infectious

Tinea capitis (scalp ringworm)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 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 against5 documents

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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Tinea Capitis" - disease-level clinical article

Presentation findings are traced to the source above.

GRISEOFULVIN

1st line

Formoral.solid

Adult dose and duration

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

Paediatric dose

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)

Dose by weight
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)

Dose 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.

Cautions

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).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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? strength differs? different route - not oral solid	KAHIRA	6.50 EGP
GRISEOVIN 2.5% SUSP. 120ML? strength differs? different route - not oral solid	DELTA PHARMA	7.25 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose 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.

Cautions

RED FLAG - Monitor liver enzymes before, during, and after oral antifungal therapy.

FLUCONAZOLE

2nd line

Strength150 mg

Formoral.solid

Adult dose and duration

150 to 300 mg once weekly

Paediatric dose

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).)

Dose by weight
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

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.

Cautions

Hypersensitivity to fluconazole or any component of the formulation
Cases of QTc prolongation and torsade de pointes are associated with fluconazole use.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
JENFUNGA 150 MG 1 CAPS.	EGPI > JENIKO MEDICINE PHARMACEUTICALS	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.A.E.	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 > PAXAL	26.50 EGP (26.50/unit)
NAVILUCA 150 MG 2 CAPS.	INTERNATIONAL DRUG INDUSTRIES > ROTABIOGEN	69.00 EGP (34.50/unit)
NAZOWELL 150 MG 3 CAPS.	EGPI > HEALTH WELL	108.00 EGP (36.00/unit)
DIFLUCAN 150 MG 1 CAPS.	PFIZER	111.00 EGP (111.00/unit)
DIFLUNAZOLE 25MG/5ML SYRUP 70ML? strength differs? different route - not oral solid	CID	28.80 EGP
FLUCAZONIL 25MG/5ML SYRUP 70 ML? strength differs? different route - not oral solid	EL NILE.	28.80 EGP

KETOCONAZOLE

add-on - not a substitute

Formtopical

Adult dose and duration

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

Paediatric dose

Ketoconazole shampoo 2% is for use in adolescents and adults:

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
KONAZOLE 2% SHAMPOO 60 ML	ALFACURE PHARMACEUTICALS	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

PREDNISOLONE

add-on - not a substitute

Strength5 mg

Formoral.solid

Adult dose and duration

5 to 60 mg/day as a single daily dose or in 2 to 4 divided doses, tapered

Paediatric dose

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.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HOSTACORTIN H 5MG 30 TAB.	SANOFI	12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.	ARAB DRUG COMPANY (ADCO)	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? strength differs? different route - not oral solid	RAMEDA	7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	9.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.