Dermatofitosi diffusa con kerion

Abstract

Tinea capitis is the most common scalp dermatophytosis and is, along with tinea corporis, one of the major skin mycoses in paediatric age. This condition is usually noninvasive and treatable with oral antifungal therapy combined with topical remedies. The paper reports the case of a 7-year-old immunocompetent boy who developed scalp kerion (an inflammatory complication of tinea capitis) and tinea corporis, despite home antifungal therapy. The purpose of this work is to provide guidance for treating cutaneous fungal infections that are resistant to standard therapies prescribed in outpatient clinics. Due to the lack of response to oral therapy, the patient was hospitalized to perform intravenous therapy. Intravenous fluconazole therapy in combination with oral amoxicillin/clavulanic acid was administered. Culture test for mycetes, performed on skin swab, resulted negative. Due to the progressive improvement of the skin lesions, a switch to oral fluconazole was made after 1 week; after 10 days, antibiotic therapy was discontinued. At the end of 14 total days of antifungal therapy, due to the almost complete resolution of kerion with normalization of inflammatory markers, the patient was discharged. After further 3 weeks of treatment with oral fluconazole, the skin lesions completely resolved. The case suggests that a switch from oral to intravenous therapy may be useful in cases of dermatophytoses resistant to empirical therapy. In these cases, the administration of higher dosages of systemic antifungals than those normally used for skin infections, reaching the dosage normally used for candidiasis and other invasive fungal infections, may be effective. The therapy should be prolonged for several weeks (at least one month) and the early combination with antibiotic therapy is essential in cases of bacterial overinfection.