A healthy 4 year old boy is brought to the Dermatology clinic at Queen Elizabeth Central Hospital, Blantyre by his parents. He has been scratching his head, and they have recently noticed that he has developed several small scaly areas with associated hair loss.
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Treatment of choice is oral griseofulvin 15-20mg/kg/day for 6 weeks. Additional application of a topical antifungal, during the early stages of treatment, may reduce the risk of transmission. Terbinafine is an unlicensed alternative, but may not be as effective for infections with M. canis. The only oral antifungal available in the department is ketoconazole, so he is prescribed this and topical Whitfield’s ointment. His parents then tell you that his elder sister was treated with the same treatment successfully earlier this year.
Other siblings with infection should also be treated and if the family pet’s fur is falling out it must be treated too.
The other differential diagnosis to consider in this case is alopecia areata but the presence of scale distinguishes these diagnoses.
This case contributed by Levie Mwale and Ann Sergeant