Laboratory monitoring during antifungal treatment of pediatric tinea capitis.

BACKGROUND Griseofulvin and Terbinafine are considered effective first-line therapies for tinea capitis (TC). Hematologic dyscrasias and hepatic injury are possible adverse effects with both drugs. There is a debate in the literature regarding the necessity of laboratory monitoring during Griseofulvin and Terbinafine treatment. OBJECTIVES We aimed at assessing the prevalence and severity of hematologic and hepatic laboratory test abnormalities in a pediatric cohort of African immigrants in Tel-Aviv with TC who were treated with Terbinafine or Griseofulvin. METHODS We conducted a retrospective study of all TC cases diagnosed and treated at the pediatric dermatology clinic, Tel-Aviv Medical center, between June 2013 and March 2019. Epidemiologic, clinical and laboratory data were collected. RESULTS Our cohort included 321 patients of whom 225 (70%) were treated with Griseofulvin and 96 (30%) with Terbinafine. We identified a total of 64 (20%) patients with hematologic or hepatic laboratory test abnormalities that in most cases (96.3%) were considered as mild. No difference in laboratory abnormalities prevalence was identified between the Griseofulvin and Terbinafine groups (21.3% and 16.6% respectively). Only one patient treated with Griseofulvin revealed significantly increased levels of hepatic aminotransferases that required discontinuation of treatment. CONCLUSIONS Mild elevation in hepatic transaminases is relatively common among pediatric patients treated with systemic antifungal treatment for TC. However, significant laboratory abnormalities are extremely rare and may be diagnosed and addressed early through periodic laboratory tests monitoring.