Erythema Nodosum Associated with Kerion: A Case Series and Narrative Review of the Literature

Kerion is a form of inflammatory tinea capitis, a fungal infection caused by various zoophilic, geophilic, and anthropophilic pathogens. Erythema nodosum (EN), a form of septal panniculitis, can be considered a dermatophyte id reaction that occurs outside the primary site of dermatophyte infection....

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Main Authors: Teerapong Rattananukrom, Isaías Uh-Sánchez, Carlos Atoche-Dieguez, Nixma Eljure, Carlos Garcia-Rementeria, Roberto Arenas
Format: Article
Language:English
Published: MDPI AG 2025-01-01
Series:Journal of Fungi
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Online Access:https://www.mdpi.com/2309-608X/11/2/103
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Summary:Kerion is a form of inflammatory tinea capitis, a fungal infection caused by various zoophilic, geophilic, and anthropophilic pathogens. Erythema nodosum (EN), a form of septal panniculitis, can be considered a dermatophyte id reaction that occurs outside the primary site of dermatophyte infection. The association between EN and kerion is rarely reported, with most cases following <i>Trichophyton mentagrophytes</i> scalp infections. Here, we describe three cases of EN associated with kerion caused by <i>T. mentagrophytes</i>, successfully treated with itraconazole or griseofulvin plus prednisone. Additionally, we conducted a narrative review of the literature, identifying 23 reported cases of EN associated with kerion on PubMed. The most commonly reported fungus was <i>T. mentagrophytes</i> (78.25%). In 52.17% of cases, patients developed EN after initiating antifungal treatment, with a mean onset time of 11.58 days (SD 7.3). Griseofulvin remains a mainstay treatment. The mean time for EN resolution was 8.31 days (SD 4.15), and the median duration of treatment for kerion leading to a complete response was 6 weeks (IQR 6–8). Scarring alopecia is a common sequela following kerion, and the use of corticosteroids has been recommended as adjunct therapy to minimize the risk of scarring.
ISSN:2309-608X