An Intractable Kerion Celsi Forming a Scutulum due to <i>Microsporum gypseum</i>

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  • YAGI Nobutake
    Department of Dermatology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
  • YAMAGUCHI Sayaka
    Department of Dermatology, Graduate School of Medicine, University of the Ryukyus
  • SANO Ayako
    Department of Animal Sciences, Faculty of Agriculture, University of the Ryukyus
  • TAKAHASHI Kenzo
    Department of Dermatology, Graduate School of Medicine, University of the Ryukyus

Bibliographic Information

Other Title
  • 経過中に菌甲を呈した <i>Microsporum gypseum</i> による難治性ケルスス禿瘡
  • 症例 経過中に菌甲を呈したMicrosporum gypseumによる難治性ケルスス禿瘡
  • ショウレイ ケイカ チュウ ニ キン コウ オ テイシタ Microsporum gypseum ニ ヨル ナンチセイ ケルスス ハゲソウ

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Abstract

<p>An 83-year-old female had been treated with immunosuppressive agents including glucocorticoid steroids for 20 years due to rheumatoid arthritis. She noticed hair loss and underwent a medical check at a nearby dermatological clinic. Her scalp lesions worsened and erythema with scale appeared on the back of her right hand after the use of a steroid ointment. Direct microscopic examination of individual hair roots and the scale from her scalp and hand showed the presence of fungal elements,and she was diagnosed with kerion celsi and tinea manus. Microsporum gypseum was identified by fungal culture. She started treatment with oral terbinafine at 125 mg/day ; however, her itching and tenderness worsened, and thick and yellowish scutula (so-called favosa) appeared on the scalp. The dose of terbinafine was increased to 250 mg/day, after which her symptoms got better, and she finally healed 5 months later. We thought that the patient may have been refractory to treatment with a standard dose of terbinafine, or even have developed favosa, because she was immunosuppressed due to her treatment for rheumatoid arthritis.</p>

Journal

  • Nishi Nihon Hifuka

    Nishi Nihon Hifuka 79 (3), 260-263, 2017

    Western Division of Japanese Dermatological Association

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