Poloxamer-enhanced solubility of griseofulvin and its related antifungal activity against Trichophyton spp

Abstract Poorly water-soluble drugs, such as the antifungal drug griseofulvin (GF), exhibit limited bioavailability, despite their high membrane permeability. Several technological approaches have been proposed to enhance the water solubility and bioavailability of GF, including micellar solubilization. Poloxamers are amphiphilic block copolymers that increase drug solubility by forming micelles and supra-micellar structures via molecular self-association. In this regard, the aim of this study was to evaluate the water solubility increment of GF by poloxamer 407 (P407) and its effect on the antifungal activity against three Trichophyton mentagrophytes and two T. rubrum isolates. The GF water solubility profile with P407 revealed a non-linear behavior, well-fitted by the sigmoid model of Morgan-Mercer-Flodin. The polymer promoted an 8-fold increase in GF water solubility. Fourier-transform infrared (FT-IR) spectroscopy, differential scanning calorimetry (DSC), and 2D nuclear magnetic resonance (NMR Roesy) spectroscopy suggested a GF-P407 interaction, which occurs in the GF cyclohexene ring. These results were supported by an increase in the water solubility of the GF impurities with the same molecular structure. The MIC values recorded for GF ranged from 0.0028 to 0.0172 mM, except for T. Mentagrophytes TME34. Notably, the micellar solubilization of GF did not increase its antifungal activity, which could be related to the high binding constant between GF and P407.

Xylaroisopimaranin A, a New Isopimarane Derivative from an Endophytic Fungus Xylaralyce sp

Five secondary metabolites, including a new isopimarane derivative xylaroisopimaranin A (1), were isolated from the endophytic fungus Xylaralyce sp. (HM-1), and their structures were elucidated by 1D, 2D NMR, MS and CD spectra. Their bioactivities were performed to antibacterial, Hep G2 cells cytotoxicity and brine shrimp inhibition. The biological evaluation results showed that the xylaroisopimaranin A (1), xylabisboein B (2), griseofulvin (3) , 5-methylmellein (4) and mellein-5-carboxlic acid (5) displayed no significant Hep G2 cells cytotoxicity and antibacterial acitivity, but they inhibited the brine shrimp with IC₅₀ from 0.5 to 25 µmol/mL.

In Vitro additive effect on griseofulvin and terbinafine combinations against multidrug-resistant dermatophytes

ABSTRACT Griseofulvin (GF) and terbinafine (TF) are commonly used drugs to treat dermatophytosis, a fungal infection of the skin. Today there is an increase in drug resistance to these antifungals which highlight the need for alternative synergistic therapies. Minimum Inhibitory Concentration (MIC) of GF and TF were determined against fungi clinical isolates from local hospitals with values ranging 0.03-2.0 µg mL-1 and 0.24-4.0 µg mL-1, respectively. A checkboard test was used to determine the combination of GF:TF which could induce an additive effect against the fungi isolates Multidrug-resistant isolates showed susceptibility after treatment with 16:2 µg mL-1 GF:TF. An MTT assay further verified that GF and TF combinations have greater additive effect against pathological and multidrug-resistant isolates than antifungals alone. Herein we disclose GF:TF combinations that could constitute as a possible new anti-dermatophyte therapy.

TeleCondutas: dermatofitoses / TeleGuides: dermatophytosis

Dermatofitoses são infecções cutâneas superficiais causadas por fungos denominados genericamente de dermatófitos (gêneros: Microsporum, Trichophyton e Epidermatophyton) que afetam tecidos queratinizados como pele, cabelos e unhas. Uma vez que estes fungos são encontrados em humanos, animais e no ambiente, o principal fator de risco para o desenvolvimento da doença é o contato direto com animais ou humanos doentes ou portadores. A transmissão também pode ocorrer através do contato com objetos ou ambientes contaminados tais como: escovas de cabelo, roupa de cama, vestiários, carpetes ou outras superfícies contaminadas. O diagnóstico das dermatofitoses costuma ser com base no quadro clínico. Porém, na dúvida diagnóstica ou falha ao tratamento, pode-se solicitar o exame micológico direto para confirmar a infecção. A seguir, são apresentadas as formas mais comuns das dermatofitoses e seus respectivos tratamentos. Esta guia apresenta informação que orienta a conduta para casos de dermatofitoses no contexto da Atenção Primária à Saúde, incluindo: tinea corporis, tinea capitis, tinea cruris, tinea pedis e mannum, encaminhamento para serviço especializado.

Majocchi's granuloma - Case report

We report the case of a three-year-old child who, following long term treatment with topical corticosteroids and their associations for a case of ringworm on the face developed a form of folliculitis known as Majocchi's Granuloma. Treatment with oral Griseofulvin was successful.

A Case of Generalized Pigmented Purpuric Dermatosis Treated with Narrowband Ultraviolet B Phototherapy in a Child / 대한피부과학회지

Pigmented purpuric dermatosis (PPD) represents a group of cutaneous lesions exhibiting petechiae, pigmentation, and occasionally telangiectasia in the absence of an associated venous insufficiency or hematological disorder. PPD may resolve spontaneously but tends to persist for months to years. Various treatment modalities such as oral griseofulvin, pentoxifylline, cyclosporine, ascorbic acid, topical corticosteroids, and PUVA therapy have been used with unsatisfactory results. Recently, some studies reported that PPD showed a dramatic response to narrowband ultraviolet B (UVB) phototherapy. In these studies, narrowband UVB phototherapy was an effective treatment method with few side effects. Here, we present the case of a 7-year-old boy with generalized PPD that improved rapidly following narrowband UVB phototherapy.

Perfil de susceptibilidad in vitro de aislados clínicos de microsporum canis a los antifungicos griseofulvina, itraconazol, voriconazol, terbinafina y anfotericina B / In vitro susceptibility profile of clinical isolates of microsporum canis to the antifungals griseofulvin, itraconazole, voriconazole, terbinafine and amphotericin B

Las dermatofitosis son las micosis superficiales más frecuentes en el humano y son causados por hongos de los géneros: Trichophyton Microsporum y Epidermophyton. En Venezuela son el principal motivo de consulta dermatológica, constituyendo un verdadero problema de salud pública por su alta morbilidad. El objetivo del estudio fue conocer el perfil de susceptibilidad in vitro de los aislados clínicos de Microsporum canis de pacientes pediátricos que asisten a la Consulta de Micología del Servicio de Dermatología del Hospital Universitario de Caracas, a cinco antifúngicos a través del método del CLSI (M38-A2). De un total de 50 aislados de dermatofitos, el rango de los valores de concentración mínima inhibitoria en µg/ml (CMI) para Griseofulvina, Itraconazol, Voriconazol, Terbinafina y Anfotericina B fueron respectivamente: <0,03 ­ 0,125; <0,0019 ­ 0,0078; <0,0019 ­ 0,0078; <0,0019 ­ 0,0156 y 0,03 ­ 0,5. Por método visual se determinaron los puntos de corte epidemiológicos (PCE) para los 5 antifúngicos en estudio obteniéndose los siguientes datos: Griseofulvina ≤ 0,125, Itraconazol ≤ 0, 0039, Voriconazol ≤0,0078, Terbinafina ≤ 0, 0156 µg/ml y Anfotericina B ≤ 0, 5. En este estudio se determinó la susceptibilidad de los aislados a todos los antifúngicos en estudio, demostrando una alta actividad in vitro para el tratamiento de Tinea capitis.

The dermatophytes are frequently superficial mycoses in humans, are caused by fungi of the genera: Trichophyton, Microsporum and Epidermophyton. In Venezuela are the main reasons for dermatological consultation, constituting a public health problem because of its high morbidity. The aim of the study was to determine in vitro susceptibility of clinical isolates of Microsporum canis of pediatric patients attending to dermatology Caracas University Hospital, five antifungal by CLSI method (M38 -A2). The total of 50 isolates dermatophytes, the range of values of minimum inhibitory concentration (CMI) in µg/ml for Griseofulvin, Itraconazole, Voriconazole, Terbinafine and Amphotericin B were: <0.03 ­ 0.125; <0.0019 ­ 0.0078; <0.0019 ­ 0.0078; <0.0019 ­ 0.0156 and 0.03 ­ 0.5. For visual were determined epidemiological cut-off (PCE) for the 5 antifungal study obtained the following data: Griseofulvina ≤ 0.125, Itraconazol ≤ 0.0039, Voriconazol ≤0.0078, Terbinafina ≤ 0.0156 µg/ml and Anfotericina B ≤ 0.5. In this study we determined the susceptibility of isolates to all the antifungal study, demonstrating a high activity in vitro for the treatment of tinea capitis.

Chronic Recurrent Dermatophytosis in the Tropics: Studies on Tinea Imbricata in Indonesia / 대한의진균학회지

Dermatophytosis is one of the major public health problems in tropical countries, especially the chronic recurrent type. Tinea imbricata (TI), a dermatophytosis caused by Trichophyton concentricum (TC), is endemic in several remote and isolated areas in Indonesia. This dermatophytosis is unique due to its predominant genetic predisposition, which leads to chronic recurrent conditions among the affected. Moreover, hot and humid climate, low socio-economic conditions, lack of hygiene, inadequate treatment due to difficult access to health care facilities, and persistent source of re-infections, are among other factors that maintain the chronic-recurrent state. Studies on TI in Indonesia have been done since the 1960s, encompassing the epidemiology, clinical features, and efficacy of antifungal treatment. Griseofulvin is still the mainstay treatment, but relapse rates are high. The latest effort in reducing relapse includes the training of healthcare providers and provision of fungal disinfectant for clothing and bedding to patients in West Papua in addition to standard treatment. Higher cure rate was achieved at the end of treatment and the four-month follow-up in comparison to previous studies. Parallel studies on the same patient populations showed that: 1. clothing and bedding were fomites and potential sources of re-infections; 2. sodium hypochlorite worked well as a fungal disinfectant, followed by anionic detergent and pine oil containing cleaner; 3. terbinafine was the most effective antifungal agent for TC in vitro, followed by griseofulvin; itraconazole, and fluconazole were less effective. In conclusion, to eradicate TI in endemic areas, appropriate and affordable antifungal treatment, concurrent with health education and efforts to identify and eradicate the source of re-infections are very important.

Efficacy of terbinafine vs. griseofulvin in tinea capitis in the Northern areas of Pakistan

Since longtime griseofulvin has been in use to treat tinea capitis. However due to its decreasing efficacy, higher doses and side effects a search is going on to find out a better treatment. alternative. Terbinafine is one such therapeutic option. To compare the efficacy and safety of terbinafine and griseofulvin in tinea capitis in Northern Areas of Pakistan. Children 3 to 12 year-old who were clinically diagnosed for tinea capitis and confirmed by potassium hydroxide microscopy were included in the study. One group was treated with terbinafine at a dose of 62.5mg for children weighing less than 20kg and 125mg for those weighing 20-40kg and other group with griseofulvin at a dose of 15mg/kg body weight. Both groups were treated for a period of 4 weeks. Visits were scheduled at baseline and week 2, 4 and 6 for evaluation of efficacy and safety monitoring. Efficacy was evaluated on the basis of clinical improvement and mycological cure. Terbinafine showed comparatively higher clinical cure in our patients as compared to griseofulvin at week 2 [35% vs. 22%], week 4 [50% vs. 38%] and week 6 [70% vs. 55%] [p<0.05]. Similarly, mycologic cure with terbinafine was better than griseofulvin at week 2 [30% vs. 20%], week 4 [45% vs. 35%] and week 6 [60% vs. 50%] [p<0.05]. Trichophyton tonsurans was the most common organism isolated. There were no major side effects except nausea and abdominal pain in either group. Terbinafine is more effective than griseofulvin in treating tinea capitis in our part of the world

Comparative study of Majoon Ushba, Marham Gulabi with griseofulvin and sulphur ointment in the management of Qooba [dermatophytosis]

Skin diseases have high prevalence throughout the world which accounts for 10% of the workload of the family doctors. One of such disease is dermatophytosis [ringworm] which is caused by dermatophytes. They are more prevalent in economically under developed and developing countries where they contribute as a major health problem. The prevalence of superficial mycotic infections had risen to such a level that skin mycoses now affects more than 20-25% of the world population, making them one of the most frequent form of infections. In spite of the advances in antifungal and corticosteroid therapy which have completely altered the nature of skin clinics, there is no diminution in the number of patients with dermatophytosis attending for assistance. Subsequently the adverse effect of drugs has also worsened the condition. As per the literature of Unani System, two compound drugs viz. [Majoon Ushba] and [Marham Gulabi] which are supposed to be novel combination were chosen for this study as test group. The result was compared with Allopathic drugs viz. Griseofulvin and Sulphur Ointment as standard. Our study includes 30 .cases in each group. After completion of the study it was found that the test group was clinically as well as statistically significant at the same level as that of standard group

Evaluation of wound healing and antimicrobial potentials of Ixora coccinea root extract

OBJECTIVE@#To evaluate the wound healing and antimicrobial activity of root extracts of Ixora coccinea (I. coccinea).@*METHODS@#To investigate the wound healing efficacy of root extract of I. coccinea Linn, five groups of animals were divided each containing six animals. Two wound models including incision and excision wound models were used in this study. The parameters studied were tensile strength on incision wound model and in terms of wound contraction for excision wound model were compared with standard Nitrofurazone (NFZ) ointment (0.2% w/w). Six extracts (ethanol, aqueous, petroleum ether, benzene, chloroform and ethyl acetate) of I. coccinea were screened for in vitro growth inhibiting activity against different bacterial strains viz, Staphylococcus aureus, Bacillus pumilius, Enterococcus faecalis, Escherichia coli, Salmonella typhi and Pseudomonas aeruginosa and fungi Candida albicans and Aspergillus niger were compared with the standard drugs ciprofloxacin and chloramphenicol for antibacterial and griseofulvin for antifungal screening. The serial dilution and cup (or) well plate methods were used for the antimicrobial study and MIC was determined.@*RESULTS@#The ethanolic extract showed significant (P<0.001) wound healing activity when compared to standard drug NFZ with respect to normal control group. Amongst all, ethanolic extract showed highly significant antibacterial activity against all bacterial strains used in this study when compared to standard. The aqueous extract showed moderate significant inhibition against all bacterial strains when compared to standard. All the extracts were shown negligible activity against the fungal strains used in this study.@*CONCLUSIONS@#The ethanolic root extract of I. coccinea showed pronounced wound healing and antibacterial activity. The probable reason to heal the wound was that the external application of the extract prevented the microbes to invade through the wound thus the protection of wound occurs against the infection of the various organisms.

Tinea Imbricata: Case series on three patients in Sarangani, Philippines

The imbricata or Tokelau ringworm is an unusual superficial dermatophytosis caused by the anthropophilic Trichophyton concentricum. Three cases of the Tinea imbricata observed at the Municipal Health Office of Kiamba, Sarangani Province, Philippines are reported in this study. All three patients were from an indigenous ethnic group of Sarangani Province and lived in isolated upland communities. Patient 1 was a 30 year old male, Patient 2 was a 40 year old female, and Patient 3 was a 19 year old female. Lesions lasted - 27 years, - 25 years, and 2 years, respectively. All patients presented with characteristic expensive polycyclic to serpiginous scaling lesions, with areas of sparing. Microscopic examination of skin scrapings prepared with potassium hydroxide revealed the characteristic broad, branched, septate, irregular hyphae. Trichopyton concentricum, the causative agent, was isolated in one of the patients using Mycobiotoc agar. Histopathologic examination on 2 of the patients revealed acute and chronic inflammation, and Periodic Acid Schiff- positive fungal hyphae. All patients were started on Griseofulvin 500mg tab once daily. The case series presented here is the first account of Tinea imbricata in the Philippines since the 1990s.

Inflammatory tinea capitis: non-healing plaque on the occiput of a 4-year-old child

<p><b>INTRODUCTION</b>Inflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition.</p><p><b>CLINICAL PICTURE</b>A 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics.</p><p><b>TREATMENT</b>The patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings.</p><p><b>OUTCOME</b>Her condition improved with the antifungal therapy, and there was no residual alopecia.</p><p><b>CONCLUSION</b>Physicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.</p>

Alterations in growth and branching of Neurospora crassa caused by sub-inhibitory concentrations of antifungal agents / Alteraciones de crecimiento y ramificación en Neurospora crassa provocadas por concentraciones subinhibitorias de agentes antimicóticos

Six antifungal agents at subinhibitory concentrations were used for investigating their ability to affect the growth and branching in Neurospora crassa. Among the antifungals herein used, the azole agent ketoconazole at 0.5 μg/ml inhibited radial growth more than fluconazole at 5.0 μg/ml while amphotericin B at 0.05 μg/ml was more effective than nystatin at 0.05 μg/ml. Morphological alterations in hyphae were observed in the presence of griseofulvin, ketoconazole and terbinafine at the established concentrations. The antifungal agents were more effective on vegetative growth than on conidial germination. Terbinafine markedly reduced growth unit length (GU) by 54.89%, and caused mycelia to become hyperbranched. In all cases, there was a high correlation between hyphal length and number of tips (r > 0.9). All our results showed highly significant differences by ANOVA, (p < 0.001, α = 0.05). Considering that the hyphal tip is the main interface between the fungus and its environment /through which enzymes and toxins are secreted and nutrients absorbed, it would not be desirable to obtain a hyperbranched mycelia with inefficient doses of antifungal drugs.

Se investigó el efecto de seis agentes antimicóticos en concentraciones subinhibitorias sobre el crecimiento y la ramificación en Neurospora crassa. El agente azólico ketoconazol a la concentración de 0,5 μg/ml inhibió el crecimiento radial más que el fluconazol a 5,0 μg/ml, y la anfotericina B a 0,05 μg/ ml fue más eficiente que 0,05 μg/ml de nistatina, entre los agentes poliénicos usados. En presencia de griseofulvina, ketoconazol y terbinafina a las concentraciones establecidas se observaron alteraciones morfológicas en las hifas. Los agentes antimicóticos fueron más eficientes sobre el crecimiento vegetativo que sobre la germinación conidial. La terbinafina redujo marcadamente (54,89%) la longitud de la unidad de crecimiento y provocó la hiperramificación del micelio. En todos los casos, existió gran correlación entre la longitud y el número de ápices de las hifas (r > 0,9). Todos los resultados mostraron diferencias altamente significativas de acuerdo con ANOVA (p < 0,001, α = 0,05). Considerando que el ápice de la hifa es la principal interfase entre el hongo y su ambiente, a través de la cual las enzimas y las toxinas son secretadas y los nutrientes son absorbidos, un micelio hiperramificado resultante de dosis ineficientes de agentes antimicóticos sería perjudicial.

Improving the aqueous solubility of piroxicam and griseofulvin using different surfactants and cosolvents

This study is an attempt to solubilize a non steroidal anti-inflamatory drug, namely, Piroxicam [PX] and an anti-fungal drug, namely, Griseofulvin [GR], using different surfactant and cosolvent systems. It could be shown that the aqueous solubility of PX is increased by 56, 57, 65, 87 and 138 fold using solution with a concentration of 18% w/v of either Tween 20, sodium lauryl sulphate [SLS], tween 80, Brij 35, or poloxamer 188, respectively. Moreover, the aqueous solubility of PX has been shown to increase by 104, 102, 92 or 34 fold using 60% w/v of either ethanol, polyethylene glycol 400 [PEG 400], propylene glycol [PG], or glycerin, respectively. Propanol, however, gave 140 fold increase in PX aqueous solubility at a cosolvent concentration of only 30% w/v. The solubility of PX has also been shown to increase from 3.6 mg/ml to 10.6 mg/ml by increasing the pH from 6 to 8 respectively. On the other hand, 9, 21, 24, 26 or 219 fold increase in the aqueous solubility of GR could be achieved by using 18% w/v of either poloxamer 188, tween 20, brij 35, tween 80, or SLS, respectively. Moreover, propanol, ethanol, PEG 400, PG, and glycerin gave 104, 99, 26, 14 and 13 and 104 fold increase in GP aqueous solubility at a cosolvent concentration 60% w/v. the addition of cosolvent to the micellar solutions of different surfactants influenced the solubility of either PX or GR in different ways depending on the type of the drug and the cosolvent added. Increasing the temperature at which the equilibration is conducted showed an increase in the aqueous solubility of either PX or GR

[ effects of antifungal azoles on inflammatory cytokine production in human keratinocytes]

Azoles drugs are being used successfully in treatment of fungal infections. Recently, immunosuppressive effects of some of these agents have been reported. Keratinocytes as the major cells of the skin, have an important role in innate immunity against pathogenic agents. Considering the scanty of information about the effects of azoles on immune responces, this study was conducted to assess the expression and secretion of inflammatory cytokines in keratinocytes following treatment with azole drugs. This is an exprimental study conducted in molecular biology division in Tehran University of Medical Sciences and Immunodermatology Department in Vienna Medical University. Primery keratinocytes were cultured and treated with different concentrations of fluconazole, itraconazole, ketoconazole and griseofulvin. Secreted IL1, IL6 and TNF-alpha by keratinocytes in culture supernatant were measured by quantitative enzyme immunoassay technique. Moreover, expression of the genes encoding IL1 and IL8 was evaluated by Real Time-PCR. Treatment of keratinocytes with different concentrations of fluconazole and low concentration of ketoconazole resulted in decrease in IL1 secretion, but itraconazole and griseofulvin did not show such an effect at the same concentrations. In addition, none of the examined drugs had an effect on secretion level of IL6 and TNF-alpha. Quantitative analysis of IL1 and IL8 encoding genes revealed that transcription on these genes might be suppressed following treatment with fluconazole or ketoconazole. Fluconazole and ketoconazole might modulate the expression and secretion of IL1 and IL8 and affect the direction of immune responses induced by keratinocytes

Antimicóticos en niños / Antifungals in Children

Las micosis superficiales son padecimientos frecuentes en la infancia y para su manejo se pueden utilizar antimicóticos tanto tópicos como sistémicos. Sin embargo, en las últimas décadas, ha aumentado la población infantil susceptible a infecciones diseminadas o sistémicas por agentes oportunistas que ponen en riesgo la vida. Las principales son la candidosis y la aspergilosis. Se han desarrollado nuevos antimicóticos con espectros más amplios de acción y menor toxicidad, pero la mayoría de los reportes en la literatura se refieren a estudios hechos en adultos, cuyos resultados son extrapolados a la población pediátrica. La presente revisión tiene como objetivo condensar la información referente al uso de antimicóticos en niños, con énfasis en las diferencias farmacocinéticas con respecto a los adultos y las indicaciones principales para su uso (AU)

Superficial mycoses are common in childhood, either topical or systemic antifungals can be used for treatment. However, in the past decade, the pediatric population at risk of a disseminated or systemic infection by opportunistic fungi has increased. The most important are candidiasis and aspergillosis. New antifungals, with a wider spectrum of action and less toxicity have been developed, nevertheless, most of the studies and reports of the literature focus on adults and the findings are extrapolated to children. The objective of this paper is to review what has been published on the use of antifungals in the pediatric age, focusing in pharmacokinetic differences regarding adults and current indications for this group of drugs (AU)

Comparative efficacy of griseofulvin and fluconazole in the treatment of tinea capitis

Tinea capitis is caused by different species of dermatophytes particularly Microsporum and Trichophyton .Children are affected predominantly. Many systemic drugs e.g.griseofulvin, fluconazole, itraconazole, terbinafine, ketoconazoe etc are available for the treatment of tinea capitis. To compare the efficacy of griseofulvin and fluconazole in the treatment of tinea capitis. A total of 50 patients of age group 2-15 years were selected for the study.The cases were diagnosed clinically and confirmed by Wood 's lamp examination, KOH microscopy and culture.The patients were divided into two equal groups. Group A was given griseofulvin and group B was given fluconazole for a period of two months. Topical adjuvant therapy econazole nitrate was given in both groups. The patients were followed up at 2 weekly interval for clinical response and Wood 's lamp examination and finally KOH microscopy and culture. In group A clinical response was 84%and mycological response was 68%whereas in group B clinical response was 68%and mycological response was 56%. The present study showed that griseofulvin is more effective in the treatment of noninflammatory type of tinea capitis than fluconazole

Erythema Nodosum Developed in a Child with Kerion Celsi / 대한피부과학회지

A 7 year-old boy visited our hospital with a 2 week history of inflammatory, pustular, tender patches and plaques on the right scalp and face area. He had been treated with topical steroid and antibiotics in a private clinic. In a KOH smear mount, multiple hyphaes and spores appeared on stratum corneum of the outer root sheath layer of his hair. The diagnosis of kerion celsi induced by dermatophytes was made. The patient was treated with oral griseofulvin, and on the 2nd day after starting treatment, multiple erythematous and tendered subcutaneous nodules occurred on his shin. A photosensitive dermatitis like lesion also occurred on his periorbital area. Griseofulvin changed to terbinafine. On the 6th day after treatment, the skin lesions on his face and scalp had improved, as had his shin lesions. The interest of this case lies in the unusual association of kerion and erythema nodosum, of which only eleven cases have been reported in dermatologic literature, and all cases were kerion induced Trichophyton species.