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

Authors

  • Roberto Arenas MD,

    Corresponding author
    1. From the Dermatology Department, “Manuel Gea Gonzalez” General Hospital, Mexico City, Mexico, and the Dermatological and Skin Surgical Institute, Santo Domingo, Dominican Republic
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  • Sonia Toussaint MD,

    1. From the Dermatology Department, “Manuel Gea Gonzalez” General Hospital, Mexico City, Mexico, and the Dermatological and Skin Surgical Institute, Santo Domingo, Dominican Republic
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  • Rafael Isa-Isa MD

    1. From the Dermatology Department, “Manuel Gea Gonzalez” General Hospital, Mexico City, Mexico, and the Dermatological and Skin Surgical Institute, Santo Domingo, Dominican Republic
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Roberto Arenas, MD Tlalpan 4800 México D.F. 14000 E-mail: dermagea@prodigy.net.mx

Abstract

Background  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.

Objectives  To present clinical, mycological and histopathological findings for 19 cases of kerion of the scalp in children.

Methods  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.

Results  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.

Conclusions  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.

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