Elsevier

Clinics in Dermatology

Volume 28, Issue 2, March–April 2010, Pages 133-136
Clinics in Dermatology

Inflammatory tinea capitis: kerion, dermatophytic granuloma, and mycetoma

https://doi.org/10.1016/j.clindermatol.2009.12.013Get rights and content

Abstract

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.

Introduction

Inflammatory tinea capitis is the result of an intense hypersensitivity reaction from a dermatophytic infection. The usual clinical forms are favus, kerion celsi, Majocchi granuloma, and mycetoma.1, 2

Section snippets

Favus

Favus is a rare mycosis of the scalp and skin with the presence of scutula. It is caused mainly by Trichophyton schoenleinii and seldom by Microsporum gypseum (Figure 1). It rarely affects other body sites and is thought to be a hypersensitivity reaction to dermatophytes that invade keratinized cells of hair follicles.

Kerion

Kerion is a suppurative and painful plaque associated with purulent drainage and regional lymphadenopathy.1 It is a carbunclelike boggy plaque of the scalp with two clinical presentations, kerion celsi and dermatophytic folliculitis. The latter is usually an initial lesion and the former a localized matted mass, but multiple plaques may also be found (Fig. 2, Fig. 3). If diagnosis and treatment are delayed, kerion causes a scarring alopecia.3 Kerion is caused by T mentagrophytes, T verrucosum,

Majocchi granuloma

The dermatophytic Majocchi granuloma is characterized by inflammatory papular, pustular, or nodular lesions, usually on the limbs or face (Fig. 4, Fig. 5). It is mainly caused by T rubrum and begins as a suppurative folliculitis that later shows a histiocytic infiltrate.4 In a prior study of four cases of kerion and five cases of Majocchi granuloma, we observed a perifollicular infiltrate in 77.7% and fungal elements in 66.6%. The histopathologic evidence of a granuloma was found in most kerion

Mycetoma

Mycetoma or pseudomycetoma caused by dermatophytes is clinically similar to eumycetoma (Figure 6). Unlike eumycetoma, it is not an exogenous infection but is a consequence of underlying tinea capitis. Histologically, there is a granuloma.11

We reported a 14-year-old girl with a scalp dermatophytic mycetoma due to M canis, present since childhood. The histopathologic findings were a dense inflammatory infiltrate with neutrophils, epithelioid histiocytes, and Langhans cells involving the

Conclusions

Kerion and other forms of inflammatory tinea capitis and dermatophytic granuloma have an excellent response to griseofulvin, itraconazole, and terbinafine. To prevent alopecia in kerion, an oral corticosteroid should be added early. The response of dermatophytic mycetoma to antifungal agents, however, is not predictable.2, 9

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