Tinea capitis mimicking dissecting cellulitis: a distinct variant

Abstract

recognition of a dissecting cellulitis-like pattern of tinea capitis will increase clinical suspicion and avoid inappropriate management of a recalcitrant "dissecting cellulitis" in favor of prompt antifungal therapy of appropriate dosage and duration for patients with this unusual variant of tinea capitis.

Tinea capitis mimicking dissecting cellulitis in three children

“…In this subtype of tinea capitis, skin biopsy reveals mixed dermal inflammation and fungal elements are inconsistently identified, even using special stains. [6][7][8][9][10] Of the seven cases described in Table 1 in which skin biopsies were performed, fungal elements were identified on pathologic examination in only three. 6,8 The reason for the negative pathology is unclear; one reason may be that the strong inflammatory response promotes digestion of fungal elements.…”

“…The infection is often misdiagnosed as dissecting cellulitis and unsuccessfully treated with antibiotics. [6][7][8][9][10] Exudative discharge may also prompt misdiagnosis as bacterial infection, but bacterial cultures are negative; fungal cultures are commonly delayed because tinea capitis is not initially suspected.…”

“…When fungal cultures are obtained, T. tonsurans is the most common causal dermatophyte. [7][8][9][10] Dissecting cellulitis-like tinea capitis may resemble other inflammatory types of tinea capitis, such as kerion, but should be recognized as a distinct variant. Whereas kerion typically presents with a localized inflammatory, boggy mass, dissecting cellulitis-like tinea capitis presents with multiple edematous alopecic plaques and nodules across the scalp in an interwoven pattern.…”

“…3 There have been several reported cases of an additional clinical subtype of inflammatory tinea capitis that resembles dissecting cellulitis. [6][7][8][9][10][11][12] Dissecting cellulitis is a noninfectious inflammatory condition of the scalp characterized by painful nodules connected by sinus tracts, with associated scarring. 6,13 Dissecting cellulitis is most common in African American men, with one study reporting a mean age of 26 years.…”

“…13 Cases of dissecting cellulitis-like tinea capitis, in contrast, have been reported in children 9-19 years of age. [6][7][8][9][10][11][12] Reported cases of this variant of tinea capitis describe its presentation as boggy, erythematous, interconnected plaques and nodules with overlying alopecia, [6][7][8][9][10][11][12] but the literature on this rare subtype is limited and it is commonly omitted in reviews of the disease. This subtype of tinea capitis is likely to be misdiagnosed because of a lack of widespread knowledge of it.…”