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Chiriac A, Diaconeasa A, Voicu C, Ivaniciuc M, Miulescu R, Chiriac AE, Nenoff P, Wollina U. Kerion Celsi in infants and children-A narrative review 2010-2023. Mycoses 2024; 67:e13675. [PMID: 37983862 DOI: 10.1111/myc.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections.
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Affiliation(s)
- Anca Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania
- Apollonia University, Iasi, Romania
- Romanian Academy, P. Poni Institute of Macromolecular Chemistry, Iasi, Romania
| | - Adriana Diaconeasa
- Dermatology Ambulatory Care Center, "Grigore Alexandrescu" Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Cristiana Voicu
- Department of Dermatology, MedLife Medical System, Bucharest, Romania
| | | | | | - Anca E Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania
| | - Pietro Nenoff
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Rötha/OT Mölbis, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum, Dresden Academic Teaching Hospital, Dresden, Germany
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Song G, Zhang M, Kong X, Liu W, Liang G. Tinea Capitis in Children Younger than Two Years Old: A Retrospective Study and Treatment Recommendations. Mycopathologia 2023; 188:461-478. [PMID: 36581775 DOI: 10.1007/s11046-022-00703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Tinea capitis (TC) is a dermatophytosis of the scalp and hair, which occurs less common in children younger than two years of age, and the data of TC in this age group are still unknown. OBJECTIVES We aimed to reveal the epidemiological, clinical and mycological characteristics of TC in children under two years old. METHODS We retrospectively analyzed all reported cases of TC in children in their first two years of life from 1991 to 2022, by searching PubMed, Embase, Web of Science, CNKI, Wanfang and Weipu databases. RESULTS A total of 47 articles involving 126 cases of pediatric TC were enrolled in this study. The sex ratio (M/F) was 1.28:1. The age of the children ranged from ten days old to two years old with a median age of three months. The main clinical manifestations were alopecic patches (40 cases, 31.7%) and scaling (39 cases, 31.0%) on the scalp, and 29 infants (23.0%) appeared kerion. The most common sources of contagion were animals (35 cases, 27.78%) and humans (31 cases, 24.60%). The leading pathogens were Microsporidium canis (64 cases, 50.79%), followed by Trichophyton violaceum (13 cases, 10.32%), T. mentagrophytes complex (12 cases, 9.52%) and T. tonsurans (10 cases, 7.94%). Ninety-five children (75.40%) were treated with systemic antifungal drugs and 22 patients (17.46%) were only treated with topical therapy. Except for 10 patients with unknown final prognosis, all the other cases were cured after treatment. There was one child (0.79%) relapsed after treatment with griseofulvin and one case (0.79%) presented with gastrointestinal symptoms from griseofulvin. CONCLUSION The principal clinical symptoms of TC in children less than two years old were alopecic patches and scaling. The top four pathogens were M. canis, T. violaceum, T. mentagrophytes complex and T. tonsurans. Oral treatment for pediatric TC had achieved good therapeutic effects, and topical therapy can be an alternative choice.
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Affiliation(s)
- Ge Song
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Xue Kong
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China.
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
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Abtahi‐Naeini B, Payandeh A, Rastegarnasab F. Successful treatment of fungal ball-associated tinea capitis in a healthy infant: An unusual presentation. Clin Case Rep 2023; 11:e7752. [PMID: 37529136 PMCID: PMC10387597 DOI: 10.1002/ccr3.7752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023] Open
Abstract
Key Clinical Message Presentation of tinea capitis with fungal mass in an infant is extremely rare. Tinea capitis with and without abscess formation is prone to be misdiagnosed in infants and should be considered as a differential diagnosis of inflammatory hair loss in infants and toddlers as well as school-aged children. Abstract Tinea capitis is the scalp fungal infection that most often affects early school children. It rarely affects neonates and adults. The presentation of fungal ball in the setting of tinea capitis is extremely rare. Herein, we describe a 7-month-old girl with a fungal ball associated with tinea capitis with a scalp mass adjacent to the scalp dermatophytosis. To our knowledge, this is the first case of fungal ball in a healthy infant with tinea capitis.
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Affiliation(s)
- Bahareh Abtahi‐Naeini
- Pediatric Dermatology Division of Department of PediatricsImam Hossein Children's Hospital, Isfahan University of Medical SciencesIsfahanIran
- Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Atefeh Payandeh
- Student Research CommitteeKerman University of Medical SciencesKermanIran
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4
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Xiao YY, Zhou YB, Chao JJ, Ma L. Successful treatment of tinea capitis caused by Microsporum canis in a 23-day-old newborn with itraconazole pulse therapy and a review of the literature. Dermatol Ther 2021; 34:e15078. [PMID: 34327790 DOI: 10.1111/dth.15078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022]
Abstract
Although tinea capitis is common in children, but it is rare in newborns. It should be differentiated with neonatal lupus erythematosus, nummular eczema, psoriasis, seborrheic dermatitis, erythema annular centrifugum, annular urticaria, and annular erythema of infancy. Tinea capitis usually needs oral antifungal therapy, but the data of use in newborn is limited. Here, we report a case of tinea capitis caused by Microsporum canis in a 23-day-old female newborn. The patient was given itraconazole oral solution pulse therapy with an excellent outcome. Itraconazole oral solution pulse therapy may be a promising therapy for tinea capitis in infants, especially in newborns.
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Affiliation(s)
- Yuan Yuan Xiao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ya Bin Zhou
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jin Jing Chao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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5
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Mayser P, Nenoff P, Reinel D, Abeck D, Brasch J, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Gräser Y, Hipler UC, Höger P, Kolb-Mäurer A, Ott H, Schaller M, Zidane M. S1 guidelines: Tinea capitis. J Dtsch Dermatol Ges 2020; 18:161-179. [PMID: 32026639 DOI: 10.1111/ddg.14026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.
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Affiliation(s)
| | - Pietro Nenoff
- Partnership Pietro Nenoff, PhD, MD & Constanze Krüger, MD, Laboratory for Medical Microbiology, Rötha OT Mölbis, Germany
| | | | | | - Jochen Brasch
- Department of Dermatology, University Medical Center of Schleswig Holstein, Kiel, Germany
| | - Georg Daeschlein
- Department of Dermatology, Greifswald University Medical Center, Greifswald, Germany
| | - Isaak Effendy
- Department of Dermatology, Bielefeld Medical Center, Bielefeld, Germany
| | | | - Yvonne Gräser
- National Reference Laboratory for Dermatophytes, Institute for Microbiology and Hygiene, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Peter Höger
- Department of Pediatrics and Pediatric Dermatology/Allergology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Annette Kolb-Mäurer
- Department of Dermatology, Venereology and Allergology, Würzburg University Medical Center, Würzburg, Germany
| | - Hagen Ott
- Department of Pediatric Dermatology and Allergology, Auf der Bult, Hanover, Germany
| | - Martin Schaller
- Department of Dermatology, Tübingen University Medical Center, Tübingen, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology and Allergology, Division of Evidence-based Medicine (dEBM) and Berlin Institute of Health, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, Berlin, Germany
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6
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Mayser P, Nenoff P, Reinel D, Abeck D, Brasch J, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Gräser Y, Hipler UC, Höger P, Kolb-Mäurer A, Ott H, Schaller M, Zidane M. S1‐Leitlinie Tinea capitis. J Dtsch Dermatol Ges 2020; 18:161-180. [PMID: 32026649 DOI: 10.1111/ddg.14026_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Pietro Nenoff
- Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Labor für medizinische Mikrobiologie, Rötha OT Mölbis, Deutschland
| | | | | | - Jochen Brasch
- Universitäts-Hautklinik Kiel, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | - Georg Daeschlein
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Hautkrankheiten, Greifswald, Deutschland
| | - Isaak Effendy
- Hautklinik, Klinikum der Stadt Bielefeld, Bielefeld, Deutschland
| | | | - Yvonne Gräser
- Konsiliarlaboratorium für Dermatophyten, Institut für Mikrobiologie und Hygiene, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - Peter Höger
- Pädiatrie und Pädiatrische Dermatologie/Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Deutschland
| | - Annette Kolb-Mäurer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Hagen Ott
- Pädiatrische Dermatologie und Allergologie, Auf der Bult, Hannover, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Miriam Zidane
- Department of Dermatology, Venerology und Allergology, Division of Evidence-based Medicine (dEBM) and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Deutschland
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7
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Zampella JG, Kwatra SG, Blanck J, Cohen B. Tinea in Tots: Cases and Literature Review of Oral Antifungal Treatment of Tinea Capitis in Children under 2 Years of Age. J Pediatr 2017; 183:12-18.e3. [PMID: 28088394 DOI: 10.1016/j.jpeds.2016.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/10/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022]
Affiliation(s)
- John G Zampella
- Department of Dermatology, Johns Hopkins University, Baltimore, MD.
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University, Baltimore, MD
| | - Jaime Blanck
- Welch Library, Johns Hopkins University, Baltimore, MD
| | - Bernard Cohen
- Department of Dermatology, Johns Hopkins University, Baltimore, MD; Department of Dermatology, Division of Pediatric Dermatology, Johns Hopkins University, Baltimore, MD
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8
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Chandra F. Kerion Type of Tinea Capitis Treated with Double Pulse Dose Terbinafine. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2016. [DOI: 10.20473/ijtid.v6i2.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: 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. Key words: double pulse dose, kerion, M. canis, terbinafine, tinea capitis
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9
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John AM, Schwartz RA, Janniger CK. The kerion: an angry tinea capitis. Int J Dermatol 2016; 57:3-9. [PMID: 27696388 DOI: 10.1111/ijd.13423] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
Tinea capitis has a high incidence with a global changing pathogen distribution, making this condition a public health concern around the world. As the infection is initially asymptomatic, it is easily spread. Moreover, it is present in many fomites, including hairbrushes, pillows, and bedding. Prompt recognition and treatment is necessary for kerion, an inflammatory subtype characterized by tender boggy plaques with purulent drainage. Kerion is usually associated with infection by zoophilic dermatophytes, although other sources have been described. Treatment for this severe form of dermatophytic infection can be challenging. In addition to the use of topical treatments, oral administration of griseofulvin, terbinafine, itraconazole, or fluconazole is often required. Griseofulvin, the first-line treatment, may not completely eradicate pathogen colonization of the host and may contribute to reinfection and prevalence of infective but asymptomatic carriers. This review highlights new agents that are being evaluated for the treatment of kerion and typical tinea capitis, enhanced diagnostic criteria, and a grading system for kerion evaluation.
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Affiliation(s)
- Ann M John
- Dermatology, Pathology, Pediatrics, and Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology, Pathology, Pediatrics, and Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA.,Rutgers University School of Public Affairs and Administration, Newark, NJ, USA
| | - Camila K Janniger
- Dermatology, Pathology, Pediatrics, and Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
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10
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Fuller LC, Barton RC, Mohd Mustapa MF, Proudfoot LE, Punjabi SP, Higgins EM. British Association of Dermatologists' guidelines for the management of tinea capitis 2014. Br J Dermatol 2015; 171:454-63. [PMID: 25234064 DOI: 10.1111/bjd.13196] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 01/19/2023]
Affiliation(s)
- L C Fuller
- Department of Dermatology, Chelsea & Westminster Hospital, Fulham Road, London, SW10 9NH, U.K
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11
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Ambooken B, Binitha MP, Chandran B. Kerion due to microsporum gypseum in a 1-month-old infant. Int J Trichology 2014; 5:214-6. [PMID: 24778536 PMCID: PMC3999656 DOI: 10.4103/0974-7753.130418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Microsporum gypseum is a rare cause of kerion in infancy. Light microscopy, fluorescent microscopy and fungal culture of the infected hair aids in early and correct diagnosis. Griseofulvin is the drug of choice for ectothrix fungi. We report a case of neonatal kerion caused by M. gypseum occurring at the age of 1 month, successfully treated with griseofulvin.
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Affiliation(s)
- Betsy Ambooken
- Department of Dermatology and Venereology, Government Medical College, Kozhikode, India
| | | | - Bini Chandran
- Department of Dermatology and Venereology, Skin and Laser Center, Kunnamkulam, Thrissur, Kerala, India
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12
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Zaraa I, Hawilo A, Aounallah A, Trojjet S, El Euch D, Mokni M, Ben Osman A. Inflammatory Tinea capitis: a 12-year study and a review of the literature. Mycoses 2012; 56:110-6. [PMID: 22757767 DOI: 10.1111/j.1439-0507.2012.02219.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inflammatory Tinea capitis (TC) is a rare form of TC. The aim of this study was to review epidemiological, clinical and mycological profile of inflammatory TC. We present a retrospective study (1999-2010), enrolled all the cases of inflammatory TC observed at a referral hospital in the northern Tunisia. One hundred and twenty-one patients with inflammatory TC, 83 male patients (68.6%) and 38 female patients (31.4%) were enrolled. The mean age was about 8 years. A majority of TC (71.9%) were in patients lesser than 10 years of age. Positive family history and contact with animals were noted in seven and 35 cases respectively. Direct examination was positive in 110 cases (59 ectothrix, 51 endothrix) and positive cultures were obtained in 105 patients (49 Trichophyton violaceum, 31 Microsporum canis, 13 Trichophyton interdigitale complex, 12 Trichophyton verrucosum). Systemic treatment was carried out in 115 patients with griseofulvin, in one with terbinafine. A complete recovery was noted in 88 cases; and persistent alopecia in 28 cases. The inflammatory TC is rare, but more common in rural families. The disease mostly affected male genders (68.6%) and T. violaceum remains the common pathogen of inflammatory TC in northern Tunisia.
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Affiliation(s)
- Inès Zaraa
- Department of Dermatology, La Rabta Hospital Tunis, Tunisia University of Medicine, El Manar Faculty Tunis, Tunis, Tunisia.
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