Kerion celsi represents the most severe inflammatory manifestation of tinea capitis, which is the dermatophyte fungal infection of the scalp. Unlike the non-inflammatory forms of scalp ringworm characterized by subtle scaling or broken hairs, kerion is distinguished by a profound host immune response that results in a palpable, tumor-like mass. The intensity of this inflammation, if left untreated, carries a considerable risk of causing permanent destruction of the hair follicles and subsequent irreversible scarring alopecia. Therefore, its identification requires high clinical suspicion, as its severity distinguishes it from typical mild tinea infections.
Who is Most Susceptible to Kerion?
While tinea capitis affects various populations, kerion celsi predominantly affects prepubescent children, specifically those between the ages of three and seven. This age-related susceptibility is attributed to the physiological composition of the prepubertal scalp, which produces less fungistatic sebum compared to the adult scalp, thereby offering reduced natural protection against fungal invasion.
Although less common, kerion can present in adolescents and adults, often when associated with compromised immunity or exposure to a highly pathogenic fungal species. Zoophilic species, such as Microsporum canis from household pets like kittens and puppies, or Trichophyton verrucosum from cattle, are the most frequent causes of kerion in developed regions. These zoophilic strains tend to elicit a more vigorous, hypersensitive inflammatory reaction in the human host compared to anthropophilic strains like Trichophyton tonsurans.
What are the Clinical Signs and Symptoms of Kerion?
Kerion presents with unmistakable and distressing clinical features, typically manifesting as a solitary, painful, raised, and highly inflamed plaque on the scalp. This lesion feels characteristically soft, spongy, or boggy upon palpation due to the deep accumulation of pus and inflammatory fluid. The surface of the mass is often dotted with multiple follicular pustules that may weep a seropurulent discharge.
Hairs within the affected area are typically loose, easily extracted, and spontaneously fall out, leading to a noticeable area of temporary alopecia. The surface may also be covered by thick, yellowish, purulent crusts. Beyond the local scalp lesion, the deep inflammatory process commonly triggers regional lymphadenopathy, with tender, swollen lymph nodes often palpable in the posterior cervical and posterior auricular regions. Furthermore, systemic signs are common, particularly in children, who may exhibit fever, general malaise, or irritability.
Can Dermatoscope Detect Kerion?
The dermatoscope is an imaging tool used to observe the surface and superficial subsurface structures of the skin. It is widely applied in dermatology, particularly as an auxiliary tool in the diagnosis of skin cancer, pigmented disorders, hair diseases, and infectious skin diseases. Therefore, the dermatoscope can be used to observe Kerion celsi. It provides a magnified and non-invasive view of the hair, follicular openings, and surrounding skin structures, helping clinicians identify features that are imperceptible to the naked eye.
Which Dermatoscope is Most Suitable for Examining Kerion?
For observing Kerion celsi, the IBOOLO DE-4100 PRO is exceptionally suitable. The DE-4100 PRO features an ultra-large field of view and 10X magnification, allowing for extremely clear observation with the naked eye.
The DE-4100 PRO boasts four distinct lighting modes: Polarized Light, Amber Polarized Light, Non-polarized Light, and UV Light. The Polarized Light mode eliminates glare, allowing the user to clearly visualize conditions in the dermal layer of the skin. The Amber Polarized Light mode is useful for better observing the morphology of lesion borders and is particularly suitable for polarized examination of individuals with darker skin tones. Non-polarized Light is primarily used to view the texture and fine details of the skin surface, focusing on the epidermal layer. The 365nm UV Light can be used to detect fungal lesions, such as those seen in Kerion, as well as pigmentary disorders. Specifically, some cases of Kerion, such as those caused by Microsporum infection, can be observed to fluoresce vividly under 365 nm UV light, typically presenting as a bright blue-green fluorescence.
How is Kerion Treated and Managed?
Management of kerion differs from non-inflammatory tinea capitis in that systemic antifungal therapy is absolutely required; topical therapy alone is inadequate. The choice of drug depends on patient age, infecting organism, severity, and local guidelines. Common systemic options include:
Griseofulvin: traditionally the standard therapy for tinea capitis and kerion, especially in children.
Terbinafine: increasingly used owing to shorter duration of therapy and favourable profile in many settings.
Itraconazole and Fluconazole: alternative options, especially in specific fungal species or patient scenarios.
Due to the significant inflammatory response, some clinical practices may temporarily combine oral corticosteroids to reduce inflammation and lower the risk of scarring alopecia, though their use varies by region and guideline. Adjuvant measures include selenium-containing solutions (such as selenium sulphide shampoo), which help reduce fungal spore transmission. The earlier formal treatment commences, the more effective it proves and the lower the risk of scarring alopecia. Misdiagnosis or delayed intervention (such as treating it as a bacterial infection) markedly exacerbates the outcome.