A randomized, comparative trial of treatment of kerion celsi with griseofulvin plus oral prednisolone vs. griseofulvin alone

Abstract

Glucocorticoids are often recommended along with oral antifungals in the treatment of kerion celsi. In this randomized study, the efficacy of combination therapy with oral griseofulvin and oral prednisolone (n =17) was compared to oral griseofulvin alone (n=13) in the treatment of kerion celsi. Both groups were treated with oral griseofulvin for 8 weeks whereas oral prednisolone was given in tapering doses for 3-4 weeks to the first group only. The final evaluation at week 12 showed a cure rate of 100% in both groups without any significant difference in terms of clinical or mycological cure (P>0.05). No adverse events were noted in either group. In our opinion the combination of oral prednisolone with griseofulvin does not result in additional objective or subjective improvement compared to griseofulvin alone in cases with kerion celsi.

Erythema nodosum induced by kerion celsi of the scalp in a child: a case report and mini‐review of literature

“…17 No significant difference was found between therapy with griseofulvin plus oral corticosteroids and griseofulvin alone in a randomised comparative trial. 18 We suggest the systemic corticosteroids therapy, in addition to antifungal therapy, if dermatophytid reaction is particularly widespread or inflamed. 19 In our case, we added the corticosteroids therapy to reduce the symptoms, to provide an anti-inflammatory effect and reduce the risk of scarring alopecia induced by kerion celsi.…”

Severe kerion celsi due to Trichophyton mentagrophytes: a case report

“…Traditionally, griseofulvin (10-25 mg ⁄ kg ⁄ day for 6-8 weeks) is the most frequently used antifungal agent, but a recent Cochrane review (8) showed newer agents like terbinafine (10-20 kg: 62.5 mg ⁄ day; 20-40 kg: 125 mg ⁄ day; >40 kg: 250 mg ⁄ day for 2-4 weeks), itraconazole (5 mg ⁄ kg ⁄ day for 2-6 weeks) and fluconazole (first dose 6-12 mg ⁄ kg, then 3-6 mg ⁄ kg ⁄ day for 2-4 weeks) to have similar efficacy in tinea capitis caused by Trichophyton species. One randomized controlled trial in 30 patients investigated the additional benefit of adding prednisolone to the treatment in kerion celsi and found none (9). After the start of oral terbinafine, the patient developed a generalized rash diagnosed as drug induced.…”

A Large, Tender Scalp Nodule in an 8-Year-Old Boy

“…6,7 One small study does not support the use of corticosteroids in kerion celsi. 6 Topical keratolytics and gentle soaks can aid in removal of the thick crust that develops on the surface of the kerion. 4 Positive dermatophyte screening results based on swabs of the affected area will distinguish Trichophyton and Microsporum species and may guide the choice of systemic antifungal therapy.…”

“…1,2,4 There is some debate about the use of topical or oral corticosteroids as part of the treatment of kerions. 6 Many suggest the use of corticosteroids because kerions present with intense inflammation and the use of these corticosteroids may allow quicker recovery and preservation of hair. 6,7 One small study does not support the use of corticosteroids in kerion celsi.…”

“…6 Many suggest the use of corticosteroids because kerions present with intense inflammation and the use of these corticosteroids may allow quicker recovery and preservation of hair. 6,7 One small study does not support the use of corticosteroids in kerion celsi. 6 Topical keratolytics and gentle soaks can aid in removal of the thick crust that develops on the surface of the kerion.…”