What is your diagnosis and what do you suggest as therapy for this poor boy?
Diagnosis: T. Capitis; kerion type
Below, you can read the opinions of the iranderma members about the therapy of this disease;
Dr. Reza Ghaderi; Associate Professor of Dermatology, Birjand UMS:
The most common treatment is an antifungal medicine taken by mouth (griseofulvin, ketoconazole, fluconazole, itraconazole , fenticonazole or terbinafine). About six weeks of treatment is usually needed. It is given once a day with a fatty meal (whole milk, cheese, french fries, etc.). If a large kerion has formed, the antifungal treatment may be supplemented with oral antibiotics and corticosteroids (oral prednisolone) for a short period of time.
The progression from a scaly eruption to a kerion depends on the nature of the infective organism and host factors. Surgical drainage remains an essential part of the treatment of bacterial abscesses. However, scalp abscesses are extremely rare unless there is immune deficiency or penetrating trauma and are usually associated with severe pain and constitutional upset. Surgical drainage of a fungal kerion in the absence of other medical or surgical problems should therefore not be undertaken.
Most fungal skin infections respond very well to topical antifungal preparations (but topical potions are of no help in treating a kerion), such as the imidazoles (miconazole, clotrimazole, econazole, ketoconazole), ciclopirox, naftifine, or terbinafine. Resistant cases or those with widespread involvement require systemic therapy.
Newer systemic drugs include itraconazole and
fluconazole, oral triazoles, and terbinafine, a second-generation
allylamine. These drugs appear to be safer and more effective than
ketoconazole, a broad-spectrum oral imidazole derivative that is
effective for dermatophyte infections, although occasional liver
toxicity (severe or even fatal) limits its use. Itraconazole
interacts with many commonly prescribed drugs. Terbinafine delays
gastric emptying, and GI side effects occur in 3 to 5% of patients.
Disturbances of taste occur less frequently, and hematologic and
hepatic side effects are rare. However, liver function should be
evaluated at baseline and periodically thereafter. The new
antifungals are more effective than griseofulvin in all
dermatophytoses, except possibly tinea capitis.
Until recently, griseofulvin was the most widely used systemic antifungal drug, but its use as first-line treatment of cutaneous fungal infections is decreasing with the availability of newer drugs. The adult dosage is microsize griseofulvin 250 mg po bid to qid, best given with a high-fat meal. Ultramicrosize griseofulvin is better absorbed and should be given in a single or divided total dose of 250 to 330 mg po for tinea corporis, capitis, or cruris and 500 to 660 mg po for tinea pedis. Headache is the most common side effect, and the drug occasionally causes GI distress, photosensitivity, rashes, or leukopenia. Angioedema has been reported. Vertigo and, rarely, exacerbation of lupus erythematosus or transient hearing reduction may occur. Topical imidazoles used with oral griseofulvin increase the cure rate.