Erythema nodosum induced by kerion celsi of the scalp in a child: a case report and mini‐review of literature

Abstract

A 9-year-old girl, presented with a 4-week history of an inflammatory suppurative plaque, 8 cm in diameter, localised in the occipital area of the scalp. Mycological direct examination showed ectoendothrix invasion of the hair and Trichophyton mentagrophytes was isolated. Oral therapy with griseofulvin 25 mg kg(-1) day(-1) was prescribed, but after 2 weeks of treatment appeared multiple erythematous subcutaneous nodules localised in the legs. Erythema nodosum (EN) was confirmed by histological examination of a nodule and then we combined therapy with 1 mg Kg(-1) day(-1) of prednisone. At the remission of the panniculitis, which occurred in about 10 days, the steroid therapy was suspended, while the orally administered griseofulvin continued for 6 weeks until full recovery. EN is the most frequent clinical form of acute nodular panniculitis and it is considered an epiphenomenon relative to various infectious and non-infectious stimuli. The association of EN with dermatophytosis of the scalp is infrequent, with only 15 cases reported in the Literature.

Are Dermatophytid Reactions in Patients with Kerion Celsi Much More Common Than Previously Thought? A Prospective Study

“…Id reactions tend to occur at the height of the dermatophyte infection, slightly thereafter, or before or just after the initiation of systemic antifungal therapy, which can vary from 5 to 20 days (6,7,9,12). Cheng et al (12) and Castriota et al (17) reported that dermatophytid reactions appeared after systemic antifungal therapy. In our study, all dermatophytid reactions were determined at the initial visit, before treatment was begun.…”

S1 guidelines: Tinea capitis

“…Criteria for the diagnosis of a dermatophytid include: (1) evidence of a (frequently) inflammatory dermatophytosis at another site of the body (here, TC); (2) no evidence of fungal elements in the dermatophytid lesions; (3) initially, there is frequently a clinical flare-up upon starting highly effective systemic antifungal therapy (release of large amounts of fungal antigens). Dermatophytid reactions reported to be associated with TC include: symmetrically disseminated papular or papulovesicular eczematous lichenoid lesions with follicular accentuation that usually develop on the trunk (lichen trichophyticus); erythema nodosum and erysipelas-like dermatitis; psoriasiform lesions; erythema multiforme; urticarial and erythema annulare centrifugum-like lesions [37,38,[41][42][43][44]. While dermatophytids usually occur on the trunk, extremities and face, generalized eruptions are also possible.…”

“…While dermatophytids usually occur on the trunk, extremities and face, generalized eruptions are also possible. Dermatophytid reactions reported to be associated with TC include: symmetrically disseminated papular or papulovesicular eczematous lichenoid lesions with follicular accentuation that usually develop on the trunk (lichen trichophyticus); erythema nodosum and erysipelas-like dermatitis; psoriasiform lesions; erythema multiforme; urticarial and erythema annulare centrifugum-like lesions [37,38,[41][42][43][44].…”

Infections, Infestations and Neoplasms of the Scalp

“…These patients have a strong delayed-type hypersensitivity [DTH] reaction to intradermal trichophytin. EN is thought to be due either the deposition of immune complexes in capillaries and venules of the dermal and adipose plexus, or to a DTH reaction to an antigen [55,56].…”