Kerion in an elderly woman

L Kumarh, D Dogra, U Banerjee, N Khanna

 Department of Dermatology and Venereology and Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India

Correspondence Address:
N Khanna
Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029
India

Introduction

Tinea capitis is uncommonly seen in healthy adults and when seen has been reported move frequently in women. We here report a 66-year-old woman presenting with kerion of the scalp.

Case Report

A 60-year-old lady presented to us with an 8-month history of multiple, itchy tender erythematous plaques with loss of hair present on the occipital area of the scalp extending down up to the nape of the neck. She had been treated with various systemic antibiotics and topical conticosteroids but there was no response.

On examination, there were multiple, well defined erythematous plaques extending from the occipital region down to the posterior hair line. These were non-indurated, studded with papules and pustules, mildly tender and showed scaling. Alopecia was seen in and around the plaques. The few hairs which were present were dull, matted and easily pluckable. There was no regional lymphadenopathy. There was no evidence of any fungal infection in any other part of the body. There was no history of having taken any immunosuppressive drugs and no other family member was suffering from a similar disease.

A KOH preparation made from the lesion showed fungal hyphae and the culture for bacterial growth showed growth of Staphylococcus. Fungal culture grew Trichophyton violaceum. She was given griseofulvin 500mg daily, for 6 weeks and the lesion showed marked improvement along with regrowth of some hair.

Discussion

Though a frequent problem in children, tinea capitis is rare in adults and when present a striking female preponderance has been noticed and this remains unexplained.[2] In the first report of tinea capitis in adults Pipkin showed that only 4.9% of tinea capitis occurred in adults. The most frequently isolated organism in adults is Trichophyton tonurans, and endothrix organism belonging to anthropophilic group of dermatophytes. However, in children, T.violaceum is the most frequently isolated organism from tinea capitis in India. In our patient T.violaceum was isolated; this usually causes black dot type of tinea capitis, though occasionally the lesion may be inflammatory. The susceptibility of children to dermatophytes is believed to result from the absence of the funguistatic activity of sebum prior to puberty. It is possible that the relatively low sebum secretion in elderly females may have been a predisposing factor in our case.[5]

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