Franky Chandra, Risa Miliawati NH, Lies Marlysa R

Abstract views = 1199 times | downloads = 836 times


Background: Tinea capitis is a common dermatophyte infection affecting hair and skin which always requires systemic treatment to get a clinical and mycologic cure, preventing relapse, and infection spread. Griseofulvin has been the antifungal therapy of choice for tinea capitis, but it often requires higher doses and a longer duration than recommended. Thus, effective alternative antifungal with good oral tolerability and shorter course of treatment are therefore required. The objective of this report is to evaluate the effectiveness of double pulse dose terbinafine for tinea capitis alternative therapy. Method: A case of kerion type of tinea capitis in a two-year-old girl was reported. Diagnosis was established based on clinical manifestations of alopecia, presented as erythematous macule with pustules, hemorrhagic crusts, and scales on the scalp, accompanied with occipital lymphadenopathy. Fungal culture showed growth of Microsporum canis (M. canis) colonies. Patient was treated with doubled pulse dose terbinafine 125 mg/day and 2% ketoconazole shampoo for two months. Result: Clinical improvements were found on 35th day of follow up, while mycologic cure was achieved on 60th day of follow up. Tolerability was excellent and no side effects observed. Conclusion: Double pulse dose terbinafine is effective for kerion type of tinea capitis.


double pulse dose; kerion; M. canis; terbinafine; tinea capitis

Full Text:



Schieke SM, Garg A. Superficial fungal infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Wolff K, Leffel DA, editor. Fitzpatrick’s dermatology in general medicine. 8th ed. New York:McGraw-Hill;2012. p. 2277-97.

Bennassar A, Grimalt R. Management of tinea capitis in childhood. Clin Cosm Invest Dermatol. 2010;3:89-98.

Mohrenschlager M, Seidl HP, Ring J, Abeck D. Pediatric tinea capitis recognition and management. Am J Clin Dermatol. 2005;6(4):203-13.

Larralde M, Gomar B, Boggio P, Abad ME, Pagotto B. Neonatal kerion celsi: report of three cases. Pediatr Dermatol. 2010;27(4):361-3.

Michaels B, Rosso JQD. Tinea capitis in infants: Recognition, evaluation, and management suggestions. J Clin Aesthet Dermatol. 2012;5(2):49–59.

Elewski EB. Clinical diagnosis of common scalp disorder. J Invest Dermatol Symp Proc. 2005;10:190-3.

Pomeranz AJ, Sabnis SS. Tinea capitis epidemiology, diagnosis and management strategies. Pediatr Drugs. 2002:4(12):779-83.

Oliver MM. Tinea capitis: Diagnostic criteria and treatment options. Dermatol Nurs. 2009:21(8):281-5.

Aste N, Pau M. Tinea capitis caused by Microsporum canis treated with terbinafine. Mycoses. 2004;47:428-30.

Chan YC, Friedlander SF. New treatment for tinea capitis. Curr Opin Infect Dis. 2004;17:97-103.

Gupta AK, Adam P. Terbinafine pulse therapy is effective in tinea capitis. Pediatr Dermatol. 1998;15(1):56-8.

Andrews MD, Burns M, Common tinea infections in children. Am fam Physician. 2008;77(10):1415-20.

Horii KA. Terbinafine vs griseofulvin for tinea capitis. AAP Grand Rounds. 2008;20;49-50.

Panagiotidou DD, Eremondi THK. Efficacy and tolerability of 8 weeks treatment with terbinafine in children with tinea capitis caused by Microsporum canis: a comparison of three doses. J Eur Acad Dermatol Venereol. 2004;18:155-9.

Gupta AK, Adamiak A, Cooper EA. The efficacy and safety of terbinafine in children. J Eur Acad Dermatol Venereol. 2003:17;627-40.

Patel GA, Schwartz RA. Tinea capitis: still an unsolved problem?

Mycoses. 2009;54:183-8.

Kelly B. Superficial fungal infections. Pediatr Rev. 2012;33(4):22-37.

Mihić LL, Barisic F, Bulat V, Buljan M, Situm M, Bradic L, Mihić J. Differential diagnosis of the scalp hair folliculitis. Acta Clin Croat. 2011;50:395-402.

González U, Seaton T, Bergus G, Jacobson J,Martínez-Monzón C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database of Systematic Reviews 2007;4:1-73

Fuller LC, Child FJ, Midgley G, Higgins EM. Diagnosis and management of scalp ringworm. Br Med J. 2003;236:539-41.

Kakourou T, Uksal U. Guidelines for the management of tinea capitis in Children. Pediatr Dermatol. 2010;27(3):226-8.

Alvarez MS, Silverberg NB. Tinea capitis. Cutis. 2006;78:189-96.

Newland JG, Abdel-Rahman SM. Update on terbinafine with a focus on dermatophytoses. Clin Cosm Invest Dermatol. 2009:2;49-63.

Graham LVD, Elewski BE. Recent updates in oral terbinafine: its use in onychomycosis and tinea capitis in the US.Mycoses.2011;54: 679-85.


  • There are currently no refbacks.

Copyright (c) 2016 Indonesian Journal of Tropical and Infectious Disease

View My Stats

IJTID Indexed by : 


IJTID (pISSN 2085-1103eISSN 2356-0991is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Lembaga Penyakit Tropis (Institute of Tropical Disease)

Universitas Airlangga

Kampus C Mulyorejo

Surabaya 60115