August 22, 2010Nova Simpson, Pharm.D.

Griseofulvin to Treat Ringworm in Kids

In an earlier article I wrote a brief summary about ringworm treatments, so you may want to read How to Treat Ringworm  first.

I wanted to do a write up about griseofulvin because it is the most used to treat ringworm in kids that need an oral treatment.

Griseofulvin (Grifulvin) is the current prescription drug of choice.  Griseofulvin was first isolated  in 1938 and yet, over 70 years later, it continues to be first line of treatment.  Griseofulvin is available in microsize suspension and tablets (Grifulvin V) and ultramicrosize tablets (Gris-Peg).  It has been approved in children older than 2 years old.

Griseofulvin works by inhibiting fungal growth and helps protect new skin from being infected. This means it stops the fungal infection from progressing, allowing the infection to clear as the infected skin dies and sheds.  Because it does not kill the fungi, griseofulvin has a long length of therapy.  General ringworm of the body is usually treated for two to four weeks, whereas infections involving the head or feet can be treated for as long as four to 12 weeks.  Yes, that’s right, 2 to 3 months of  treatment.

Griseofulvin is typically given to children in the suspension form because it allows specific weight based dosing.  Both suspension and tablets are best absorbed when taken with a fatty meal.  Peanut butter or ice cream are recommended, which makes administering the medication a bit easier for parents J.  The ultramicrosize tablets may be crushed and mixed with 1 tablespoon of applesauce and taken right away without chewing.

Griseofulvin has a low incidence of serious side effects.  The most common adverse reaction is headache.  Also included are belly upset, oral thrush, sensitivity to sunlight and dizziness.  Rare but serious side effects include liver toxicity and decrease in white blood cells; these often disappear even with continuation of therapy.  Perhaps most interesting and pertinent is the estrogen-like effects that griseofulvin can cause in children.  Estrogen-like effects in children can include bloating, depression, headaches, thyroid interference and impaired blood sugar control- once again serious but rare.

Other antifungal medications used to treat ringworm are terbinafine (Lamisil), itraconzaole (Sporanox) and fluconazole (Diflucan).  These drugs appear to have similar efficacy as griseofulvin but with a shorter therapy cycle, typically four weeks.

It is imperative to treat ringworm in children.  If left untreated, bacterial infections and permanent hair loss can occur.  Griseofulvin remains the drug of choice for treatment of ringworm, however this is mostly based on old information.  Back in the day, griseofulvin was the only treatment option available in generic formulation and was therefore bumped to first in line due to price.  Nowadays, all of the medications have some dosage forms available in generic.  When discussing your child’s treatment plan with her physician, be sure to consider the length of treatment, dosage forms and price of the medications.

What do you think?  Love to hear from you -please leave a comment!

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41 comments

  1. My child and dog have both been on this medication for 2 weeks and have seen results. my child does complain of a headache.

  2. tonight was the first dose of this medication for my 7 year old boy. this better work????!!!!! the ringworm is on the back of his head and I’m mortified at the fact that this may lead to permanent hair loss. please please let it work, I know it’s going to take a while, but I really have my fingers crossed here!

  3. We have just been given the prescription for griseofulvin after trying to fight off this ringworm for 3 months on my 3yr old daughter. However we were told today this may be a ringworm or may be excema. We are going to be starting treatment tonight and I will keep you all posted on the progress.

  4. My son is 2yrs old and he has been taken this treatment for a month now. He has a nice size bald spot and im hoping his hair goes back. I feel bad this happened to him. Yes I he is still using the treatment.

  5. have used this drug to a 2 year old child and has realy worked,her head is now smomth and looks much healthy.

  6. My 10 yr old has been on this for a month now, serious kerion developed and also got a staph infection as well, we saw significant improvement in the first week, and I was interested in the sun exposure precautions on the label. What kind of reactions does this med have with sun exposure?

  7. Hi Mr. Youngs,

    Griseofulvin can be a rough medication!! I am glad that your 10 year old is improving. The sun exposure precaution, meaning if he/she is exposed to sun while using this medication, he/she has a higher risk of getting a sun burn. He/she should avoid sun exposure and wear sunblock/hat/clothes to protect his skin if he is going to be outside for a bit.

    I hope this helps!! Take care,
    Nova

    Nova Simpson, Pharm.D.

  8. Hi my son is 4 years old and apparently there was a ringworm outbreak at his school and he has multiple areas of ringworm on his head, he went to the doc this am and has been started on this medication, are there any serious things that i have to look out for.

  9. I will start this medication on Monday. I have being diagnosed with Lupus will this effective me in any way and also how long after I take it can I see results cause I am itching everywhere and breaking out each day with a new ringworm. Thanks i advance!

  11. Is it possible to see new ringworm spots while on the medication? I gave my daughter her first dosage last night and my mom told me she has two new spots on her feet.

    Thanks!
    Julissa

  12. Hi Julissa,

    Yes -after just a few doses, it is possible to see new spots. Most likely, those spots were erupting through as the drug was started. Once she has been on the medication for 5-7 days, there should not be any new spots…although it is possible with extreme cases.

    Thanks,
    Nova

  13. My opinion is to put ivory soap on the ringworm and to give the child the medication for the timely length the doctor ordered. My son has a ringworm which is formed on the inside but left his skin looking irritated and itches on the outside.she gave me medication and shampoo for the itch. I used the ivory and it makes the ringworm vanish on the outside. Continue to give the child the medication too.

  14. Good morning, my one year old grandson was diagnosed as having eczema, then acne, when in fact it was a ringworm. The ringworm got infected. . . . .a bacterial infection. He started griseofulvin; he has been on it for about a week now. He has three spots in his head, one of the three spots is HUGE. We have noticed some improvement. It appears as though the inflammation has improved. There is also less fluid (puss or white blood cells as the ER doc called it) leaking. He still picks at it, I believe because he knows something is wrong and there is probably some irritation. My question is. . in reading your article, the medicine is normally prescribed for children the age of two and up. . . is my grandson more susceptible to the side effects because he is one years old and do you think his hair loss will be permanent since it did turn into a bacterial infection?

    Thank you,
    SUPER CONCERNED ANXIOUS UPSET GRANDMOTHER

  15. Hi Ms. Adams,

    I am sorry to hear about your little grandson! The dose of griseofulvin
    is weight based. Typically, it is not given to children that weigh less
    then 30 lbs. However, it has been given to kids <30 lbs. Most likely the
    physician is giving him a lower dose based on his weight. If the dose is
    based on his weight than most likely the risk of side effects will be the
    same. Just keep an eye out for them so the medicine will be changed if
    needed.

    Another option you can discuss with the physician includes Diflucan
    (fluconazole). Diflucan has been studied in kids >6 months to treat
    ringworm on the head (tinea capitis). The dose was 8mg/kg once weekly.

    Most of the hair loss from ringworm is temporary. It can be permanent but
    that is typically when not treated for an extended period of time (months
    to years). Plus babies are super resilient! 🙂

    Kids pick up ringworm in different ways. Sometimes, it is from a family
    pet. If you have a dog or cat that the baby is living with, you may want
    to have it checked out for ringworm and treated if needed (sometimes dogs
    and cats will not show symptoms).

    I hope this helps and I hope he feels better very soon!! Let us know if
    you have any follow up questions or comments.

    Take care,
    Nova

    Nova Simpson,Pharm.D.

  16. My 1 year old has ringworm of the scalp that turned into kerion. She has been on griseofulvin for a week now. My question is how long before I Starr to see improvement and what will that look like and also what can I put on her head to make the inflammation and redness go down after washing her hair and removing the crust and scabs

  17. Can I give this medication to my son which is 4 yrs old with cough syrup because he has a bad cold ,

  19. Hi Megha,

    Griseofulvin starts working with the first dose. However, it may take days up to weeks to see a major improvement. To help with her pain, itching and inflammation you can apply some cool compresses. Some other options that should first be approved by her pediatrician because she is only 1 year old — topical antifungal OTC creams and topical selenium sulfide.

    I hope this helps and she feels better soon!

    Take care,
    Nova

    Nova Simpson,Pharm.D.

  20. I’m 16 years old and I started taking Griseofulvin exactly 3 weeks ago, I’m not sure what it was at the beginning because I felt pain and itch I just knew it was a type of tinea capitis but I still had a bit of hair. A week later, the pain began to go away and the bump seemed to get smaller but I think my scalp dried up and caused my hair to fall easily. Last week, my doctor told me to take 2 pills a day when I usually just took one, he told me to use nizoral too but that was too strong that my skin didn’t react very well to it. Now I just take the pills twice a day and apply baking soda paste to my scalp of it ever itches. Am I doing anything wrong? Is there still a chance my hair can grow back?

  21. Hi Emanuel,

    It sounds like you are doing exactly what you need to! It can take a long time to treat tinea capitis. Griseofulvin dose ranges, so most likely you were taking the 250mg or 500mg pills and your doctor wanted to increase to double the dose to help treat the infection better. Most times, hair will grow back once the infection is fully treated.

    Nizoral has an antifungal (ketoconazole) that can help treat the fungal infection topically. However, if it hurts too much you can talk to your mom/dad about using a selenium sulfide shampoo -like Selsun Blue. It may be more gentle but still help topically. And keep using the baking soda paste to help with any itching!

    I hope this helps!
    Nova

    Nova Simpson,Pharm.D.

  23. Hi Danshella,

    Griseofulvin can cause a headache -it is actually one of the main side effects. Most of the time, it will go away after a few days to weeks. It is good to tell your doctor and keep an eye on it, especially if it continues longer than a week. Drinking extra water can help with the headache.

    Hope you feel better very soon!
    Nova

    Nova Simpson,Pharm.D.

  24. Hi my 6 year old son has had this ring worm in his scalp for about 3 months. Ive tried home remedies and creams, no luck at all. All the doctors say they can’t give him oral medication, because of a liver test. I really need help. I live in Lancaster Ca and the doctors out here are no help. What can I do to get rid of it. Please help

  25. Hi Doc, my three year daughter has ringworm on her scalp. She was recently proscribed griseofulvin. The problem is she can’t keep it down. We’ve tried putting it in milk, milkshakes and chocolate milk. She eats fatty foods before and after. But she can’t keep it down. Do you have any other suggestions that we could tey to help it stay down. I think she mainly hates how it tastes. We dont let her see us put it in there but she tastes it and most if the time refuses it.

    Help!
    Sincerely A concerned mother

  26. Hi all,

    I’m looking for GRISEOFULVIN – ORAL SUSPENSION (Syrup) medication, but cannot find it in the market anywhere. Please help to find out selling outlets.

    Currently I’m in Dubai-UAE.

    Thanks

  27. Hi
    My 7 year old son was on this medications for 2 months. The infection has cleared up and not reuturned which is great.
    He has been off the medication for about 6-8 weeks now but still has a sore stomach. Can side effects still be a problem after the treatment? Is there common long term side effects?

  28. How do you all get them to take this medicine?! My one yr old has on her scalp and had to start today. I put some in a bottle, she gagged then threw the btl. Then tonight I try straight on and she gags so much that she throws up. I have the shampoo but afraid that alone is not going to work… frustrated Mom… lol

  29. My 9 year old son has been on the oral suspension for two weeks. Because of high demand of the oral suspension it is on back order in the pharmacy and had to be switched to the 250mg tabs twice daily. He has not mastered swallowing pills so my question is can these pills be crushed and given to him?

  32. My almost 3 years old son has been on the medication for a week and around the 5th day his sculp erupted with pimple like looking stuff, no pus just shiny. The medication is prescribed for six weeks, must he continue

  33. My 3 year old son was diagnosed with tinea capitis last week he got after a haircut 4 weeks ago ! He is on griseofulvin medication , for six weeks , tomorrow will be 1 week since hes been on it and im noticing more bald spots ? Is this normal? When will it start taking effect and stop the hairloss ? Will this be permanet hair loss ? Very concerned , i was also told canesten cream will help with scalp infection is this true ?

  34. My 3 year old son has tinea capitis he started treatment last week thursday , is he still contageous to others ?

  35. Hi nova my daughter is 6 years old and she has a lot of pus oozing out her head from the ring worm and she getting fever and she been given the antibiotic she been taking it about a week ago how can we get to stop oozing so much

  36. My 3 year old was diagnosed with ringworm in scalp its been 3 weeks on griseofulvin and he is still getting more bald spots ? When do baldspots stop appearing ?

  37. Hi Ruby,

    Once tinea capitis is being treated with oral antibiotics, it is typically NOT contagious after 72 hours of treatment.

    Sometimes, topical treatments can help with oozing and hair regrowth. Some options are: Selsun Blue, Nizoral (antifungal shampoo) and neem oil. Most bald spots are only temporary if it is treated. It can take 6-12 months for the hair to grow back.

    If he has been treated for 3 weeks and has new spots appearing, I would speak with his doctor. It could be that topical treatment needs to be added or perhaps the dose increased (if he happen to be started on a lower dose).

    I hope this helps and your little one is feeling better very soon!
    Nova

    Nova Simpson, PharmD

  38. My now 12 year old contracted ringworm and tinea capitis from a neighbor’s kids who got it from a cat. Initially we put lotrimin on the spot on her arm and the spot on the top of her head …. FYI- don’t put lotrimin on your head… it makes the hair fall out pretty immediately. She began taking griseofulvin prescribed by pediatrician. After 3-4 weeks of no big change and noticing it was spreading on the scalp we went to dermatologist who misdiagnosed it as sebhorric dermatitis and prescribed a topical solution that I later learned was a steroid. This was a HUGE failure on the part of the Doctor…as I tried many times to tell him I believed it WAS ringworm. The steroids made the fungus EXPLODE. It spread throughout the hair follicle system. She had 2-3 big kerions on her head as well as puss and sores on 80% of her hair follicles with extreme hair loss in patches and her scalp looked like something you’d see on a burn victim. We immediately stopped the topical steroid solution after only 2 doses and had 2 biopsies done at another dermatologist who referred us to a specialist at Emory in Atlanta, Ga. She confirmed it was tinea capitis and again prescribed griseofulvin. My daughter had swollen lymph nodes in neck and at base of scalp… sometimes fever and rash at the back of the neck. After taking the medicine for about 3 months the infection was gone, scalp began to return to normal appearance and thank GOD, 98% of hair grew back!! You can barely see 1 small patch of normal scalp now if you really look for it, where hair did not come back.
    Fast forward about 3.5 years… no outbreaks in her or any other family member. One day I used a mortician mud mask designed to “pull” impurities from the pores. Immediately after using this I developed a kerion on my face under my nose. A few days later I got another patch on my chin at which point I could see the more well defined circle pattern and knew that it was ringworm… how could this have stayed dormant in my system so long undetected?
    I started griseofulvin and took for 2 months. All symptoms cleared up. Less than a year later I got 2 new patches on my face, AGAIN!
    I am now 2 months in to my 2nd treatment with griseofulvin. The external spots appeared to have gone completely.. before getting my 3rd month supply… I decided to go a few days without the medicine to see if anything came back. I am concerned about using this medicine for so long as it is not good for your liver and I am a very organic natural lifestyle person. After only 3 days without medicine the spots came back!! Now, to make matters worse, my daughter has JUST shown symptoms of having it in her scalp again!!! Itchy head, rash at base of neck and last night stated she wasn’t feeling well and that lymph nodes at neck were sore.
    I don’t feel that griseofulvin is strong enough or effective enough to completely kill what we are dealing with… what else is there to take that can completely kill this dreaded fungus?!!!! Help!

  39. A kitten introduced ringworm into our home and my 3 year old son got it on his scalp. He has been on griseofulvin for 7-8 weeks now and the spots look great to the naked eye and are growing back hair. We have been using a black light on it since the beginning since the fungus makes the hairs flouresce. The spots still both have some hairs that glow. Should we continue treatment until all glowing stops? Or at some point will his immune system fight off the remaining glowing follicles?

  40. Hi Elizabeth -I am sorry to hear of your long battle with ringworm!There are other antifungals that can be used. Because I would consider this as a failure of griseofulvin and a new antifungal should be used. I would suggest talking with your physician about terbinafine and itraconazole

    Please let us know how you are doing!

    I hope this helps!
    Nova

    Nova Simpson,PharmD

  41. Hi Nova,

    We got a kitten that was asymptomatic for ringworm (a carrier perhaps) and gave it go my daughter initially. It started out only on her body (face included) and only a month later went into her hair (is that normal?). My son got it on his body (face included) too and also a month later on his head. We (mom and dad) also got it on our bodies (face too) but not our hair. We were all using topical antifungals 2x daily for a month and the spots would go but others would just arise in their place. It was not until we were a month into this mess that it showed balding spots (overnight?) on my daughter and then my son that we ALL got on oral antifungals. Sadly, when we saw the bald spots we made a decision that we had to get rid of the kitten because it just became too much. We were using oral antifungals on the cat along with sulfur dips, we were cleaning sheets and towels daily after a single use, bleaching everything, threw out rugs, steam cleaned carpets multiple times, etc. It’s been a nightmare. We have only been on the oral antifungals for less than a week. I am assuming from what I have read that after 72 hours we are all not contagious anymore. I am wondering what we need to do at home to get rid of any spores lingering in the house as I am very concerned about a relapse after we are all “cured”. Here are my questions.

    1) How common is it to get ringworm on the body first and then on the head? Is that typical or atypical?
    2) If the antifungals are effective, how common is a reoccurrence from remaining spores?
    3) Is there anything I can do to stop the fungus that is already present on my kids head? I am using the nizoral and applying topical clotrimazole 2% 2x daily.

    Thank you!

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