Late Diagnosis of Pediatric Kerion Celsi: a case report

• DOI: https://doi.org/10.22533/at.ed.0159642620036

• Palavras-chave: Tinea capitis. Dermoscopy. Inflammatory alopecia.

• Keywords: Tinea capitis. Dermoscopy. Inflammatory alopecia.

• Abstract: Inflammatory tinea capitis (Kerion celsi) is a severe form of dermatophytosis of the scalp, often misdiagnosed as bacterial infection due to suppuration and thick crusting. This case report describes an 8-year-old boy from Duque de Caxias, Rio de Janeiro, Brazil, presenting with an approximately one-year history of rounded alopecic patches characterized by erythema, edema, scaling, and pain, with recent worsening marked by exudation and honey-colored crusts consistent with secondary bacterial infection. The patient was initially evaluated during a practical clinical activity at a primary health care unit and received treatment for impetiginization with azithromycin (10 mg/kg/day for 5 days) and prednisolone (1 mg/kg/day for 5 days), resulting in significant improvement in suppuration and pain. Upon reevaluation at the teaching outpatient clinic, once the lesions were cleaner, dermoscopy was performed and revealed zigzag hairs and broken hairs, findings consistent with tinea capitis. Systemic terbinafine was initiated at a dose of half a 250 mg tablet daily for 30 days, combined with selenium sulfide 2% shampoo three times per week. Biweekly follow-up demonstrated favorable progression, with reduction of inflammation and progressive clinical improvement. The patient's mother reported social impairment and embarrassment related to the child's appearance prior to treatment, with improvement in self-esteem after therapy initiation. This case highlights that suppurative presentations may delay the diagnosis of inflammatory tinea capitis and underscores the value of dermoscopy in settings where immediate access to mycological culture is unavailable. Early recognition and appropriate management are essential to reduce the risk of sequelae, particularly when prolonged disease duration complicates the initial diagnosis.