<p>Sir,</p> <p>In recent years due to improvements in the health status of the population, the incidence of some diseases is reduced and medical practitioners and medical students rarely meet such cases Therefore, in practice, the patients may be misdiagnosed and don′t receive proper treatment and almost the wrong or late management may cause irreversible sequels.</p> <p>We faced with an 11-year-old boy in Razi′s Hospital (Qa′em Shahr City-North of Iran) <xref ref-type="fig" rid="F1">Figure 1</xref>who he had a primary presenting scaly and pruritic plaque on his scalp since 2 weeks before that progressively changed to an ulcerated crusted, exudative, and painful erythematous plaque with palpable indurations. Otherwise, he was quite healthy without any underlying immunity disorder. The patient had contact with soil. He had received oral antibiotics (full dose of cephalexin and cloxacillin), without any improvement, our impression was kerion. In direct smear with KOH and endothrix hyphae within hair shaft was seen but because of surface contamination and saprophytes growth in culture laboratory could not report type of fungous. He was treated with oral terbinafine 125 mg/day for 4 weeks and completely cured <xref ref-type="fig" rid="F2">Figure 2</xref>. Not any other drugs such as corticosteroid, antibiotics or anti histamines used. Kerion is a hypersensitivity reaction due to dermatophyte infection of the scalp (scalp ring worm) that characterized by an exudative painful mass lesion. Etiology of disease is a zoophilic fungi that species varies from geographic region. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>Boys less than 15 years old are more susceptible for this disease and in older age it is seen mostly in immune diffident patients. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>It may induce the scaring alopecia if untreated. <fig id="F1"> <label>Figure 1</label> <caption> <p>Before treatment</p> </caption> <alt-text>Figure 1</alt-text> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="JResMedSci_2013_18_11_1014_124794_u1.tif" /> </fig> <fig id="F2"> <label>Figure 2</label> <caption> <p>Figures 2: After treatment</p> </caption> <alt-text>Figure 2</alt-text> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="JResMedSci_2013_18_11_1014_124794_u2.tif" /> </fig></p> <p>Although recently in modern world, kerion is infrequently seen, tinea capitis as a world-wide health problem needs careful clinical consideration, evaluation, and regional epidemiologic studies. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Tinea capitis kerion in any scalp lesion with crusted and infected lesions with lymphadenopathy are in the differential diagnosis list and physician should be suspicious to this disease and with clinical and mycological diagnosis treatment begin to prevent scarring alopecia. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Although griseofulvin is drug of choice, but Terbinafine because of shorter course of treatment and lesser side-effects than griseofulvin and fluconazole is better recommended. <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup></p> <p>Neglected infectious diseases need more attention. Inadvertency and incuriosity to these types of disease may cause some irreversible problems for patients.</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Health Protection</surname> <given-names>Agency</given-names> </name> </person-group> <article-title>Tinea capitis in the United Kingdom: A report on its diagnosis, management and prevention</article-title> <source>London: Health Protection Agency,</source> <year>7</year> <volume></volume> <fpage></fpage> <comment>Tinea capitis in the United Kingdom: A report on its diagnosis, management and prevention London: Health Protection Agency, 2007</comment> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Yazdanfar</surname> <given-names>A</given-names> </name> </person-group> <article-title>Tinea capitis in primary school children in Hamedan (West of Iran)</article-title> <source>Int J Med Med Sci</source> <year>2010</year> <volume>2</volume> <fpage>29</fpage> <lpage>33</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Vena</surname> <given-names>GA</given-names> </name> <name> <surname>Chieco</surname> <given-names>P</given-names> </name> <name> <surname>Posa</surname> <given-names>F</given-names> </name> <name> <surname>Garofalo</surname> <given-names>A</given-names> </name> <name> <surname>Bosco</surname> <given-names>A</given-names> </name> <name> <surname>Cassano</surname> <given-names>N</given-names> </name> </person-group> <article-title>Epidemiology of dermatophytoses: Retrospective analysis from 2005 to 2010 and comparison with previous data from 1975</article-title> <source>New Microbiol</source> <year>2012</year> <volume>35</volume> <fpage>207</fpage> <lpage>13</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Grover</surname> <given-names>C</given-names> </name> <name> <surname>Arora</surname> <given-names>P</given-names> </name> <name> <surname>Manchanda</surname> <given-names>V</given-names> </name> </person-group> <article-title>Comparative evaluation of griseofulvin, terbinafine and fluconazole in the treatment of tinea capitis</article-title> <source>Int J Dermatol</source> <year>2012</year> <volume>51</volume> <fpage>455</fpage> <lpage>8</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Higgins</surname> <given-names>EM</given-names> </name> <name> <surname>Fuller</surname> <given-names>LC</given-names> </name> <name> <surname>Smith</surname> <given-names>CH</given-names> </name> </person-group> <article-title>Guidelines for the management of tinea capitis.British Association of Dermatologists</article-title> <source>Br J Dermatol</source> <year>2000</year> <volume>143</volume> <fpage>53</fpage> <lpage>8</lpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Kakourou</surname> <given-names>T</given-names> </name> <name> <surname>Uksal</surname> <given-names>U</given-names> </name> <name> <surname>European Society for Pediatric</surname> <given-names>Dermatology</given-names> </name> </person-group> <article-title>Guidelines for the management of tinea capitis in children</article-title> <source>Pediatr Dermatol</source> <year>2010</year> <volume>27</volume> <fpage>226</fpage> <lpage>8</lpage> </nlm-citation> </ref> <ref id="ref7"> <label>7</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>

JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

India

JRMS-18-1014

24520238

Letter to Editor

Kerion, report of a missed case

Babamahmoodi

Farhang

Babamahmoodi

Abdolreza

Davoodi

Lotfollah

Antimicrobial Drug Resistant Research Centre, Mazandaran University of Medical Sciences, Sari, Iran Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Antimicrobial Drug Resistant Research Centre, Mazandaran University of Medical Sciences, Sari, Iran

Address for correspondence:Abdolreza Babamahmoodi, Vanak sq-Research Deputy, Baqiyatallah University of Medical Sciences, Tehran, Iran srm@dr.com

November 2013

18 11 1014 1015

2013

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>In recent years due to improvements in the health status of the population, the incidence of some diseases is reduced and medical practitioners and medical students rarely meet such cases Therefore, in practice, the patients may be misdiagnosed and don′t receive proper treatment and almost the wrong or late management may cause irreversible sequels.</p> <p>We faced with an 11-year-old boy in Razi′s Hospital (Qa′em Shahr City-North of Iran) <xref ref-type="fig" rid="F1">Figure 1</xref>who he had a primary presenting scaly and pruritic plaque on his scalp since 2 weeks before that progressively changed to an ulcerated crusted, exudative, and painful erythematous plaque with palpable indurations. Otherwise, he was quite healthy without any underlying immunity disorder. The patient had contact with soil. He had received oral antibiotics (full dose of cephalexin and cloxacillin), without any improvement, our impression was kerion. In direct smear with KOH and endothrix hyphae within hair shaft was seen but because of surface contamination and saprophytes growth in culture laboratory could not report type of fungous. He was treated with oral terbinafine 125 mg/day for 4 weeks and completely cured <xref ref-type="fig" rid="F2">Figure 2</xref>. Not any other drugs such as corticosteroid, antibiotics or anti histamines used. Kerion is a hypersensitivity reaction due to dermatophyte infection of the scalp (scalp ring worm) that characterized by an exudative painful mass lesion. Etiology of disease is a zoophilic fungi that species varies from geographic region. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>Boys less than 15 years old are more susceptible for this disease and in older age it is seen mostly in immune diffident patients. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>It may induce the scaring alopecia if untreated. <fig id="F1"> <label>Figure 1</label> <caption> <p>Before treatment</p> </caption> <alt-text>Figure 1</alt-text> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="JResMedSci_2013_18_11_1014_124794_u1.tif" /> </fig> <fig id="F2"> <label>Figure 2</label> <caption> <p>Figures 2: After treatment</p> </caption> <alt-text>Figure 2</alt-text> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="JResMedSci_2013_18_11_1014_124794_u2.tif" /> </fig></p> <p>Although recently in modern world, kerion is infrequently seen, tinea capitis as a world-wide health problem needs careful clinical consideration, evaluation, and regional epidemiologic studies. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Tinea capitis kerion in any scalp lesion with crusted and infected lesions with lymphadenopathy are in the differential diagnosis list and physician should be suspicious to this disease and with clinical and mycological diagnosis treatment begin to prevent scarring alopecia. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Although griseofulvin is drug of choice, but Terbinafine because of shorter course of treatment and lesser side-effects than griseofulvin and fluconazole is better recommended. <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup></p> <p>Neglected infectious diseases need more attention. Inadvertency and incuriosity to these types of disease may cause some irreversible problems for patients.</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Health Protection</surname> <given-names>Agency</given-names> </name> </person-group> <article-title>Tinea capitis in the United Kingdom: A report on its diagnosis, management and prevention</article-title> <source>London: Health Protection Agency,</source> <year>7</year> <volume></volume> <fpage></fpage> <comment>Tinea capitis in the United Kingdom: A report on its diagnosis, management and prevention London: Health Protection Agency, 2007</comment> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Yazdanfar</surname> <given-names>A</given-names> </name> </person-group> <article-title>Tinea capitis in primary school children in Hamedan (West of Iran)</article-title> <source>Int J Med Med Sci</source> <year>2010</year> <volume>2</volume> <fpage>29</fpage> <lpage>33</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Vena</surname> <given-names>GA</given-names> </name> <name> <surname>Chieco</surname> <given-names>P</given-names> </name> <name> <surname>Posa</surname> <given-names>F</given-names> </name> <name> <surname>Garofalo</surname> <given-names>A</given-names> </name> <name> <surname>Bosco</surname> <given-names>A</given-names> </name> <name> <surname>Cassano</surname> <given-names>N</given-names> </name> </person-group> <article-title>Epidemiology of dermatophytoses: Retrospective analysis from 2005 to 2010 and comparison with previous data from 1975</article-title> <source>New Microbiol</source> <year>2012</year> <volume>35</volume> <fpage>207</fpage> <lpage>13</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Grover</surname> <given-names>C</given-names> </name> <name> <surname>Arora</surname> <given-names>P</given-names> </name> <name> <surname>Manchanda</surname> <given-names>V</given-names> </name> </person-group> <article-title>Comparative evaluation of griseofulvin, terbinafine and fluconazole in the treatment of tinea capitis</article-title> <source>Int J Dermatol</source> <year>2012</year> <volume>51</volume> <fpage>455</fpage> <lpage>8</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Higgins</surname> <given-names>EM</given-names> </name> <name> <surname>Fuller</surname> <given-names>LC</given-names> </name> <name> <surname>Smith</surname> <given-names>CH</given-names> </name> </person-group> <article-title>Guidelines for the management of tinea capitis.British Association of Dermatologists</article-title> <source>Br J Dermatol</source> <year>2000</year> <volume>143</volume> <fpage>53</fpage> <lpage>8</lpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Kakourou</surname> <given-names>T</given-names> </name> <name> <surname>Uksal</surname> <given-names>U</given-names> </name> <name> <surname>European Society for Pediatric</surname> <given-names>Dermatology</given-names> </name> </person-group> <article-title>Guidelines for the management of tinea capitis in children</article-title> <source>Pediatr Dermatol</source> <year>2010</year> <volume>27</volume> <fpage>226</fpage> <lpage>8</lpage> </nlm-citation> </ref> <ref id="ref7"> <label>7</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>