In well appearing children with clinical kerion (tinea capitis) with a collection should incision and drainage be performed?
Date First Published:
April 22, 2026
Last Updated:
April 22, 2026
Report by:
David Herd, Senior Medical Officer (Queensland Children's Hospital)
Search checked by:
Qianyun Lin, University of Queensland 3rd year medical student
Three-Part Question:
in children with kerion does surgical intervention (incision and drainage) result in faster resolution of the illness
Clinical Scenario:
A 10-year-old child presents with with lump on head, loss of hair above the lump. The lump appears fluctuant and an US has been requested and the child started on intravenous flucloxacillin by a previous doctor. Was also started on antifungal medication for kerion. The mother would like the lump drained, but you are unsure if that is necessary.
Search Strategy:
PubMed advanced search: kerion AND (surgical OR surgery OR incision OR drainage)
Search Details:
("kerions"[All Fields] OR "tinea capitis"[MeSH Terms] OR ("tinea"[All Fields] AND "capitis"[All Fields]) OR "tinea capitis"[All Fields] OR "kerion"[All Fields]) AND ("surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgical"[All Fields] OR "surgically"[All Fields] OR "surgicals"[All Fields] OR ("surgery"[MeSH Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields] OR "surgery s"[All Fields] OR "surgerys"[All Fields] OR "surgeries"[All Fields]) OR ("incise"[All Fields] OR "incised"[All Fields] OR "incises"[All Fields] OR "incising"[All Fields] OR "incision s"[All Fields] OR "incisions"[All Fields] OR "surgical wound"[MeSH Terms] OR ("surgical"[All Fields] AND "wound"[All Fields]) OR "surgical wound"[All Fields] OR "incision"[All Fields]) OR ("drainage"[MeSH Terms] OR "drainage"[All Fields] OR "drainaged"[All Fields] OR "drainages"[All Fields]))
Translations
kerion: "kerions"[All Fields] OR "tinea capitis"[MeSH Terms] OR ("tinea"[All Fields] AND "capitis"[All Fields]) OR "tinea capitis"[All Fields] OR "kerion"[All Fields]
surgical: "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgical"[All Fields] OR "surgically"[All Fields] OR "surgicals"[All Fields]
surgery: "surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields] OR "surgery's"[All Fields] OR "surgerys"[All Fields] OR "surgeries"[All Fields]
incision: "incise"[All Fields] OR "incised"[All Fields] OR "incises"[All Fields] OR "incising"[All Fields] OR "incision's"[All Fields] OR "incisions"[All Fields] OR "surgical wound"[MeSH Terms] OR ("surgical"[All Fields] AND "wound"[All Fields]) OR "surgical wound"[All Fields] OR "incision"[All Fields]
drainage: "drainage"[MeSH Terms] OR "drainage"[All Fields] OR "drainaged"[All Fields] OR "drainages"[All Fields]
Translations
kerion: "kerions"[All Fields] OR "tinea capitis"[MeSH Terms] OR ("tinea"[All Fields] AND "capitis"[All Fields]) OR "tinea capitis"[All Fields] OR "kerion"[All Fields]
surgical: "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgical"[All Fields] OR "surgically"[All Fields] OR "surgicals"[All Fields]
surgery: "surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields] OR "surgery's"[All Fields] OR "surgerys"[All Fields] OR "surgeries"[All Fields]
incision: "incise"[All Fields] OR "incised"[All Fields] OR "incises"[All Fields] OR "incising"[All Fields] OR "incision's"[All Fields] OR "incisions"[All Fields] OR "surgical wound"[MeSH Terms] OR ("surgical"[All Fields] AND "wound"[All Fields]) OR "surgical wound"[All Fields] OR "incision"[All Fields]
drainage: "drainage"[MeSH Terms] OR "drainage"[All Fields] OR "drainaged"[All Fields] OR "drainages"[All Fields]
Outcome:
178 papers found. No systematic reviews. Only one controlled trial was found comparing two forms of antifungal treatment. 26 reviews were identified which when filter for children resulted in 11 papers. Case reports were excluded leaving 4 papers with reviews.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Review of Tinea Capitis in a Cohort of Asian Children Tan CW, Foong AY, Liew HM, Koh MJ 2018 Apr Singapore | 17 children aged 16 years and younger with tinea capitis |
Author Commentary:
There are no controlled studies to help the clinical question. There are several case reports which tend to suggest that surgical treatment may not be the best option (in terms of causing unnecessary pain and distress). The natural history of kerion on antifungal treatment is resolution. The primary role for the clinician is to ensure that the presentation is not one of the many differentials which would require treatment; in particular abscess secondary to staphylococcus. We were fortunate to have a dermatology registrar review and agree that this is a kerion and that antifungal treatment without operation would be the best treatment pathway. We also did hair pull and fungal skin scraping and arranged follow-up.
Bottom Line:
We discussed with the mother explaining that incision and drainage now would not be required. He was discharged on oral antibiotics with close clinical follow-up.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Schwartz RA, Janniger CK. Tinea capitis
- Ferguson L, Fuller LC. Spectrum and burden of dermatophytes in children
- Chiriac A, Diaconeasa A, Voicu C, Ivaniciuc M, Miulescu R, Chiriac AE, Nenoff P, Wollina U. erion Celsi in infants and children-A narrative review 2010-2023
- Tan CW, Foong AY, Liew HM, Koh MJ. Review of Tinea Capitis in a Cohort of Asian Children
- Gibbon KL, Goldsmith P, Salisbury JA, Bewley AP. Unnecessary surgical treatment of fungal kerions in children