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Background/Objective: Tinea capitis is a common scalp fungal infection with significant implications for public health, particularly in regions where proper hygiene and access to healthcare are limited. Emerging evidence suggests that this disease, particularly in young male individuals, may be related to certain unsanitary practices in barbershop settings, such as the use of contaminated shaving equipment. To increase awareness of the risk of scalp dermatophyte infections by disclosing different cases of tinea capitis that had arisen shortly after hairdressing procedures and providing a comprehensive review of the existing literature. Patients and Methods: 10 cases of young, adult male patients developed tinea capitis after haircuts carried out at different local barbershops in Sardinia. A collection of data regarding age, sex, location of the disease, clinical manifestations as well as direct microscopy and cultural investigations were performed. Results: Clinical manifestations varied among patients, exhibiting both non-inflammatory and inflammatory features, cultural investigations were positive for Trichophyton tonsurans. Patients were treated with griseofulvin or terbinafine in combination with topical antimycotics. Two cases out of the ten patients developed scarring alopecia. Conclusions: Outbreaks of T. tonsurans-induced tinea capitis, linked to hairdressing, have been recorded in many different countries. Timely diagnosis and therapy are crucial, since any delay can result in disease dissemination and potential complications such as scarring alopecia, particularly in the inflammatory forms. [ABSTRACT FROM AUTHOR]

Microsporum canis, a zoophilic dermatophyte, infects the stratum corneum and keratinized tissues like hair and nails in cats and dogs, with cats serving as the primary reservoir. Most human infections arise from animal contact. We present the case of a girl aged 8 with skin scalp lesions persisting for two months. Several scalp lesions, with a maximum diameter of 4 cm, presented as erythematous plaques with superficial scaling, yellow crusts, and edematous areas with purulent exudate. Dermoscopy revealed yellow crusts on an erythematous background, along with white scales, pustules, broken hairs, and comma hairs. Ultraviolent-enhanced fluorescence dermoscopy (UEFD) showed slight celadon green fluorescence, which enhanced the diagnosis and further helped to monitor the treatment. The PCR test confirmed the presence of M. canis. Treatment included topical ciclopirox and oral terbinafine. Lesions on the scalp and noticeable hair regrowth were observed in the areas of hair loss after two months. Kerion celsi can result in severe alopecia. To prevent scarring associated with hair loss in children, early mycological diagnostics, supported by dermoscopy and UEFD, is recommended. [ABSTRACT FROM AUTHOR]

Abstract Background Kerion, 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. Methods In 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. Results One 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. Conclusion We 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.

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We report a case of kerion celsi caused by Trichophyton tonsurans in a teenage male judo athlete, presenting with a lesion in the occipital region. Following the initiation of systemic antifungal therapy, the patient developed a dermatophytid reaction, necessitating differentiation from a drug eruption. Direct microscopy of the affected area confirmed the presence of fungal elements, and histopathological examination revealed endothrix invasion, supporting the continuation of treatment. A drug-induced lymphocyte stimulation test for terbinafine, conducted post-treatment, was negative. This case highlights the importance of distinguishing dermatophytid reactions from drug eruptions to ensure uninterrupted antifungal therapy.

Copyright of Dermatologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dermatophytoses of the skin and scalp are common disorders in the pediatric population. The resemblance of the clinical presentation to other dermatoses can make fungal infections challenging to diagnose. We present three cases of dermatophytoses in children. The presence of fungi within skin lesions was confirmed in all cases. The diagnoses were "id" reaction in response to Trichophyton tonsurans infection, Kerion celsi because of Microsporum canis infection, and hair loss during microsporosis. Based on our review and clinical experience, we suggest diagnostic paths and treatments for dermatophytoses in children. [ABSTRACT FROM AUTHOR]

The diagnosis of tinea capitis is usually made by clinical signs and direct microscopic examination. Early diagnosis of this dermatophytic infection, which may cause permanent hair loss if not treated appropriately, is very crucial. In recent years, the use of dermoscopy has helped with early diagnosis. However, when tinea capitis has an atypical course and develops in adulthood, it can be confused with several diseases, such as psoriasis, seborrheic dermatitis, folliculitis decalvans, acne keloidalis, and dissecting cellulitis. Due to the different treatment approaches and prognoses, it is important to distinguish tinea capitis from invasive dermatoses on the scalp. In this article, histopathological findings of tinea capitis and several advantages and disadvantages of histopathology in the diagnosis of fungal infections are also reviewed and updated. [ABSTRACT FROM AUTHOR]

The patient was a 13-year-old boy who was a member of the judo club at his junior high school. Approximately 1 week prior to his presentation, he developed multiple erythematous pilaris papules on his occipital area and was treated by a local doctor. The erythematous lesions expanded to 10 x 10 cm, showing granulation with drainage and strong spontaneous pain. At this point, he visited our hospital. He was diagnosed with kerion celsi due to Trichophyton tonsurans by fungal examination. The patient was treated with terbinafine (125 mg/day) for 6 weeks, and a brush test at 6 weeks was negative. All 18 members of the judo club, including this patient, were investigated; brush tests were positive in 4 cases, and one was positive for tinea corporis alone. The patient's family members parents were both negative. When an athlete is diagnosed with ringworm, T. tonsurans infection should be considered, and testing and treatment of family members and fellow athletes should be carried out to prevent the spread of infection. [ABSTRACT FROM AUTHOR]

A 64-year-old woman presented with a fist-sized, severely painful lesion with scales, crusts, pustules, erythema with subcutaneous abscess, and hair loss on the left temporal region. Direct microscopic examination revealed a large number of spores around the hair, which indicated ectothrix hair invasion, and some hyphae were also found. Histopathological examination showed significant inflammatory cell infiltration from the dermis to the subcutaneous tissues and into the hair follicles, destruction of the hair follicles with granulomatous reactions, and fungal masses along the hair within the hair follicles. Microsporum canis was identified based on morphological features via culture method and molecular biological analysis of the internal transcribed spacer region DNA sequence. The patient was diagnosed with kerion celsi caused by M. canis. For treatment of kerion celsi, we chose an oral antifungal agent, fosravuconazole (FRVCZ), which has been available since 2018 only in Japan. Clinical symptoms were cured in 12 weeks without scarring. No side effects were observed during oral administration of FRVCZ. The results of our case and several previous reports suggest that FRVCZ is effective in treating various types of dermatomycoses. [ABSTRACT FROM AUTHOR]

A 34-year-old female patient presented with hair loss due to black dot tinea capitis caused by Trichophyton tonsurans for 6 months. Hair loss progressed to painful swelling for 2 months due to kerion Celsi which may be associated with treatment like topical minoxidil, antibiotic and corticosteroid previously. The patient was treated with oral Itraconazole initially without success but cured by Terbinafine eventually. It's very interesting that the patient caught kerion celsi secondary to a four-month history of hair loss due to black dot tinea capitis. [ABSTRACT FROM AUTHOR]

We herein report a case of kerion celsi of the scalp and tinea corporis due to Trichophyton tonsurans. A 17-year-old Japanese male high school student who practiced judo had alopecic patches with severe inflammation on the scalp. We performed a fungal culture and identified the causative fungus as T. tonsurans. A plate culture of T. tonsurans showed lemon-yellow colonies with yellow-green fluorescence under UVA light, which are typical findings for Microsporum canis. However, genetic analysis of the ribosomal RNA gene of the isolate facilitated differential diagnosis of T. tonsurans. In contrast to dermatophytosis due to other dermatophytes, the clinical features of infection caused by T. tonsurans, an anthropophilic dermatophyte, are initially not very apparent and, thus, are frequently overlooked. We herein present a case of a severe type of kerion celsi caused by T. tonsurans with a fluorescence pattern mimicking M. canis colonies under UVA light.We suspect that yellow pigment metabolites, such as riboflavin, which are fluorescent under UV when secreted into the culture medium, are the virulence factors for not only M. canis, but also T. tonsurans, as shown in the present case. [ABSTRACT FROM AUTHOR]

Introduction: Tinea capitis refers to a dermatophyte infection usually caused by Microsporum and Trichophyton species. Kerion celsi, an inflammatory variant, predominantly affects children and is frequently misdiagnosed in clinical practice. Case Report: A 15-year-old male patient presented to the Dermatology Clinic with a two-month history of an inflammatory, suppurative, impetiginized plaque localized on the right frontoparietal area. The lesion was characterized by yellow crusts and pustules. The patient was previously hospitalized and treated with systemic acyclovir, antibiotics, and corticosteroids due to fever, leukocytosis, and positive bacteriological examination for Staphylococcus aureus. When presented to our clinic, the patient had preauricular and postauricular reactive lymphadenopathy, but he was otherwise healthy. Wood's lamp examination and mycological cultures were negative. Based on clinical presentation and medical history, the diagnosis of kerion celsi was made. He started systemic itraconazole pulse therapy regimen. Locally, wet dressings for one hour daily and ketoconazole 2% shampoo washings 2-3 times per week were recommended. Twelve weeks post-initiation, following three itraconazole pulses, the clinical cure was achieved, with subsequent replacement of the inflammatory lesion by an alopecic plaque followed by regrowth of hair. Discussions : In inflammatory tinea capitis, fungal invasion results may lead to scarring alopecia if treatment initiation is delayed. PCR testing provides a rapid and accurate means of identifying the causative fungal agent. However, its accessibility is limited for many patients due to financial constraints. Despite challenges in species identification, prompt antifungal therapy initiation is mandatory, given the broad spectrum of modern antifungal agents. Griseofulvin has been considered a first-line systemic agent for managing tinea capitis in children, however, due to its unavailability in most European countries, alternative treatments should be used. Conclusions: This case highlights the efficacy of itraconazole in treating kerion celsi in children and the importance of early treatment initiation to prevent the development of cicatricial alopecia. [ABSTRACT FROM AUTHOR]

The article informs about an 8-year-old boy with a 2-week history of edema and skin lesion on the left upper eyelid, initially diagnosed with preseptal cellulitis but later identified as kerion celsi caused by Candida albicans, requiring treatment with oral griseofulvin for clinical cure. Topics include the patient's clinical presentation, diagnostic challenges, and successful management with antifungal therapy.

Background: Kerion celsi is a severe inflamed deep abscesses form of tinea capitis which mostly occurs in children population. Despite good regular treatment with antifungals, the prognosis of kerion celsi is poor with scarring alopecia. Case Illustration: A 5-year-old boy had history of an alopecia with locally large painful oedema on his scalp a month before treatment. From the physical examination, a painful large area with alopecia was found with abscess covered by thick crust. Pull test showed hair breakage and right retro-auricular lymphatic nodes enlargement was also found. Endo-ectothrix spores were positive in potassium-hydroxide examination and the culture showed colony of Trichophyton mentagrophytes. A surgical debridement was performed to remove the thick crust covering the abscess with alopecia and followed by application of normal saline gauze dressing and terbinafine cream on the top of the lesion for 6 weeks. Systemic micronized griseofulvin was also administered for 6 weeks. Combination treatment of debridement-topical and systemic antifungal gave a good result without scarring alopecia. Discussion: Kerion celsi was diagnosed based on clinical findings and mycological examination. From the laboratory examination, a dermatophyte fungal infection was found. Skin debridement was performed to create a good environment for topical antifungal application and wound healing, with 20mg/kg bodyweight of systemic griseofulvin administered as the first line therapy for tinea capitis. A good prognosis was achieved after those treatments combination. Conclusion: In this case, combination between skin debridement with topical and systemic antifungals gave a better result in treating kerion celsi.

BACKGROUND: Tinea barbae is a rare manifestation of dermatophytosis, and even more those cases complicated as kerion Celsi by the strong inflammatory response; this manifestation is more common in young men and associated with zoophilic fungi; this manifestation can be related with severe aesthetic sequelae, hence the importance of a correct antifungal treatment. CLINICAL CASE: A 28-year-old male patient with vesicular and seborrheic dermatitis with an important inflammatory component with the isolation of T. mentagrophytes. CONCLUSIONS: Prognosis of tinea barbae may be satisfactory if the proper etiological characterization is done and the adequate treatment is initiated. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tinea capitis is a term used to refer to dermatophyte lesions on the scalp, that occur mainly in children, immunodeficient patients or older adults. They can be dry or inflammatory (kerion Celsi) and can be generated by agents such as Trichophyton tonsurans, Microsporum canis, M. gypseum and T. mentagrophytes. Although its treatment is simple, it can leave alopecia if it is not treated. CLINICAL CASES: We report the cases of two children from Nicoya, Guanacaste and Golfito, Puntarenas, Costa Rica, who were diagnosed as kerion Celsi and tinea capitis by T. mentagrophytes. CONCLUSIONS: T. mentagrophytes is a zoophilic fungus capable of generating kerion Celsi because it has antigens that arouse an exacerbated immune response on the host. [ABSTRACT FROM AUTHOR]

Nannizzia gypsea, previously known as Microsporum gypseum, is a geophilic dermatophyte that infects humans from the soil. We isolated N. gypsea from a two-year-old girl with kerion celsi. Because of her serious medical condition, she was admitted to the pediatric ward immediately after birth. We struggled to identify the route of infection, and eventually identified her grandmother’s handmade belt, which covered the endotracheal-tube-holding device, as the infection source. To prevent indirect transmission of pathogenic microorganisms from outside the hospital environment, our hospital prohibited the bringing of belongings from outside. [ABSTRACT FROM AUTHOR]

Tinea capitis, uma infeção do couro cabeludo por dermatófitos, é a infeção fúngica mais comum em idade pediátrica. A apresentação clínica é variável, desde uma dermatose descamativa não inflamatória até à evolução para lesões tipo Kerion celsi que podem ser semelhantes a abcessos bacterianos. Relatamos o caso de um rapaz de 22 meses de idade, admitido no Serviço de Urgência com uma lesão em placa eritemato-descamativa do couro cabeludo e fronte, com flutuação e drenagem espontânea, com 2 semanas de evolução e agravamento após aplicação de corticoide tópico e com febre desde há 3 dias. Os estudos laboratoriais revelaram leucocitose, aumento da proteína C reativa e hemocultura negativa. Foi internado para tratamento com flucloxacilina endovenosa e submetido a drenagem cirúrgica.À observação por Dermatologia foi diagnosticado um Kerion celsi, tendo iniciado tratamento com itraconazol oral, betametasona e clotrimazol tópicos. O exame microbiológico do exsudado foi negativo. O exame micoló- gico do raspado da lesão revelou a presença de hifas e a cultura mostrou o crescimento de Trichophyton mentagrophytes. Devido à reação inflamatória cutânea exuberante e aparecimento de múltiplas pápulas eritematosas na face, iniciou betametasona oral ao quarto dia de internamento. Manifestou melhoria clínica com total resolução do abcesso após 15 dias de antibioticoterapia. Teve alta medicado com itraconazol e esquema de redução de corticoide oral, com seguimento em consulta de dermatologia apresentando resolução parcial. A tinea capitis tem geralmente um prognóstico favorável, com total resolução da infeção na maioria dos casos. Nos casos de Kerion celsi, a terapêutica conjugada com corticoide oral é necessária para reduzir a inflamação e prevenir a alopécia cicatricial. O reconhecimento atempado desta condição é muito importante e as lesões do couro cabeludo que se assemelhem a abcesso devem ser cuidadosamente investigadas para que a terapêutica antifúngica seja iniciada e não se submetam os pacientes a intervenções cirúrgicas desnecessárias.

Kerion celsi (KC), known as scalp ringworm, is the most common dermatophytosis in children. In Mexico, it ranks fourth among dermatophytoses, with a frequency of 4%-10%. KC is the inflammatory variety of tinea capitis (TC), with the most common causative agents being Microsporum canis and Trichophyton mentagrophytes. We present the clinical case of a six-year-old male diagnosed with KC. Direct examination stained with chlorazol black and cultures were performed, yielding negative results. Histopathological study revealed spores and short hyphae within and surrounding the hair shaft. Treatment with itraconazole was initiated based on suspicion of Microsporum spp. from the trichoscopy findings. We propose a diagnostic and therapeutic algorithm for kerion celsi., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Figueroa Basurto et al.)

We report a case of kerion celsi due to Trichophyton tonsurans. An 18‐year‐old male student judo practitioner had alopecic patches, black dots and subcutaneous abscesses on the right temporal region. The damaged hair represented endothrix infection with T. tonsurans, as assessed by mycological examinations. He was treated with oral itraconazole without any therapeutic effect, followed by terbinafine with good effect. A skin biopsy showed neutrophil, lymphocyte and histiocyte infiltration into the dermis and subcutaneous tissue with abscesses around a number of dilated hair follicles. Immunostaining showed that the expression level of human β‐defensin 2 (HBD‐2) was decreased in the epidermis of the alopecic and adjacent skin. Because interleukin (IL)‐17A generally induces HBD‐2 production by epidermal keratinocytes, we also immunohistochemically investigated IL‐17A expression. Unexpectedly, many IL‐17A‐bearing cells were found around destructed hair follicles, indicating that IL‐17A expression was not attenuated, but rather increased in the skin lesion. Our case suggests that IL‐17A‐upregulated antimicrobial peptide expression is disordered in kerion celsi, and severe inflammation with IL‐17A may cause tissue damage and resultant scar. [ABSTRACT FROM AUTHOR]

We report a severe case of kerion Celsi of the scalp in a previously healthy 13-year-old girl due to Trichophyton quinckeanum, an emerging dermatophyte species in Europe. The species was definitely identified by DNA sequencing and the patient was successfully treated by oral terbinafine for 6 weeks. Kerion Celsi is a severe inflammatory form of tinea capitis, which is characterised by a purulent discharge and alopecia [1]. It typically occurs in children infected with zoophilic dermatophytes, such as Trichophyton mentagrophytes , and an increasing number of cases caused by other Trichophyton species has recently been reported [2]. Herein we report a severe case of kerion Celsi of the scalp caused by the emerging species Trichophyton quinckeanum , which was successfully treated by oral antifungal. [ABSTRACT FROM AUTHOR]

We report a severe case of kerion Celsi of the scalp in a previously healthy 13-year-old girl due to Trichophyton quinckeanum, an emerging dermatophyte species in Europe. The species was definitely identified by DNA sequencing and the patient was successfully treated by oral terbinafine for 6 weeks. Kerion Celsi is a severe inflammatory form of tinea capitis, which is characterised by a purulent discharge and alopecia [1]. It typically occurs in children infected with zoophilic dermatophytes, such as Trichophyton mentagrophytes, and an increasing number of cases caused by other Trichophyton species has recently been reported [2]. Herein we report a severe case of kerion Celsi of the scalp caused by the emerging species Trichophyton quinckeanum, which was successfully treated by oral antifungal., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

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Summary: Deep trichophytosis is relatively uncommon. The infection of the bearded area is also known as sycosis barbae or tinea barbae and can be caused by various fungal species, most often zoophilic fungi. We report on an 80‐year‐old male patient with severe sycosis barbae who had no animal contact and was treated with systemic antibiosis without improvement. Microbial and mycological investigations using swabs from oozing lesions revealed Staphylococcus haemolyticus and Candida parapsilosis. Histology demonstrated fungal elements in hair follicles. Paraffin‐embedded material was subjected to further mycological analysis. For molecular diagnostics DNA was prepared from paraffin sections for real‐time polymerase chain reaction (RT‐PCR). For sequencing, DNA was isolated from paraffin‐embedded skin tissue and the ITS region of the rDNA was selected. Sequencing of the ITS2 region of rRNA revealed a 100% accordance with Trichophyton (T.) verrucosum. Treatment with oral terbinafine achieved a complete remission. Sycosis barbae is an important differential diagnosis for infections of the bearded area. Nucleic acid amplification techniques (NAAT) are more and more used for direct examination of dermatophytes in clinical samples, eg T. verrucosum. NAAT are also used as culture confirmation tests for identification of rare dermatophytes like T. verrucosum. Today, singleplex and multiplex quantitative real‐time PCR (qRT‐PCR) assays for the detection of the most common dermatophytes including T. verrucosum in clinical specimens are available. Recently, an ITS2 PCR assay has been successfully used for direct detection of T. verrucosum in paraffin‐embedded formalin‐fixed skin tissue. The PCR is fast and highly specific. The sensitivity of direct molecular detection of the dermatophytes both in native clinical material, and in paraffin‐embedded skin tissue can been increased. [ABSTRACT FROM AUTHOR]

A 67-year-old female patient developed drug-induced liver dysfunction after taking oral itraconazole (ITCZ) for the treatment of kerion celsi. Red papules appeared on the temporal area of the patient one month prior to her visit to our clinic. The patient presented with a nodule with yellow crust, erosion, infiltration, and hair loss on the area. Diagnosis of kerion celsi caused by Trichophyton rubrum was made from clinical, pathological, and mycological findings. Laboratory data showed normal liver function, and the patient was not taking any other medication, thus, daily oral ITCZ 100 mg was started. The skin lesion improved, but severe liver dysfunction was found1month after starting ITCZ. Oral ITCZ was therefore terminated, and the patient was admitted to a medical ward for the treatment of liver dysfunction. Hepatobiliary enzymes increased after admission: AST 232 IU/L, ALT 465 IU/L, T-bil 6.1 mg/dL, and D-bil 3.9 mg/dL. The patient was kept at rest and was given oral ursodeoxycholic acid. Hepatobiliary enzymes returned to normal level 2 1/2 months after starting ITCZ. The skin lesion healed without further treatment. No recurrence was observed. It is noteworthy that liver function has to be carefully monitored during treatment with oral ITCZ. [ABSTRACT FROM AUTHOR]

T. tonsurans is an anthropophilic dermatophyte causing several clinical variants of tinea capitis including the Kerion celsi that can be often unrecognised or confused with other lesions. We report a case of Kerion celsi caused by Trichophyton tonsurans in a child following an excoriation to the scalp caused by a fall in a public park. The use of multiplex PCR assay has enabled rapid diagnosis of tinea capitis from T. tonsurans with a result in less than 48 hours and therefore the possibility of quickly starting antifungal therapy. The patient had a complete recovery at the end of the antifungal treatment. [ABSTRACT FROM AUTHOR]

Kerion is an inflammatory type of tinea capitis which can be mistaken for bacterial infection or folliculitis as both conditions display similar clinical features. It occurs most frequently in prepubescent children and rarely in adults. We report a 26-yearold woman who presented with multiple tender inflammed nodules on her scalp. Her condition was misdiagnosed as bacterial abscess and treated with multiple courses of antibiotics without improvement. Later, her condition was re-diagnosed as kerion based on clinical appearance, history of contact with infected animal and Wood’s lamp examination. symptoms and lesions resolved completely with systemic antifungal treatment leaving residual scarring alopecia. the delay in the diagnosis and treatment of this patient resulted in permanent scarring alopecia.

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Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Kerion celsi is generally known as an inflammatory form of tinea capitis which is the result of delayed type hypersensitivity reaction of the body to fungal agents. It causes a painful, inflamed, crusty mass on the scalp and is often associated with purulent drainage and regional lymphadenopathy. Kerion celsi is often reported in children between three to seven years of age and it has a male predominance. This diagnosis should be kept in mind in patients with scalp scaling and alopecia, especially if they have pustular, crusted and nodular lesions and easily breaking hairs on the scalp. If untreated, alopecic scar tissue inevitably develops on the scalp. Differential diagnosis with bacterial pyoderma or abscess is important and may avoid unnecessary and inappropriate surgical drainage. Although causative species show variations between regions, zoophilic dermatophytes such as Microsporum canis, Trichophyton verrucosum and Trichophyton interdigitale complex are usually isolated from cultures. Herein, we report a ten year-old boy who was referred to our clinic because of pyodermic skin lesion and abscess formation which did not respond to antibacterial treatment. He was diagnosed as kerion celsi related to Trichosporon asteroides and successfully treated with systemic fluconazole within eight weeks. To our knowledge this is the first case of kerion celsi in the literature caused by T. asteroides. [ABSTRACT FROM AUTHOR]

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Tinea capitis is a scalp fungal infection involving the hair. Inflammatory cases are usually caused by zoophilic and geophilic species of the genus Microsporum and Trichophyton, and are almost always seen in children. The most effective treatments are with Griseofulvin, itraconazole and terbinafine. We report two cases in children 5 and 7 years old, in which Microsporum gypseum and Trichophyton tonsurans were isolated. [ABSTRACT FROM AUTHOR]

Introdução: A tinea capitis, considerada a dermatofitose mais comum em idade pediátrica, pode ter várias apresentações clínicas, desde uma descamação não inflamatória até uma severa erupção pustular designada de Querion de Celsi. Esta última pode evoluir para uma alopécia cicatricial, situação que pode ser evitada com o diagnóstico e tratamento atempados da doença. Descrição do Caso: Criança do sexo masculino, 12 anos e raça caucasiana, sem antecedentes patológicos de relevo, foi observada em Novembro de 2011, na consulta aberta da unidade de cuidados de saúde primários da área de residência, por placa supurativa da região occipitoparietal esquerda, com cerca de cinco centímetros de diâmetro, dolorosa e com cinco meses de evolução. Admitida a hipótese de diagnóstico de abcesso do couro cabeludo, foi medicada com antibioterapia sistémica. Cerca de um mês depois, em Dezembro de 2011, por agravamento progressivo da lesão, recorreu ao serviço de urgência do hospital, altura em que foi pedida a colaboração da Dermatologia. Após o estabelecimento do diagnóstico de Querion de Celsi, foi instituída terapêutica com terbinafina (125 mg/dia) e champô de cetoconazol, durante três meses, com cura da infecção fúngica e alopécia cicatricial como sequela. Comentário: Pretende-se alertar para a necessidade do reconhecimento precoce destas lesões, permitindo instituir o tratamento adequado, de forma a evitar a alopécia cicatricial.

Kerion celsi is an inflammatory form of tinea capitis caused by a T-cell–mediated hypersensitivity reaction to the causative dermatophyte. Differential diagnosis is very difficult when a scalp wound is abscess-like. Early diagnosis may avert unnecessary and inappropriate surgical drainage. Here we present 10 year old boy with a complaint of a head wound and diagnosis as kerion celsi. If there is a scalp wound with crusting, serious oozing, pus and keratin debris in childhood, and especially if there is resistance to the usual treatment modalities, kerion celsi should be considered in differential diagnosis. [ABSTRACT FROM AUTHOR]

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A three-year-old Sri Lankan boy residing in Japan developed a nodule on his scalp after visiting Sri Lanka. Two months later, the lesion increased in size to 22 × 19 mm2, and was identified as an erythematous nodule with alopecia. Direct examination of the infected hair shafts indicated fungal hyphae outside the shafts. The fungus was identified as Microsporum gypseum following mycological examination. The sequence of the internal transcribed spacer 1 region of ribosomal RNA gene (ITS1 rDNA) exhibited 95.7-100.0% homology with that of Arthroderma incurvatum. The patient was successfully treated with a 6-week itraconazole course. We also examined DNA samples from eight clinical isolates of A. incurvatum. Alignments of ITS1 sequences of these strains and our isolate, showed gaps in the 64-bp positions 140-142 and 141-143 of the 205-207-bp ITS1 alignment. We performed phylogenetic analysis using the neighbor-jointing (NJ) method based on the ITS1 sequences of the present isolate and twenty related strains. Fifteen A. incurvatum strains were divided into East Asia and non-East Asia clusters. The present isolate belonged to the non-East Asia cluster, suggesting that the patient was infected outside Japan. Moreover, the trees suggested area-dependent genetic polymorphism of A. incurvatum. [ABSTRACT FROM AUTHOR]

We report a rare case of kerion celsi of the scalp caused by Microsporum gypseum in a boy 1 month after he received dermatoplasty for a scalp injury from a road accident. Species identification was performed by observation of morphologic and biochemical characteristics and sequencing of the internal transcribed spacers (ITS) 1 and 2. Treatment with oral terbinafine and topical naftifine-ketoconazole cream after washing the hair with ketoconazole shampoo was effective. [ABSTRACT FROM AUTHOR]

We report a case of kerion celsi caused by Microsporum gypseum and present some epidemiological statistics and a distribution of the mating types of M. gypseum. A 10-year-old healthy boy living in Narita, Chiba Prefecture, visited the Narita Red Cross Hospital in October 2004 with complaints of a scaly erythematous plaque and alopecia. Before the visit, he had been treated with steroid lotions and antibiotics without success. A direct examination of the diseased hair shaft using a potassium hydroxide (KOH) solution revealed the presence of fungal hyphae outside the hair shafts. The patient showed a positive reaction to the trichophytin test. The fungus isolated from the lesion was identified as M. gypseum on the basis of its morphological and physiological characteristics and the results of molecular biological analysis. The sequence of the gene coding for the internal transcribed spacer (ITS) 1 region of ribosomal RNA (ITS 1 rDNA) was homologous to that of Arthroderma gypseum (DDBJ accession no. AB193684). The isolate was confirmed to be A. gypseum (-) mating type on the basis of crossing experiments with (+) and (-) mating types of A. gypseum, A. incurvatum, and A. fluvum. The patient was successfully treated with 50 mg/day (1.6 mg/kg/day) of itraconazole for 4.5 months. [ABSTRACT FROM AUTHOR]