A Peculiar Scalp Lesion

Background: Tinea is a fungal infection and it is an increasing problem worldwide. Kerion is a severe manifestation of tinea capitis developing from an intense immune response to the infection, which is less common than the non-inflammatory variants. It can often mimic other conditions, leading to inaccurate diagnosis and delay in treatment with scarring alopecia.

Objective: Our goal is to report a case of atypical presentation of tinea capitis and highlight the importance of a careful clinical history and examination and timely diagnosis.

Methods: We analyzed the atypical presentation of a tinea capitis scalp infection and reviewed the literature.

Results: A three-year-old girl presented with a painful, soft plaque in the scalp, 3 cm of larger diameter, with thick crusting, pustules, dark spots, broken hair strands and some drainage areas, evolving for two weeks. She had no other skin lesions nor fever. There had been no trauma, contact with animals nor contacts with similar lesions. After inspection of the lesion, our hypothesis was a kerion. Empirical treatment with oral fluconazole and topic cetoconazol was begun. There were not any lasting lesions nor scarring, after four weeks of treatment.

Conclusion: Kerion is often misdiagnosed. Our choice of antibiotic was fluconazole and cetoconazol, as griseofulvin is not available in our country and terbinafine is not available as oral solution. Timely diagnosis and treatment led to recovery without scarring or residual alopecia.