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Three Part Question

In [children diagnosed with kerion], is [intralesional corticosteroid] effective in [reducing the duration of the disease]?

Clinical Scenario

A pediatric patient presents to the ER with an inflammatory fungal infection of the scalp, a kerion. It has been proposed that steroid administration may reduce the time for the kerion to resolve. Is intralesional corticosteroid administration effective in reducing the duration of symptoms?

Search Strategy

Medline 1966-07/04 using the OVID interface
{(kerion.mp) or [(suppurative.mp) and (tinea.mp)]} and [(steroid.mp) or (corticosteroid.mp)]

Search Outcome

One paper was found to be relevant. This paper is shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Ginsburg, Charles M., Vanthaya N. Gan, and Petruska, Mary December 1987 United States of America	30 African American children aged 1 year to 12 years 1 month presenting with kerion to a pediatric clinic.	A randomized controlled unblinded trial comparing children receiving 2.5 mg of intralesional triamcinolone acetonide injection and oral griseofulvin treatment to oral griseofulvin alone.	Percentage of negative fungal cultures measured at 7 days	Sterile cutures were present in 44% in the treated group vs. 38% in the control group (p>0.05)	Small study size (n=30) could fail to show statistical significance if a larger trial was performed. Also, the study was unblinded and could be confounded by observer bias.
			Percentage of negative fungal cultures measured at 4 weeks	100% of cultures were sterile in both groups. (p>0.05)
			Mean time for new hair growth	26.8 days for the treatment group vs. 28.5 days for the control group (p>0.05)
			Mean time for scalp clearing	65 days for the treatment group, 74 days for the control group (p>0.05)

Comment(s)

Kerion development occurs in response to dermatophytic antigens resulting in significant local and sometimes regional inflammation. The inflammatory response can lead to significant pain, deformity, and permanant alopecia or scarring. The standard treatment is with an antifungal, typically griseofulvin, given orally until resolution of symptoms. It has been proposed by some that intralesional injection of corticosterioids may reduce the duration of symptoms by limiting the inflammatory response. Although there are anecdotal reports of success; this lone study fails to provide evidence for the benefit of intralesional steroid injection in the treatment of kerion.

Clinical Bottom Line

Intralesional administration of corticosteriods in the treatment of kerion has not been shown to reduce the duration of disease.

References

1. Ginsburg, Charles M., Vanthaya N. Gan, and Petruska, Mary Randomized controlled trial of intralesional corticosteroid and griseofulvin vs. griseofulvin alone for treatment of kerion Pediatric Infectious Disease Journal December 1987, 1084-1087