A child with circular, scaly lesions with central clearing on the arms and trunk, plus a scalp lesion. How should this be treated?

• A. Obtain scrapings of the lesions for fungal cultures.
• B. Prescribe oral griseofulvin for 2 to 4 weeks.
• C. Order prescription-strength antifungal creams.
• D. Recommend OTC antifungal creams and shampoos.

Answer: (B)

Tinea capitis on the scalp requires systemic antifungal therapy because the fungus invades hair shafts and follicles, which topical treatments cannot reach effectively. Oral griseofulvin is a classic choice for children because it concentrates in keratinized tissues and clears dermatophyte infections that involve the scalp. The presence of a scalp lesion along with body lesions signals that simply using creams would not be sufficient; you need a systemic option to eradicate the organism in the hair follicles and prevent ongoing transmission. Once systemic treatment is started, the body lesions can also resolve as the scalp infection is controlled. While fungal cultures can help confirm the diagnosis, they don’t replace the need for systemic therapy in this scenario. Topical prescription-strength antifungals or OTC creams and shampoos may help surface lesions but aren’t adequate when the scalp is involved, which is why oral griseofulvin for a several-week course is the best choice.