백선종창 및 비염증성 두부백선의 임상적 연구

김수민 ( Soo Min Kim ),김영아 ( Young Ah Kim ),조남준 ( Nam Joon Cho ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.4

Background: Tinea capitis manifests either as a non-inflammatory or inflammatory type including kerion, which may cause permanent alopecia. In addition to antifungals, systemic corticosteroids (prednisolone at 1∼2 mg/kg/day) have been used to reduce inflammation in patients with kerion. Objective: We studied the clinical and laboratory features, treatments, and prognosis of tinea capitis. Methods: We performed a retrospective review of 12 cases of kerion and 12 cases of non-inflammatory tinea capitis (median age, 8 years; range, 3 months∼80 years) diagnosed using a potassium hydroxide mount at the National Health Insurance Service Ilsan Hospital between November 2011 and April 2018. Results: Fungal cultures showed Microsporum species in 6 cases and Trichophyton species in 1 case. The duration of diseases and extent of lesions were greater in the kerion group than in the non-inflammatory tinea capitis group (p<0.05). Sixteen patients were treated with systemic antifungals. In the kerion group, 10 patients were treated with systemic antifungals (6 with itraconazole [median, 26 days; range, 21∼58 days] and 4 with terbinafine [median, 24.5 days; range, 13∼31 days]). The median intervals between the onset of treatment and scalp clearing (in 10 cases), the onset of new hair growth (in 9 cases), and complete regrowth of hair (in 7 cases) were 27 (range, 13∼ 77), 33 (range, 19∼63), and 89 (range, 42∼180) days, respectively, in the kerion group. The median dosage of prednisolone used in patients with kerion was 0.26 mg/kg/day (range, 0.15∼0.42) with good clinical response. Conclusion: The patients with kerion responded well to antifungal treatments. A lower dose of prednisolone was adequate when systemic corticosteroids were required for the treatment of kerion. (Korean J Dermatol 2019;57(4): 182∼190)

[P234] Kerion celsi misdiagnosed as bacterial folliculitis of scalp

( Beom Jun Kim ),( Won-soo Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Kerion celsi is a severe inflammation, caused by vigorous T-cell mediated responses to the dermatophyte infection. It can be misdiagnosed as various diseases including bacterial folliculitis, dissecting folliculitis, and abscess, etc. Early Diagnosis of kerion celsi is important for proper treatment. We report a 70-year-old female who presented with a 6-months history of follicular lesions that includes erythematous scaly papules, pustules, and crusts on scalp with alopecic patches. The patient was diagnosed as folliculitis and treated with topical steroid and oral minocycline for 1 month by other clinician. However, she presented to our clinic because of no improvement despite treatments. We performed biopsy to distinguish cicatricial alopecia caused by severe folliculitis, furunculosis, or kerion celsi and premalignancy. The pathologic findings revealed deep inflammation caused by fungi. We finally diagnosed kerion celsi from clinicopathologic findings and treated the patient with topical and oral antifungal agents with topical steroid. After the treatment, lesions improved rapidly and remains in good condition until now. This case shows kerion celsi should be considered in severe folliculitis and lesions not responded to treatment. It is important to diagnose kerion celsi accurately and early for proper treatment. Herein we report an educational case of kerion celsi easy to misdiagnosed and mistreated for bacterial folliculitis.

Kerion celsi caused by Trichophyton erinacei from hedgehog

( Kanghoon Lee ),( Jiyun Jang ),( Myeonghyeon Yang ),( Joonhee Kim ),( Minsoo Jang ),( Keesuck Suh ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Kerion celsi, highly inflammatory form of tinea capitis, appears as a painful edematous plaque and alopecia. Trichophyton erinacei is zoophilic dermatophyte most probably infected directly from the hedgehog. Among cases of T. erinacei skin infection in Korea, the most common infection site is hand and kerion celsi has not been reported. A 9-year-old male presented with a solitary erythematous and edematous plaque covered with crust on the scalp. For the past 2 years, he had kept a hedgehog as a pet. The lesion did not fluoresce under Wood``s light. KOH microscopy showed numerous fungal spores coating the outside of the shaft (ectothrix). Macroscopic view of a colony isolated from skin lesion after culture on Sabouraud agar showed a white lightly powdery with concentric ripples at the periphery. On microscopic findings stained with lactophenol cotton blue, round to pear-shaped microconidia and club-shaped macroconidia were seen. The sequence of ITS-1 regions amplified by PCR was found to be identical to that of T. erinacei. The diagnosis of kerion celsi caused by T. erinacei was made. The patient was treated with terbinafine (250 mg/day) for 8 weeks and methylprednisolone (12mg/day) for the first week, and the skin lesion was completely resolved. Following conversion to negative of KOH microscopy and fungal culture, the treatment was continued for 2 weeks more. Herein, we report a case of kerion celsi caused by T. erinacei from hedgehog.

Kerion celsi caused by Trichophyton rubrum in an elderly

( Sang Youl Yu ),( Min Woo Park ),( Moo Kyu Suh ),( Gyoung Yim Ha ),( Jong Im Lee ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Kerion celsi is a severe inflammatory type of tinea capitis that presents as a boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, Kerion celsi caused by T. rubrum is rare. Kerion celsi is uncommon in adult. We report a case of kerion celsi caused by T. rubrum in a 72-year-old woman. She presented with localized tender erythematous plaques with pustules with oozing purulent material on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud``s dextrose agar and showed typical whitish cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. rubrum strain UZ1588_14(GenBank accession number KP326579.1). She was treated with 200mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.

노인에서 Microsporum canis에 의해 발생한 광범위한 두부 독창 1예

안은영,이지범,이승철,원영호 대한의진균학회 2000 대한의진균학회지 Vol.5 No.1

Kerion celsi, a severe inflammatory type of tinea capitis, which occurs chiefly in children between the ages of 4 and 14 years. We report a case of kerion celsi occuring in an elderly woman. She is a 67-year old woman, presented with inflammatory, boggy mass studded with broken hairs, and oozing purulent materials from follicular orifices on the parietal scalp, which had been extending over almost entire scalp for 2 weeks. Kerion celsi caused by M. canis with atypical microscopic findings of the colony on the Sabouraud's dextrose agar was diagnosed by PCR analysis using RAPD method. This case is reported with two interesting facts: Kerion celsi is occuring rarely in old persons; Clinically kerion celsi progressed rapidly after onset in this case. [Kor J Med Mycol 5(1): 31-34]

Kerion celsi caused by Trichophyton rubrum in a 91-year-old woman

( Jun Gyu Song ),( Sang Youl Yun ),( Moo Kyu Suh ),( Gyoung Yim Ha ),( Jong Im Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Kerion celsi is an inflammatory type of tinea capitis. It is present as boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, Kerion celsi caused by T. rubrum is rare. Kerion celsi is ucommon in adult. We report a case of kerion celsi caused by T. rubrum in a 91-year-old woman. She presented with localized tendererythematous plaques with abscess on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud``s dextrose agar and showed typical whitish cottony colonies of T. rubrum. She was treated with 200mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.

A case of kerion celsi caused by Microsporum gypseum in an elderly patient

( Seung Ah Yoo ),( Eun Jung Byun ),( Jae Yeon Ryu ),( Hyun Ji Lee ),( Yeong Ho Kim ),( Ju Hee Han ),( Chul Hwan Bang ),( Young Min Park ),( Jun Young Lee ),( Ji Hyun Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 66-year-old woman presented with tender and pruritic, diffuse, erythematous nodules and pustules with crusts on vertex of the scalp 2 months. The patient had been treated with steroid lotions and antibiotic ointment for 1 month previously, but the lesion was worse. Tinea capitis was diagnosed by Wood’s lamp examination and KOH examination on the lesion. Species identification was performed by observation of morphologic and biochemical characteristics and sequencing of the internal transcribed spacers (ITS), and Microsporum gypseum was confirmed. Treatment with oral itraconazole and topical flutrimazol cream after washing the hair with sertaconazole shampoo for 2 months was effective. Kerion celsi is a type of tinea capitis often caused by the zoophilic dermatophyte species of the genus Microsporum, and almost always seen in children. Kerion celsi is a severe inflammatory or suppurative type of tinea capitis, characterized by a painful, inflamed, crusty mass and often associated with purulent drainage and regional lymphadenopathy. Microsporum gypseum complex is a group of dermatophytes with a worldwide distribution and is a rare cause of dermatomycoses in humans and also rarely infects the scalp. Kerion celsi in the elderly is unusual and may be misdiagnosed as many other disease as dissecting cellulitis or seborrheic dermatitis. Herein, we report a rare case of kerion celsi caused by Microsporum gypseum.

Trichophyton mentagrophytes에 의한 두부 독창 1예

장봉석,조주현,오창근,장호선,권경술 대한의진균학회 2002 대한의진균학회지 Vol.7 No.2

Kerion celsi is an inflammatory type of tinea capitis, which occurs chiefly in children between the ages of 4 and 14 years. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 69 year-old man, who showed a 8×8 ㎝ sized, erythematous boggy mass with pustules and crusts on the right occipital scalp. Cultures from scalp lesion and infected hair on Sabouraud dextrose agar media showed T. mentagrophytes. Histopathologic findings showed inflammatory cell infiltration in entire dermis and many spores around the hair shaft. The skin lesion was successfully treated with terbinafine (250 ㎎/day) for 8 weeks. This case is reported with three interesting facts: Kerion celsi caused by T. mentagrophytes has been rarely reported in Korean literatures; Kerion celsi is occuring in an aged man with decreased cellular immunity after chemotherapy; Kerion celsi caused by T. mentagrophytes responded well to oral terbinafine. [Kor J Med Mycol 7(2); 86-91]

Kerion celsi caused by Trichophyton verrucosum misdiagnosed herpes zoster

( Jun Gyu Song ),( You Bum Song ),( Moo Kyu Suh ),( Gyoung Yim Ha ),( Jong Im Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Kerion celsi is a severe inflammatory type of tinea capitis that presents as an inflammatory, tender boggy mass with broken hairs and hair loss. Often kerion celsi can be misdiagnosed herpes zoster involving cervical or cranial nerve. We report a case of kerion celsi caused by T. verrucosum in a 53-year-old female. The patient presented with localized tender erythematous patches with pustules on the left parietal and occipital scalp for 1 month. She was diagnosed as herpes zoster in other hospital and was treated with antiviral agent. However, the lesion gradually increased in size, and eventually more pustules developed. Chains of chlamydoconidia were observed in KOH mount and slide culture by light microscopy. A fungal culture from tissue of the lesions was grown on Sabouraud``s dextrose agar and showed typical T. verrucosum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. verrucosum strain YY01986998. She was treated with 200mg of oral itraconazole daily for 3 months and short term therapy of low dose of prednisolone. The skin lesions improved 2 months after treatment, and recurrence has not been observed.

노인에서 발생한 Trichophyton rubrum 에 의한 백선종창

윤상열,박민우,서무규,하경임,이종임,최종수 대한의진균학회 2016 대한의진균학회지 Vol.21 No.3

Kerion celsi is a severe inflammatory type of tinea capitis that presents as a boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, kerion celsi caused by T. rubrum is rare. Kerion celsi is uncommon in adult. We report a case of kerion celsi caused by T. rubrum in a 72-year-old woman. She presented with localized tender erythematous plaques with pustules with oozing purulent material on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer region for clinical isolate was identical to that of T. rubrum strain UZ1588_14 (GenBank accession number KP326579.1). She was treated with 200 mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.