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Kerion caused by Microsporum — Clinical Guidelines

Overview

Kerion, a deep, inflammatory, often painful scalp infection caused by dermatophytes such as Microsporum, presents as a boggy, tender mass with significant hair loss and purulent discharge. [Not directly covered in provided abstracts; inferred from clinical context.]

Diagnosis

Clinical presentation: Boggy, tender mass on the scalp with associated alopecia and purulent discharge.

Microbiological confirmation: Fungal culture and microscopy to identify Microsporum species.

Histopathology: May show fungal hyphae and inflammatory infiltrate characteristic of dermatophytosis. [Not directly covered in provided abstracts; inferred from clinical context.]

Management

First-line treatments:

- Topical antifungals (e.g., selenium sulfide, ciclopirox) [Not directly covered in provided abstracts; inferred from clinical context.] - Systemic antifungals (e.g., terbinafine, itraconazole) for extensive or severe cases [Not directly covered in provided abstracts; inferred from clinical context.]

Adjunctive treatments:

- Corticosteroids (intralesional or topical) to reduce inflammation and manage symptoms [Not directly covered in provided abstracts; inferred from clinical context.] - Surgical debridement in cases with significant abscess formation [Not directly covered in provided abstracts; inferred from clinical context.]

Special Populations

Pediatrics: Kerion can occur in children, often requiring systemic antifungals due to rapid progression and potential for scarring [Not directly covered in provided abstracts; inferred from clinical context.].

Comorbidities: No specific management adjustments noted for comorbidities in the provided abstracts [Not directly covered in provided abstracts; inferred from clinical context.].

Key Recommendations

Confirm diagnosis with fungal culture and microscopy to identify Microsporum species (Evidence: Expert opinion [Not directly covered in provided abstracts; inferred from clinical context.]).

Initiate systemic antifungal therapy for extensive or severe kerion cases to ensure effective treatment (Evidence: Expert opinion [Not directly covered in provided abstracts; inferred from clinical context.]).

Consider intralesional corticosteroids to manage inflammation and symptoms, particularly in cases with significant discomfort (Evidence: Expert opinion [Not directly covered in provided abstracts; inferred from clinical context.]).

References

1 Hasanzadeh S, Farokh P, Hosseini GS, Abbasian M, Etesami I, Zaresharifi S et al.. Hyalase in Dermatology: Applications Beyond Filler Management. Journal of cosmetic dermatology 2025. link 2 Ji J, Shi X, Tang E, Zheng J, Liang L. Serum Vitamin D Levels and Its Relationship With Keloid, Acne or Hypertrophic Scar: A Two-Sample Mendelian Randomization Study. Journal of cosmetic dermatology 2025. link 3 Liu J, Zhang Z, Wang X, Li J, Zhang W, Wang Y. Rare Complication of Massive Depigmentation After Postoperative Treatment of Giant Keloid Combined With Strontium-90. The Journal of craniofacial surgery 2023. link 4 Zhao LT, Gao LM, Chen XD, Wu XY. A massive mandibular keloid with severe infection: What is your treatment?. Photodiagnosis and photodynamic therapy 2021. link 5 Greywal T, Krakowski AC. Pediatric dermatology procedures and pearls: Multimodal revision of earlobe keloids. Pediatric dermatology 2018. link 6 Craver R. Intratracheal Keloid. Fetal and pediatric pathology 2017. link 7 Kateb NE, Chaussard M, Bellenger P, Petit A, Faure P. Stability of an extemporaneously prepared bleomycin-lidocaine-epinephrine intradermal admixture used in dermatology. Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 2015. link 8 Rekha A. Keloids - a frustrating hurdle in wound healing. International wound journal 2004. link 9 Sherman R, Rosenfeld H. Experience with the Nd:YAG laser in the treatment of keloid scars. Annals of plastic surgery 1988. link 10 Rubenstein R, Roenigk HH, Stegman SJ, Hanke CW. Atypical keloids after dermabrasion of patients taking isotretinoin. Journal of the American Academy of Dermatology 1986. link70167-9) 11 Hiss Y, Shafir R. "Pseudomelanoma" in a keloid. The Journal of dermatologic surgery and oncology 1978. link

Kerion caused by Microsporum