a real benefit, but it is not what the label covers. This is an adjunct and nothing more. A shampoo cannot cure tinea capitis - the fungus is inside the hair shaft, below where anything topical reaches. Treating scalp ringworm with shampoo alone is how it runs for months and scars. Check the rest of the household, and the combs, hats and pillowcases. Reinfection from home is the usual reason a proper course seems to fail. A boggy, pustular, tender swelling is a kerion - an inflammatory reaction, not a bacterial abscess. It should not be incised. It still needs the oral antifungal, and it is the presentation that scars if it is treated as a boil. Egypt KONAZOLE 2% SHAMPOO 60 ML ALFACURE PHAR... 12.00 EGP KETODERM 2% GEL SHAMPOO 60 GM SEDICO 18.00 EGP KENZO 2% SHAMPOO 60 ML BORG 27.50 EGP CURAZOLE 2% TOPICAL CREAM 15 GM EVA PHARMA 7.00 EGP ZAKAN 2% CREAM 15 GM SIGMA 7.00 EGP NIZODERM 2% CREAM 15 GM UNIPHARMA 15.00 EGP ZAKAN 2GM/100ML SHAMPOO 60 ML SIGMA 18.30 EGP NIZAPEX 20MG/GM SHAMPOO 80 ML APEX PHARMA 68.00 EGP 5. PREDNISOLONE [add-on - not a substitute] Adult 5 to 60 mg/day as a single daily dose or in 2 to 4 divided doses, tapered Peds The ENDF prednisolone monograph gives no paediatric figure for this indication, so none is stated here. Tinea capitis is mainly a childhood disease, so this row's adult range should not be applied to a child without a paediatric source. Source Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) Why Added to - never instead of - the oral antifungal, for a kerion, to reduce inflammation and the risk of permanent scarring alopecia. Caution Adjunct only - the oral antifungal remains the treatment; a steroid alone does not clear the infection. Abrupt withdrawal is not recommended, particularly with doses of 40 mg or more or 3 weeks of treatment or more. The dose should be gradually decreased to the lowest dose that maintains an adequate clinical response. No paediatric dose is stated in the ENDF for this use, and this is a predominantly paediatric condition - refer rather than extrapolate. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)