Kerion


Kerion is the result of the host's response to a fungal ringworm infection of the hair follicles of the scalp that can be accompanied by secondary bacterial infection. It usually appears as raised, spongy lesions, and typically occurs in children. This honeycomb is a painful inflammatory reaction with deep suppurative lesions on the scalp. Follicles may be seen discharging pus. There may be sinus formation and rarely mycetoma-like grains are produced. It is usually caused by dermatophytes such as Trichophyton verrucosum, T. mentagrophytes, and Microsporum canis. Treatment with oral griseofulvin common.

Symptoms

There may be loss of hair as hair will come out easily. Sometimes, there is growth of organisms. Lymph and fever symptoms may be present. This condition can be mistaken for a case of impetigo.

Diagnosis

The basis for the diagnosis of Kerion is clinical finding, positive microscopic examinations, mycological culture and modern molecular tests of clinical specimens. Wood's lamp examination will reveal a bright green to yellow-green fluorescence of hairs infected by Trichophyton mentagrophytes var. Mentagrophytes, in kerion infection caused by Trichophyton verrucosum Invaded hairs show an ectothrix infection and fluorescence under Wood's ultra-violet light has been noted in cattle but not in humans.

Treatment

Unlike most other manifestations of Tinea dermatophyte infections, Kerion is not sufficiently treated with topical antifungals and requires systemic therapy. Typical therapy consists of oral antifungals, such as griseofulvin or terbinafine, for a sustained duration of at least 6-8 weeks depending on severity. Successful treatment of kerion often requires empiric bacterial antibiotics given the high prevalence of secondary bacterial infection.