Inflammatory Tinea Capitis Research Articles

Epidemiology, clinical features, and outcome of the hospitalized patients with Kerion in Fars Province, Iran: an eleven-year retrospective study

BackgroundKerion, a severe inflammatory type of tinea capitis, presents with purulent, boggy swelling and alopecia. Few articles in the literature provide information on this uncommon manifestation of tinea capitis (TC). This study aimed to determine the epidemiological and clinical characteristics of patients with Kerion over an 11-year period in an inpatient setting.MethodsIn this retrospective cross-sectional study, we enrolled all the admitted patients with inflammatory TC in the dermatology department of Shahid Faghihi referral hospital during 2011–2022. The data included demographic factors, animal contact, treatment, outcome, and past medical profiles. We used STATA 14.2 to analyze the data.ResultsOne hundred and thirty-two patients with Kerion were enrolled in to the study. the mean age of patients was 7.6 ± 5.8 years. Boys (82.5%, n = 109) significantly outnumbered girls (17.5%, n = 23), and 82.2% of patients were under 11 years of age. Eight patients were one to two years old, two were infants under one year old, and five were adults. More than half (52.2%) of the patients were from rural areas. Most of the cases had heavily utilized systemic antifungal therapy, antibiotics, and corticosteroids. In addition, 43 patients reported positive animal contact. Over the course of an eleven-year period, there was a downward trend in the number of hospitalized patients.ConclusionWe report one of the largest studies on Kerion patients over an eleven-year period. We have expanded the information on Kerion patients’ epidemiology, transmission mode, and clinical outcomes. To develop preventative strategies for Kerion, future studies should focus on additional risk factors and individual susceptibilities.

Tinea capitis with kerion complicated by keloid formation in a 34-year-old man: A case report

A kerion, also known as a dermatophyte, is a type of inflammatory tinea capitis caused by an exaggerated immune response to a fungal ringworm infection primarily affecting the scalp. A keloid is an abnormal scar tissue proliferation occurring at the site of tissue injury or spontaneously. It occurs more commonly in darker-skinned individuals. The coexistence of kerion and keloid is rare. This case involves a 34-year-old man who presented with a four-year history of scalp swelling, itching, and occasional fluid discharge. There is a history of keloids in multiple parts of the body. Examination revealed multiple keloids on the scalp alongside a purulent, oozing rash with satellite nodules. Skin scraping for KOH microscopy was positive for fungal spores and hyphae. This case highlights the rare complication of keloid formation in kerion which can hinder effective treatment of the underlying fungal infection.

Inflammatory Tinea Capitis Masquerading as Erosive Pustular Dermatosis

Inflammatory Tinea Capitis Masquerading as Erosive Pustular Dermatosis

Successful Treatment of Diffuse Pustular Inflammatory Tinea Capitis in the Elderly with Repeated Debridement, Oral Terbinafine and Short-Course Steroids.

Successful Treatment of Diffuse Pustular Inflammatory Tinea Capitis in the Elderly with Repeated Debridement, Oral Terbinafine and Short-Course Steroids.

Kerion in an elderly patient

Tinea capitis is generally considered a common condition in children, but not in adults. If the infection occurs in adults, it may have an atypical appearance. We present an elderly woman with inflammatory tinea capitis. A 71-year-old rural woman presented with a 2-month history of multiple pruritic, crusted, and pustular lesions on the scalp. She had been treated with antibiotics without any improvement.

Adult Inflammatory Tinea Capitis Presenting as Diffuse Pustular Type.

Adult Inflammatory Tinea Capitis Presenting as Diffuse Pustular Type.

Tinea capitis caused by Trichophyton tonsurans among adults: Clinical characteristics and treatment response.

Trichophyton tonsurans tinea capitis has become a growing epidemiological concern. Yet, its clinical manifestations and treatment response, specifically among adults, have only been described among small sample size studies. To assess clinical manifestations and treatment outcome of T. tonsurans tinea capitis among adults. A retrospective cohort study was carried out among 111 adults with T. tonsurans tinea capitis. Diagnosis was confirmed by fungal culture or polymerase chain reaction. Examinees' demographics, disease characteristics and treatment response were measured. The risk factors for the treatment failure were evaluated. The mean age was 20.1 years (±3.1), with men (98.2%) outnumbering women. The follow-up lasted 12.2 months (±5.6). The majority of T. tonsurans tinea capitis was seen in the occipital area (87.6%). In 78.9% of the cases, the scalp manifestation was non-inflammatory (scaly plaques and papules:76.1% and seborrhoea-like: 2.8%). 21.1% of cases presented with inflammatory tinea capitis (21.1%; Kerion: 10.1% and pustular: 11%). Concomitant involvement of other than scalp areas was common: tinea corporis was seen in 38.7% of the cases; tinea faciei and barbae in 24.3%; nape and anterior neck in 76.6% and 2.7% of the cases, respectively. An adequate treatment course with oral terbinafine resulted in 83.2% clinical cure rate. Treatment failure was significantly associated with concomitant tinea corporis (odds ratio 3.9; 95% confidence interval 1.3-12.1, p-Value< .02). The most common clinical presentation of T. tonsurans tinea capitis included occipital scaly plaques and papules with concomitant non-scalp lesions. Oral terbinafine was found to be highly effective. Concomitant tinea corporis increased the risk for treatment failure.

269 10 year experience of pediatric kerion celsi in Costa Rica

The Kerion Celsi (KC) is an inflammatory tinea capitis,. It is a public health problem listed by the World Health Organization as the second most common childhood dermatological infection. Proper diagnosis and treatment are crucial to prevent permanent sequelae. Aim: To determine the characteristics of children with KC in an Outpatient Clinic of a tertiary, pediatric, reference center in Costa Rica between January 01, 2009 to December 31, 2019. Methods: Retrospective, observational study based on chart review.

A Case Report of a &amp;lt;i&amp;gt;Microsporum gypseum&amp;lt;/i&amp;gt; Tinea Capitis Diagnosed at the Laboratory of Parasitilogy-mycology of the Avicenne Military Hospital of Marrakech

Historically, tinea capitis has been a problem among the population in general and in Morocco in particular. It is still a significant reason for consultation in routine medical practice, particularly among the population living in poor hygienic conditions. It is an infection almost exclusively of preschool and school-age children, due to changes in sebaceous secretion and skin pH during puberty, affecting both sexes, with a female predominance. Inflammatory cases or Kerion are caused by zoophilic species such as <i>Trichophyton mentagrophytes, Trichophyton verrucosum, Microsporum canis</i>, and less frequently by <i>Microsporum gypseum</i>. The identification of the species makes it possible to pinpoint the source of contamination and to condition the prophylaxis. Aware of the rarity of inflammatory tinea capitis caused by M. gypseum, we thought it would be interesting to report a new case diagnosed in the Parasitology-Mycology laboratory of the Avicenne Military Hospital in Marrakech, while focusing on the epidemiological, clinical and mycological characteristics of this dermatophyte through a review of the literature.

A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope

IntroductionTinea capitis is a scalp infection caused by different fungi. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. The association of clinical and dermatoscopic findings in suspected cases of tinea capitis may help the identification of the etiological agent, facilitating precocious, specific treatment.Materials and methodWe report a prospective descriptive analytical study of 34 children with tinea capitis. We performed a trichoscopic examination of all patients; only six children were able to have the mycological culture.ResultsTrichoscopy was abnormal in all 34 patients; it showed hair shaft abnormalities and, in some cases, scalp disorders too. We found that the comma and corkscrew appearance was found in microsporic tinea capitis, V-shaped hair was mainly seen in inflammatory tinea capitis, scales and follicular keratosis in non-inflammatory tinea capitis, and crusts and follicular pustules in inflammatory tinea capitis. Finally, erythema was seen in trichophytic and inflammatory tinea capitis.ConclusionWe propose a classification of trichoscopic signs of tinea capitis. This classification will enable rapid diagnosis and prediction of the type of fungus before mycological culture, thus a faster and more adapted management.Our study shows the importance of trichoscopy in the diagnosis and monitoring of tinea capitis. We suggest further prospective studies with a larger number of patients with tinea capitis, having performed mycological culture, to confirm this classification.

Answer to April 2014 Photo Quiz

Answer: Inflammatory tinea capitis. The differential diagnosis included acute bacterial abscesses, tinea capitis (kerion), seborrheic dermatitis, atopic dermatitis, alopecia folliculitis, and psoriasis. Upon presentation, the patient was diagnosed with kerion, the most exaggerated cellular response to tinea capitis, a fungal infection of the scalp and hair shaft (1, 2). A patient's history and physical examination results are often used to make a clinical diagnosis; however, clinical diagnosis is often unreliable, making laboratory confirmation necessary (3, 4). Specimens should be aspirated for a superior sample or collected via the toothbrush or cotton swab method, which involves rubbing the respective sterile object over the lesions and sending it to the laboratory for evaluation (5, 6). Microscopic evaluation using 10 to 20% potassium hydroxide, with or without a fungal stain, such as calcofluor white for enhancement of hyphal elements, should be performed (3). Additionally, cultures should be sent, due to the potential for false negatives with the use of potassium hydroxide smears in patients with early or inflammatory tinea capitis (2). Specimens should be plated on one medium containing cycloheximide, such as dermatophyte test medium, and one medium without cycloheximide. Dermatophyte test medium changes from yellow to red in the presence of dermatophytes, including Microsporum canis and Trichophyton tonsurans, the pathogens most often implicated in tinea capitis. Confirmatory cultures may require a 3- to 4-week incubation period, and treatment should be initiated immediately for all patients for whom there is a high level of suspicion. Treatment requires systemic therapy, due to inadequate absorption of topical therapeutic agents into the hair shaft (1, 4). Currently, griseofulvin at 20 to 25 mg/kg of body weight/day is considered the gold standard treatment for tinea capitis, although treatment with newer agents such as itraconazole and terbinafine may be as effective (2). Mycological cure rates for a 6- to 8-week treatment course range from 70 to 100%, depending on dose, duration, and causative organism. Adjunctive therapeutic agents, such as 2% ketoconazole or 1% selenium sulfide shampoo, are effective at reducing the risk of transmission once oral therapy has been initiated by reducing the keratin food source for the fungus. Initial stains demonstrated hyphae, and cultures subsequently grew out Trichophyton tonsurans. The patient had been empirically started on griseofulvin at 500 mg daily with dinner and 1% selenium sulfide shampoo nightly and was to return to clinic in 4 weeks for a follow-up. (See page 1027 in this issue [doi:10.1128/JCM.00020-13] for photo quiz case presentation.)

Tinea Capitis: An Adult Invasion of a Childhood Scourge

A 52 year-old female patient presented with multiple painful pustules all over the scalp associated with loss of hair over the affected areas. On hair root examination, ectothrix was detected and histopathology showed multiple arthrospores within hair follicles and hyphae within stratum corneum. The patient was unresponsive to oral antifungals; hence, oral corticosteroids with oral terbenafine were administered, which produced drastic improvement within one week. We report this case to highlight the rare occurrence of a childhood infection in adults mimicking erosive pustular dermatoses. We stress the importance of using oral corticosteroids in the management of inflammatory tinea capitis.

Inflammatory tinea capitis mimicking dissecting cellulitis in a postpubertal male: a case report and review of the literature

Tinea capitis in postpubertal patients is unusual and may be misdiagnosed as dissecting cellulitis. We report a case of a healthy 19-year-old Hispanic male presenting with a 2-month history of a large, painful subcutaneous boggy plaque on the scalp with patchy alopecia, erythematous papules, cysts and pustules. Although initially diagnosed as dissecting cellulitis, potassium hydroxide evaluation (KOH preparation) of the hair from the affected region was positive. A punch biopsy of the scalp demonstrated endothrix consistent with tinea capitis, but with a brisk, deep mixed inflammatory infiltrate as can be seen with chronic dissecting cellulitis. Fungal culture revealed Trichophyton tonsurans, and a diagnosis of inflammatory tinea capitis was made. The patient was treated over the course of 17months with multiple systemic and topical antifungal medications, with slow, but demonstrable clinical and histopathological improvement. A rare diagnosis in adults, clinicians should have a high index of suspicion for this condition in an adult with an inflammatory scalp disorder not classic for dissecting cellulitis or with a recalcitrant dissecting cellulitis. Prompt, appropriate diagnosis and treatment is necessary to prevent the long-term complications of scarring alopecia.

Inflammatory Tinea capitis: a 12‐year study and a review of the literature

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.

Inflammatory tinea capitis due to Trichophyton tonsurans in a high school wrestler

Inflammatory tinea capitis due to Trichophyton tonsurans in a high school wrestler

Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child

Inflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition. 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. 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. Her condition improved with the antifungal therapy, and there was no residual alopecia. Physicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.

Inflammatory tinea capitis: kerion, dermatophytic granuloma, and mycetoma

Inflammatory tinea capitis is the result of a hypersensitivity reaction to a dermatophytic infection. The usual forms are favus, kerion celsi, dermatophytic Majocchi granuloma, and mycetoma. Inflammatory tinea capitis can be caused by Microsporum canis, Trichophyton mentagrophytes, T tonsurans, T rubrum, and M gypseum. Histopathologic findings include a spectrum from mild suppurative folliculitis to dense granulomatous infiltrates. In mycetoma, grains must be present.

Familial keratosis follicularis spinulosa decalvans associated with woolly hair

Keratosis follicularis spinulosa decalvans (KFSD) is a rare inherited disorder of keratinization clinically characterized by diffuse follicular hyperkeratosis, progressive scarring alopecia of scalp, eyebrows and eyelashes, corneal dystrophy and photophobia. Woolly hair is a hereditary condition, transmitted as an autosomal dominant or recessive trait, usually seen in Caucasians at birth or shortly after, in which there are curly, thick, often heavily pigmented hairs. We report two cases, a son and his mother, in whom KFSD occurred in association with woolly hair. In addition, various dental anomalies, including agenesis, inclusions and teeth malformations, were present in the child. Interestingly, both patients simultaneously developed an inflammatory tinea capitis caused by Microsporum canis. To our knowledge, the association of KFSD with woolly hair has not been described. The dental anomalies found in the child are intriguing, as they have never been reported previously in patients with KFSD. Finally, the concomitant onset of inflammatory tinea capitis in both patients may be explained by the enhanced susceptibility to fungal infection in keratinizing disorders.

Kerion and dermatophytic granuloma. Mycological and histopathological findings in 19 children with inflammatory tinea capitis of the scalp

Inflammatory tinea capitis or kerion is the result of a hypersensitivity reaction to a dermatophytic infection. Majocchi's granuloma, in contrast, usually begins as a suppurative folliculitis and culminates in a granulomatous reaction. To present clinical, mycological and histopathological findings for 19 cases of kerion of the scalp in children. Nineteen children were investigated (14 boys and five girls) with a mean age of 6.5 years. A potassium hydroxide (KOH) exam and culture in Sabouraud dextrose agar were performed, followed by a biopsy with hematoxylin and eosin, periodic acid-schiff (PAS) and Gomori-Grocott stains. The same investigations were carried out in four control cases of noninflammatory tinea capitis. Clinical history varied from 2 to 16 weeks (mean 6.6 weeks). Diagnosis was confirmed by a positive KOH exam: all cases except one had a positive culture. The following dermatophytes were isolated: Microsporum canis (32%), Trichophyton mentagrophytes (27%), Trichophyton tonsurans (21%), Trichophyton rubrum (10%) and Microsporum gypseum (5%). The histopathological findings were: suppurative folliculitis (SF) 11%, SF plus suppurative dermatitis 37%, suppurative and granulomatous dermatitis (SGD) 26% and SGD plus fibrosing dermatitis 26%. Fungi were observed in 63% of the histopathological sections. Perifollicular infiltrates (PF) around the parasitized hair follicles were identified in the four noninflammatory control cases due to M. canis. Kerion Celsi is an inflammatory or suppurative type of tinea capitis caused by zoophylic dermatophytes (M. canis and T. mentagrophytes), but also by antrophophylic (T. tonsurans and T. rubrum) and geophylic (M. gypseum) dermatophytes. Histopathological findings showed a spectrum from mild suppurative folliculitis to dense granulomatous infiltrates without a clear relationship with the clinical features.

Trichophyton rubrum‐induced inflammatory tinea capitis in a 63‐year‐old man

Tinea capitis caused by Trichophyton rubrum is a rare event worldwide. We report on an elderly otherwise healthy man with inflammatory fungal disease of the scalp caused by this pathogen. He had no signs of concomitant mycosis of the skin and nails and no underlying immunosuppressive disease. The fungal infection primarily had been misdiagnosed in terms of a pyoderma. Failure of antibiotic treatment, a positive mycological study and molecular diagnostics eventually led to the correct diagnosis. After systemic and local administration of terbinafine the lesion improved totally.