January/February 2012 • Volume 10 • Issue 1 - SKINmed Journal

January/February 2012
Figure 1. Case 2: Kerion before treatment shows crusted
pustular plaque on posterior scalp with significant lymphadenopathy.
Figure 2. Case 2: Kerion shows total resolution 2 weeks after
treatment with prednisone.
ORIGINAL CONTRIBUTION
In patients treated prior to 2001, we saw complete resolution
in kerions treated with SSKI in 22 of 25 patients within 2 to 4
weeks. This is similar to the resolution of kerions alluded to by
Dobson 2 and was also similar to the resolution routinely seen
in sporotrichosis. 9 The three patients who did not respond to
SSKI (2 did not take it due to the taste, and 1 had worsening
of his “id” reaction) had rapid clearance on prednisolone. After
2001, when SSKI became scarce because of the threat of nuclear
attacks and dirty bombs, we shifted to prednisolone and noted
complete response to treatment in 15 of 15 patients. With both
treatment protocols, the kerions cleared and the patients’ hair
subsequently regrew without scarring.
Two prospective randomized, controlled studies by other investigators
have examined the treatment of kerions with oral doses of corticosteroids.
10,11 Neither demonstrated a difference in the management
of kerion between using oral corticosteroids plus griseofulvin vs griseofulvin
alone. These findings are contrary to our observations that all
our patients responded to short courses of anti-inflammatory agents
and are also contrary to oral corticosteroids being recommended for
kerions that present simultaneously with “id” eruptions, 12 as well as
in situations in which the kerion becomes “inflamed.” 13 In addition,
John Kenney (personal communication, 1983), who treated this
disease in many children, routinely included oral corticoids in his
regimen for kerions and saw results similar to ours.
We believe the findings by some investigators 11 demonstrate the
natural resolution of kerions. Similarly, findings in another study 10
may also show the natural resolution; moreover, their treatment
protocol, which included untapered prednisone at a maximum
dose of 30 mg/d for only 10 days, in our opinion, may have been
insufficient. 14
We believe untreated kerions require 3 to 6 months to resolve.
Many case reports consistent with this concept have been published.
15–17 In one of our patients, who preferred not to take
prednisolone and was treated with griseofulvin alone, the kerion
took 4 months to resolve. In contrast, patients treated with antiinflammatory
treatment responded rapidly.
CONCLUSIONS
Based on our observations, we believe the addition of prednisolone
to the treatment of kerions is safe and allows the duration of therapy
to be dramatically shortened. Adjunctive therapy with selenium
sulfide shampooing remains useful, 4 and griseofulvin may
be continued if scaling from tinea capitis remains after the kerion
resolves. 18 Further studies would help resolve the differences in the
prospective trials compared with the clinical observations.
SKINmed. 2012;10:14–16 15
Treatment of Kerions