A young boy presents with a boggy, tender, fluctuant mass on the scalp with broken-off hair and cervical lymphadenopathy. Hairs are easily extracted painlessly. KOH shows endothrix pattern (spores inside hair shaft). The organism and appropriate treatment are:

• A M. canis (ectothrix) — oral itraconazole
• B T. schoenleinii — oral terbinafine
• C Sporothrix schenckii — oral potassium iodide
• D T. violaceum (endothrix) — oral griseofulvin 15–20 mg/kg/day for 6–8 weeks ✓

Explanation

Kerion Celsi is a severe, boggy, suppurative form of tinea capitis resulting from a host hypersensitivity reaction to the dermatophyte, most commonly Trichophyton species causing endothrix infection (T. violaceum, T. tonsurans). Hairs show endothrix spores (arthroconidia filling the hair shaft). KOH shows the characteristic endothrix pattern. Griseofulvin remains first-line for paediatric tinea capitis (and kerion) at 15–20 mg/kg/day for 6–8 weeks in India; oral terbinafine and itraconazole are alternatives. Systemic antifungals are essential as topicals do not penetrate the hair shaft. Oral steroids may reduce inflammation in kerion.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.