Letter to the Editors
Kerion Celsi caused by Trichophyton tonsurans with dermatophytid reaction
Kerion de Celso producido por Trichophyton tonsurans con reacción dermatofítide
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Each line represents the growth curve over time of a sole <span class="elsevierStyleItalic">Candida</span> isolate, grown either in amniotic fluid or in Sabouraud broth (control). Each symbol represents the log10 CFU value at different time points. <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001; Student's <span class="elsevierStyleItalic">t</span> test.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sofia Maraki, Dimitra Stafylaki, Spyridon A. Karageorgos, Filippos Koutroumpakis, George Hamilos, Antonis Makrigiannakis, George Samonis" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Sofia" "apellidos" => "Maraki" ] 1 => array:2 [ "nombre" => "Dimitra" "apellidos" => "Stafylaki" ] 2 => array:2 [ "nombre" => "Spyridon A." "apellidos" => "Karageorgos" ] 3 => array:2 [ "nombre" => "Filippos" "apellidos" => "Koutroumpakis" ] 4 => array:2 [ "nombre" => "George" "apellidos" => "Hamilos" ] 5 => array:2 [ "nombre" => "Antonis" "apellidos" => "Makrigiannakis" ] 6 => array:2 [ "nombre" => "George" "apellidos" => "Samonis" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014062100019X?idApp=UINPBA00004N" "url" => "/11301406/0000003800000003/v2_202109250626/S113014062100019X/v2_202109250626/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editors</span>" "titulo" => "Kerion Celsi caused by <span class="elsevierStyleItalic">Trichophyton tonsurans</span> with dermatophytid reaction" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editors</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "151" "paginaFinal" => "152" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elisabeth Gómez-Moyano, Ana María Fernández-Sánchez, Vicente Crespo-Erchiga, Leandro Martínez-Pilar" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elisabeth" "apellidos" => "Gómez-Moyano" "email" => array:2 [ 0 => "eligm80@hotmail.com" 1 => "elisabeth.gomez.moyano@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana María" "apellidos" => "Fernández-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Vicente" "apellidos" => "Crespo-Erchiga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Leandro" "apellidos" => "Martínez-Pilar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatology Department, Hospital Regional Universitario de Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Microbiology Department, Hospital Regional Universitario de Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Kerion de Celso producido por <span class="elsevierStyleItalic">Trichophyton tonsurans</span> con reacción dermatofítide" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1673 "Ancho" => 2534 "Tamanyo" => 604613 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Boggy plaque with purulent drainage and alopecia surrounding the lesion. (b) Dermoscopy: broken hairs, black dots and pustules.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We herein set out the case of a 6 year-old boy who presented with a two week history of pruritus and pain on the scalp, and purulent drainage. His medical history was unremarkable and any previous contact with pets was not reported. Through physical examination we observed a crusty carbuncle-like boggy plaque, 11<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm, with clear demarcation of the borders and overlying erythema and alopecia surrounding the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). Cervical and suboccipital-ipsilateral lymphadenopathies were revealed. Under dermoscopy, broken hairs, black dots and pustules were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). Potassium hydroxide preparation of skin scrapings and hair showed multiple hyaline septate hyphae and endothrix invasion of the hair, with arthroconidia within the hair shaft and the cuticle layer remaining intact (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Complete blood cell count, as well as liver and renal function tests, were within normal ranges, with normal values for CD4 and CD8 lymphocytes count and immunoglobulins, and increased C-reactive protein. Serology for HIV was negative. Sulfur yellow colonies with granular surface and red reverse grew on Sabouraud glucose agar culture (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a). Numerous microconidia were seen microscopically, with varying shape (tear-shaped, pyriform, club-shaped or swollen) and size (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>b). <span class="elsevierStyleItalic">Trichophyton tonsurans</span> was identified by morphologic features and by mass spectrometry (MALDI-TOF MS biotyper, Bruker). The patient was treated with selenium sulphide shampoo and oral terbinafine (62.5<span class="elsevierStyleHsp" style=""></span>mg/day) based on patient's weight (19<span class="elsevierStyleHsp" style=""></span>kg). One week after the systemic antifungal therapy was started, the patient presented with acute inflammation on the scalp lesion and eczematous lesions in the retroauricular area, as well as on the neck, as a dermatophytid reaction (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). However, the treatment was maintained for 8 weeks, leading to complete healing. Systemic corticosteroids were not added because the dermatophytid reaction was not widespread.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Kerion clinical form in <span class="elsevierStyleItalic">tinea</span> represents a delayed hypersensitivity reaction to the causative dermatophyte. Children with kerion are more likely to develop marked regional lymphadenopathy and produce id reactions. If early treatment is not started, kerion can cause scarring alopecia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The use of corticosteroids remains unclear. Some authors recommend them to minimize the risk of scarring alopecia. However no significant difference has been found between griseofulvin alone and griseofulvin plus oral corticosteroids in a comparative trial.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Dermatophytid reactions may occur before or after beginning a systemic antifungal therapy. Systemic corticosteroids can be added when the dermatophytid reaction is extremely widespread.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is important to distinguish a dermatophytid reaction from a drug reaction.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">None of the authors have a conflict of interest nor have received funding resources regarding the case presented.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1673 "Ancho" => 2534 "Tamanyo" => 604613 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Boggy plaque with purulent drainage and alopecia surrounding the lesion. (b) Dermoscopy: broken hairs, black dots and pustules.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 891 "Ancho" => 1583 "Tamanyo" => 175008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Endothrix invasion of the hair.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2393 "Ancho" => 1586 "Tamanyo" => 444611 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a) <span class="elsevierStyleItalic">Trichophyton tonsurans</span> isolated in Sabouraud glucose agar. (b) Microconidia with different sizes or shape: tear-shaped, pyriform, club-shaped or swollen.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1808 "Ancho" => 1583 "Tamanyo" => 343906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Eczematous patches, along with an acute inflammation (Kerion Celsi), on the neck and ears.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are dermatophytid reactions in patients with kerion celsi much more common than previously thought? A prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Topaloğlu Demir" 1 => "A.S. Karadag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12515" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2015" "volumen" => "32" "paginaInicial" => "635" "paginaFinal" => "640" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25677472" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe kerion with dermatophytid reaction presenting with diffuse erythema and pustules" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Z.-H. Liu" 1 => "H. Shen" 2 => "A.-E. Xu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1439-0507.2010.01973.x" "Revista" => array:6 [ "tituloSerie" => "Mycoses" "fecha" => "2011" "volumen" => "54" "paginaInicial" => "e650" "paginaFinal" => "e652" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21605182" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized, comparative trial of treatment of kerion celsi with griseofulvin plus oral prednisolone vs. griseofulvin alone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Hussain" 1 => "F. Muzaffar" 2 => "T. Rashid" 3 => "J. Ahmad" 4 => "M. Jahangir" 5 => "T.S. Haroon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Mycol" "fecha" => "1999" "volumen" => "37" "paginaInicial" => "97" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10361264" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000003800000003/v2_202109250626/S1130140621000024/v2_202109250626/en/main.assets" "Apartado" => array:4 [ "identificador" => "8081" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Carta a los Directores" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000003800000003/v2_202109250626/S1130140621000024/v2_202109250626/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140621000024?idApp=UINPBA00004N" ]
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