Tinea Capitis & Kerions
I think that we all believe we are adept at diagnosing tinea capitis in the pediatric emergency department. We certainly see it enough… but, remember:
The diagnosis can be unclear:
- Tinea Capitis (caused by a dematophyte fungal infection in the hair shaft) can occur in all ages.
- Can vary from mild itch with no hair loss to severe inflammatory reactions and alopecia.
- Seborrheic dermatitis, eczema, psoriasis, alopecia areata, and folliculitis may resemble tinea captitis.
- One tip to assist you – Use the otoscope as a way to magnify the skin and see whether there are broken shafts of hair (the black dot phenomena).
Tinea capitis requires systemic antifungal Rx
- Griseofulvin is the most commonly chosen agent – often for 8 weeks!!
- Fluconazole, terbinafine and itraconazole have also been studied and offer the benefit of shorter duration… but generally thought of as second-line agents used for treatment failure. They are more expensive.
- Topical antifungals do not penetrate the hair shaft adequately enough to resolve the fungal infection.
- Antifungal shampoos may help reduce transmission… but, again, will not resolve the problem.
The Kerion is not likely superinfected!
- They may look disgusting and have purulent drainage, but they are not commonly superinfected. Antibiotics are usually not necessary… and should not be administered in lieu of systemic antifungals.
- The main therapy is still systemic antifungals (griseofulvin, etc).
- Many will also add systemic steroid therapy. This is thought to counteract the inflammatory response the body is having against the fungus.
- There is literature to both support and refute this practice… just like all fun issues in medicine.
- My personal approach to Kerion therapy (humbly submitted to you) is to start Griseofulvin and add steroids. It is also important to ensure that they are followed up by their physician closely as to determine treatment response. You do not want them to develop scaring and permanent alopecia from a condition that should be treatable.
Urbà González, Terry Seaton, George Bergus, Jim Jacobson, Cecilia Martínez-Monzón. Cochrane review: Systemic antifungal therapy for tinea capitis in children. Article first published online: 26 MAR 2009
Pomeranz A.J.; Sabnis S.S. Tinea Capitis: Epidemiology, Diagnosis and Management Strategies. Pediatric Drugs, Volume 4, Number 12, 2002 , pp. 779-783(5)
Möhrenschlager, Matthias; Hans Peter Seidl,; Ring, Johannes; Abeck, Dietrich. Pediatric Tinea Capitis: Recognition and Management. American Journal of Clinical Dermatology, Volume 6, Number 4, 2005 , pp. 203-213(11)
Pomeranz AJ, Fairley JA. Management Errors Leading to Unnecessary Hospitalization for Kerion. Pediatrics Vol. 93 No. 6 June 1, 1994 pp. 986 -988