Querión de Celso: a propósito de un caso

Divulgamos el caso de Queiron de Celso del cuero cabelludo en una niña de 6 años, procedente de área urbana con antecedente patológico de tiña capitis. La tiña de la cabeza, tinea capitis o dermatofitosis es una infección fúngica causada por hongos, denominados «dermatofitos». El querión es una manifestación grave de tinea capitis que resulta de una intensa respuesta inmune a la infección y caracteriza por el desarrollo de una placa inflamatoria con pústulas, costras gruesas y/o drenaje.

We report the case of Queiron de Celso of the scalp in a 6-year-old girl from an urban area with a pathologic history of tinea capitis. Tinea capitis or dermatophytosis is a fungal infection caused by fungi called "dermatophytes". Kerion is a severe manifestation of tinea capitis resulting from an intense immune response to infection and characterized by the development of an inflammatory plaque with pustules, thick crusts and/or drainage.

Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín / Tinea capitis outbreak and other superficial mycosis in an urban community of Medellín

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico' lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Materials and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion.Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Brote de tinea capitis tricofítica en un grupo de niños escolares en un área rural del departamento del Cauca, Colombia / An outbreak of trichophytic tinea capitis in a group of schoolchildren in a rural area of the department of Cauca, Colombia

Introducción. La tiña de la cabeza es una micosis que se presenta en el tejido queratinizado, afecta al cuero cabelludo y puede causar alopecia, prurito y descamación. Este tipo de micosis es más frecuente en niños de edad escolar, por lo que puede desencadenar un problema de salud pública. En Colombia, los principales agentes etiológicos reportados son los dermatofitos zoofílicos. Objetivo. En el presente estudio se buscó caracterizar un brote de tinea capitis en 32 niños de un colegio de la zona rural del departamento del Cauca. Materiales y métodos. Se llevó a cabo una investigación epidemiológica de campo en la que se aplicó una encuesta estructurada para caracterizar aspectos sociodemográficos y factores predisponentes para su ocurrencia. Se recolectaron muestras de escamas de cuero cabelludo y cabellos afectados para estudios micológicos. Finalmente, por medio de la Secretaría Departamental del Cauca y del hospital local, se manejó el brote de tinea capitis y se hicieron recomendaciones a los niños, los padres de familia y la población en general para prevenir estas micosis. Este estudio contó con el consentimiento informado verbal por parte de los padres de familia y los niños. Resultados. El agente etiológico aislado en el 63 % de las muestras recolectadas fue Trichophyton tonsurans y el principal factor predisponente para esta micosis fue compartir máquinas rasuradoras (87,5 %). El agente etiológico de este brote de tinea capitis no inflamatoria fue un dermatofito antropofílico. Conclusión. Idealmente, se deben practicar los estudios micológicos con el fin de establecer el agente etiológico y, así, plantear las terapéuticas y recomendaciones según las guías de manejo. Además, se debe realizar un trabajo multidisciplinario para el control del brote y la educación de la población respecto a esta micosis.

Introduction. Tinea capitis is a mycosis of keratinized tissue, which affects the scalp and may cause alopecia, pruritus, and desquamation. This type of mycosis is more frequent in school-age children, and it may represent a public health problem; the main etiological agents reported for Colombia are zoophilic dermatophytes. Objective. To characterize an outbreak of Tinea capitis in 32 children from a rural school in the department of Cauca. Materials and methods. We conducted an epidemiological field study using a structured survey to characterize sociodemographic aspects and predisposing factors for this mycosis. We collected samples of affected scalp scales and hair for mycological studies. The children and the general population received recommendations, about these mycoses' prevention, from Cauca's health authorities and the local hospital. The parents verbally approved the informed consent. Results. The etiological agent isolated in 63% of the collected samples was Trichophyton tonsurans, an anthropophilic dermatophyte, and the main predisposing factor was sharing razors (87.5%). Conclusions. Ideally, mycological studies define the etiological agent to propose therapeutics and recommendations in agreement with management guidelines. Implementation of multidisciplinary measures to control the outbreak and educate the population is required.

Querión Celso, dermatofitosis del cuero cabelludo infantil / Kerion Celsi, dermatophytosis of the scalp in young boy

Resumen Querión Celso es una micosis ocasionada por hongos dermatofitos que daña el cuero cabelludo principalmente a niños y en raras ocasiones a adultos. La forma de infección para los humanos proviene de los animales y del suelo y se relaciona con mala higiene personal, hacinamiento en las viviendas, condiciones de subdesarrollo y pobreza. Se presenta un caso de un niño de 9 años con una úlcera de 7 cm de diámetro en el cuero cabelludo y en forma de placa circular que presentaba material purulento, pelo quebradizo y un área alopécica. Al inicio, se abordó de manera terapéutica como una infección bacteriana; posteriormente, se solicitó estudio micológico que evidenció una coinfección por el microorganismo Microsporum gypseum. Se le confirmó el diagnóstico de tiña capitis con afección inflamatoria y se le prescribió griseofulvina, lo que resultó en una curación completa.

Abstract Kerion Celsi is a mycosis caused by dermatophyte fungi that mostly affects children and rarely adults, causing damage to the scalp. The form of infection for humans comes from animals and the soil. The infection is related to poor personal hygiene, overcrowded homes, underdeveloped conditions, and poverty. A case of a 9-year-old boy with a 7cm diameter ulcer on the scalp and in the form of a circular plaque that presented purulent material, brittle hair and an alopecic area is presented. Initially it was therapeutically addressed as a bacterial infection, a mycological study was requested, which showed coinfection by the microorganism Microsporum gypseum, the diagnosis of tinea capitis with inflammatory condition was confirmed, and Griseofulvin was prescribed, resulting in complete cure.

Clinical types and fungal pathogens of children′s tinea capitis analysis of 542 cases in a tertiary first-class hospital of Wuhan / 中国热带医学

@#Abstract: Objective To investigate the clinical types of children's tinea capitis and the distribution of fungal pathogens in Wuhan from 2011 to 2020, and to provide scientific basis for the prevention, diagnosis and treatment of children's tinea capitis. Methods Laboratory data of children with tinea capitis in outpatient and inpatient department of dermatology in Wuhan No.1 Hospital from January 2011 to December 2020 were collected. A total of 542 cases of pediatric tinea capitis were included, with 239 male cases and 303 female cases. Microscopic examination of fungi and culture identification were performed on the affected skin lesions of the children. Chi-square test was used to analyze the differences in pathogen spectrum of children with different age groups and clinical type. Results Among the pediatric tinea capitis patients, the age group with the highest prevalence was preschool children（3 to <7 years old), accounting for 48.52%（263/542). The top three pathogenic fungi were Trichophytes violaceum（49.26%, 267/542), Microsporum canis（31.55%, 171/542) and Trichophyton mentagrophytes （9.96%, 54/542). Trichophyton violaceum was the main pathogen in all ages, followed by Microsporum canis. The infection rate of Microsporum canis in children over 7 years old was lower than that in children under 7 years old, and the infection rate of Trichophyton rubrum in infants was higher than that in other ages. The distribution of Trichophytes violaceum, Trichophyton mentagrophytes, Nannizzia gypseum and Microsporum ferrugineum was uniform in all age groups. Trichophytes violaceum and Trichophyton tousurans mainly caused black-dot ringworm, Microsporum canis mainly caused tinea alba, Trichophyton mentagrophytes,Nannizzia gypseum and Trichophytonrubrum mainly caused kerion. Except for Microsporum ferrugineum, the composition ratios of other fungi species showed statistically significant differences among different clinical types of tinea capitis（P<0.05). Conclusions Preschool children are the most commonly affected age group by pediatric tinea capitis, and black-dot ringworm caused by Trichophytes violaceum is the main clinical type. Analysis of the high-riskage group, pathogenic fungi and clinical types of tinea capitis in children can enhance the understanding of its epidemiological characteristics, which is helpful for early diagnosis and targeted standardized treatment of pediatric tinea capitis.

Analysis of pathogenic fungi causing tinea capitis: a single-center retrospective study / 中华皮肤科杂志

Objective:To investigate the distribution of pathogenic fungi in patients with tinea capitis diagnosed in Xijing Hospital, Air Force Medical University in the past 10 years.Methods:A total of 871 outpatients or inpatients with tinea capitis were collected from the Department of Dermatology, Xijing Hospital from January 2011 to December 2020, and their clinical data and pathogen distribution were retrospectively analyzed. Pearson chi-square test was used to analyze differences in the pathogen distribution between children and adult patients with tinea capitis.Results:Of 871 patients with tinea capitis, 588 (67.5%) were males and 283 (33.5%) were females; 21 (2.40%) were aged less than 1 year, 266 (30.50%) aged 1 - 3 years, 352 (40.40%) aged 4 - 6 years, 187 (21.50%) aged 7 - 12 years, 4 (0.50%) aged 12 - 18 years, and 41 (4.70%) were aged 18 - 74 years. A total of 705 pathogenic strains were isolated from these patients, including 599 strains of Microsporum canis (85.0%) , 52 strains of Trichophyton mentagrophytes complex (7.4%) , 27 strains of Trichophyton tonsurans (3.8%) , and 18 strains of Trichophyton violaceum (2.6%) . Among the pathogenic fungi of tinea capitis, the proportion of Trichophyton violaceum was significantly higher in adults (8.8%) than in children (2.2%, P = 0.048) . Conclusions:In the past 10 years, the patients with tinea capitis in the Department of Dermatology, Xijing Hospital were mainly children aged 1 - 6 yearswhile adults, and adult patients with tinea capitis were uncommon. The main pathogen of tinea capitis was Microsporum canis, followed by Trichophyton mentagrophytes complex.

Comparison of oral terbinafine versus itraconazole in the treatment of tinea capitis in children / 中华皮肤科杂志

Objective:To compare the efficacy and safety of oral terbinafine versus itraconazole in the treatment of pediatric tinea capitis.Methods:From January 2021 to December 2021, a randomized clinical trial was conducted among 53 children with tinea capitis in Beijing Children′s Hospital. These patients were randomly divided into 2 groups by using a random number table: terbinafine group treated with oral terbinafine at different doses (weight <20 kg, dose: 62.5 mg/d; weight 20 - 40 kg, dose: 125 mg/d; weight >40 kg, dose: 250 mg/d), while itraconazole group treated with oral itraconazole at doses of 3 - 5 mg·kg -1·d -1. Statistical analysis was performed using the SPSS 23.0 software, and enumeration data were compared between groups by using chi-square test or Fisher′s exact test. Results:Totally, 27 patients were treated with oral terbinafine, including 17 with tinea alba and 10 with kerion; 26 were treated with oral itraconazole, including 17 with tinea alba and 9 with kerion. After treatment, 14 (51.85%) patients were cured in the terbinafine group, including 5 with tinea alba and 9 with kerion, while 25 (96.15%) were cured in the itraconazole group, including 16 with tinea alba and 9 with kerion. The response rate was significantly higher in the itraconazole group than in the terbinafine group ( χ2 = 13.37, P < 0.001) . Conclusion:The efficacy of itraconazole was superior to that of terbinafine in the treatment of pediatric tinea alba, but their efficacy was equivalent in the treatment of pediatric kerion.

Epidemiological aspects of pediculosis by Pediculus humanus capitis (Phthiraptera: Pediculidae) in Minas Gerais: a systematic review / Aspectos epidemiológicos da pediculose por Pediculus humanus capitis (Phthiraptera: Pediculidae) em Minas Gerais: uma revisão sistemática

Abstract Background Head lice, or head pediculosis, is a parasitosis considered a serious public health problem that affects mainly resource-limited countries. Objective To describe epidemiological aspects of the pediculosis capitis in Minas Gerais, in Brazil. Method This systematic review was conducted through the standards established by the Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). PubMed, LILACS, and SciELO databases, as well as the gray literature, were searched. Results Nine of 1,167 studies were included, published between 1988 and 2019. These studies reported a total prevalence of parasitosis that ranged from 1.4% to 57.4%. The prevalence of head lice ranged from 0.0% to 66.7% for males and 2.3% to 57.4% for females, thus being higher in black-skinned people (1.4% to 40.3%). Regarding age, the highest prevalence was 10-12 years old (45.3%). As for the characteristics of the hair, there was a greater infestation in people with long (16.0% to 79.5%), wavy (0.0% to 44.7%), dark (0.0% to 36.6%), with low capillary density (35.4%), and thick hair (39.2%). Conclusion Head pediculosis affects both sexes, different ages, and races, representing an important health problem in Minas Gerais, not only due to the presence of ectoparasite but also to the secondary complications that can be generated from this parasitism.

Resumo Introdução A pediculose de cabeça é uma parasitose considerada um sério problema de saúde pública, afetando principalmente países com recursos limitados. Objetivo Descrever os aspectos epidemiológicos da pediculose de cabeça em Minas Gerais, Brasil. Método Revisão sistemática conduzida por meio dos padrões estabelecidos pelo Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). Foram pesquisadas as bases de dados PubMed, LILACS e SciELO, bem como a literatura cinza. Resultados Nove de 1.167 estudos foram incluídos, publicados entre 1988 e 2019. Relatou-se uma prevalência total da parasitose que variou de 1,4% a 57,4%. Ela variou de 0,0% a 66,7% para homens e 2,3% a 57,4% para mulheres, sendo maior em pessoas de cor negra (1,4% a 40,3%). Em relação à idade, a maior prevalência foi de 10 a 12 anos (45,3%). Quanto às características dos cabelos, houve maior infestação em pessoas com cabelos longos (16,0% a 79,5%), ondulados (0,0% a 44,7%), escuros (0,0% a 36,6%), com baixa densidade capilar (35,4%) e fios grossos (39,2%). Conclusão A pediculose atinge ambos os sexos, diferentes idades e raças, representando um importante problema de saúde em Minas Gerais, não só pela presença do ectoparasita, mas também pelas complicações secundárias que podem ser geradas desse parasitismo.

Uso da Curcuma longa associada à terapia fotodinâmica para o tratamento do Kerion Celsi / Photodynamic therapy with Curcuma longa for the treatment of Kerion celsi

O Kerion Celsi é uma forma inflamatória da tinea capitis, cujo principal agente etiológico é o Microsporum canis. O tratamento padrão-ouro é a griseofulvina, porém seu uso é aprovado pela Food and Drug Administration (FDA) em crianças a partir dos dois anos de idade. Apesar de rara em crianças com menos de três anos, a tinea capitis pode ocorrer, como é o caso desta criança de um ano de idade que foi submetida, com sucesso, à terapia fotodinâmica com curcumina e houve a remissão completa do quadro

Kerion Celsi is an inflammatory variant of tinea capitis and is usually caused by Microsporum canis. Griseofulvin is the gold standard treatment, but FDA approves its use only for children up to two years. Even though it is rare in children younger than three years, tinea capitis can still occur, as in the case of the one-year-old child who was successfully treated with photodynamic therapy combined with curcumin, resulting in total remission.

Kerion celsi caused by Trichophyton tonsurans in an adult

Abstract Tinea capitis is an uncommon infection in adults, and predominantly affects women and the elderly with hormonal disorders and immunosuppression. Clinical features are often polymorphic and atypical. A kerion celsi case in an elderly female patient with type 2 diabetes mellitus and menopause is presented. The diagnosis was established by direct examination and the isolation of Trichophyton tonsurans in culture and typified by microculture. Treatment with prednisone and itraconazol was very successful. Recognizing the presentation of tinea capitis in adults will help clinicians to avoid delay in the diagnosis, awareness of the risk factors and provide early treatment to minimize sequelae of the disease.

Tiña capitis por Trichophyton tonsurans en un paciente pediátrico / Tinea capitis by Trichophyton tonsurans in a pediatric patient

La tiña capitis (TC) es una micosis superficial del cuero cabelludo, considerada una de las infecciones más frecuentes por dermatofitos en niños. Hasta la actualidad, las especies descritas con mayor frecuencia en nuestro medio son el Microsporum y, en segundo término, Trichophyton, los cuales se contraen principalmente por contacto directo con animales o seres humanos infectados, respectivamente. Se presenta el caso de una paciente de 8 años con alopecia y lesiones inflamatorias de 2 años de evolución, en la que finalmente se llegó al diagnóstico de TC inflamatoria causada por T. tonsurans, un hongo antropofílico considerado poco frecuente en Argentina y emergente en la provincia de Buenos Aires. Este patógeno presenta alta transmisibilidad; son varios los países que han reportado brotes escolares y comunitarios. Se debe resaltar la importancia de su sospecha clínica temprana para un tratamiento adecuado.

Tinea capitis (TC) is a superficial mycosis of the scalp, considered one of the most common dermatophyte infections in children. Until now, the species mainly described in our environment are Microsporum and secondly Trichophyton, which are contracted mainly by direct contact with infected animals or humans, respectively. We present the case of an 8-year-old patient with alopecia and inflammatory lesions of 2 years of evolution, finally reaching the diagnosis of inflammatory tinea capitis caused by T. tonsurans, an anthropophilic fungus considered rare in Argentina and emerging in the province of Buenos Aires. This pathogen has high transmissibility; several countries have reported school and community outbreaks. The importance of its early clinical suspicion for adequate treatment should be emphasized.

Anatomical characteristics of semispinalis capitis plane under ultrasound / 中华麻醉学杂志

Objective:To observe the anatomical characteristics of the semispinalis capitis plane (SCP) to provide a reference for clinically effective implementation of ultrasound-guided SCP block.Methods:Ultrasound scanning was performed in six certain districts of SCP in 30 healthy volunteers (60 sides). The key point was to examine and describe the anatomical characteristics of semispinalis capitis (SCA), deep space of SCA and structures within the space.Results:(1) Transverse scanning at the posterior arch of atlas revealed that the SCA was separated into medial and lateral head by an oblique thick septum; in the space between SCA and obliquus capitis inferior (SCA-OCI), the third occipital nerve (TON) and the greater occipital nerve (GON) were separated by a fascia.There was often a branch of occipital vein between them.The distance from TON to GON was (12.9±0.6) mm.(2) Transverse scanning at the lamina of axis revealed that the axial image of SCA and the structures in SCA-OCI space were similar to the results previously described in (1). The distance from TON to GON was (12.1±0.5) mm.(3) Sagittal scanning beside the spinous process of axis revealed that SCA was separated into superior and inferior belly by a septum which connected to the end of axis spinous process.(4) Sagittal scanning at the C 2, 3 facet joint revealed that in the space between OCI and C 2, 3 facet joint (OCI-C 2, 3) beneath SCA, there was no septum between TON and GON.The distance from TON to GON was (8.0±0.5) mm.(5) Transverse scanning at the lamina of C 4 revealed that in the space between SCA and semispinalis cervicis, the deep cervical artery and vein were observable except medial branch of C 4, and the characteristics of the short axis of the SCA belly were similar to the results previously described in (1). (6) Transverse scanning at the lamina of C 5 revealed that the view was similar to the results previously described in (5). The posterior branch of C 5 nerve was not found. Conclusions:SCP is rich in fascia, and blood vessels often pass through the deep surface space of SCA under ultrasound.The anatomical structure is complex, and there is individual variation.Grasping its ultrasonic anatomical characteristics is helpful in safely and effectively implementing ultrasound-guided SCP block.

Alopecia and pet: a case report

ABSTRACT Dermatophytoses are fungal infections affecting the skin and cutaneous annexes. This clinical case report describes a 7-year-old girl with Kerion celsi, a severe manifestation of Tinea capitis. The patient presented with painful edematous crusty scalp lesions and alopecia, which required surgical debridement and long-term antifungal treatment. Culture of samples collected from scalp and arm skin lesions (patient and patient's mother respectively) were positive for Trichophyton mentagrophytes. The family owned a pet guinea pig. This particular dermatophytosis is easily transmitted from guinea pigs to humans, with some studies showing up to 34.9% prevalence of Trichophyton mentagrophytes infection in these animals.

Querión de Celso, aspectos diagnósticos y terapéuticos: Presentación de un caso / Kerion Celsi, diagnostic and therapeutic aspects: a case report

RESUMEN La tiña capitis es una enfermedad que afecta con mayor frecuencia a la población pediátrica; es ocasionada por hongos dermatofitos y es el querión su forma inflamatoria severa. Su diagnóstico e intervención temprana evita posibles secuelas estéticas y psicológicas en quienes lo padecen. Se presenta caso de paciente masculino de 4 años quien consultó al servicio de dermatología por cuadro de 4 meses de placa eritemato-descamativa con pústulas que progresó a única placa de predominio alopécica y adenopatías cervicales. El reporte microbiológico confirmó su diagnóstico, y el ultrasonido contribuyó al pronóstico y conducta terapéutica.

ABSTRACT Tinea capitis is a disease that most frequently affects the pediatric population caused by dermatophyte fungi, of which kerion is the severe inflammatory form of it. Its early diagnosis and intervention avoids possible aesthetic and psychological consequences in those who suffer from it. The case of a 4-year-old male patient is presented, who attend the dermatology service for 4 months of erythematous-desquamative plaque with pustules that evolved to a single plaque of predominantly alopecia and cervical lymphadenopathy. Microbiological report confirmed its diagnosis, and ultrasound contributed to the prognosis and therapeutic behavior.

Clinical effects of excision and setons drainage management in treatment of early and medium-term perifolliculitis capitis abscedenset suffodiens / 中华医学美学美容杂志

Objective:To investigate the surgical management of perifolliculitis capitis abscedenset (PCAS).Methods:From June 2015 to October 2018, 8 patients with PCAS were treated, aged 13-26 years, with an average age of 23 years. Hypepigmented plaques in size were from 0.5-4.0 cm. The operative technique was based on the complete excision of the entire diseased skin and subcutaneous fatty tissue, the fistula was explored using a probe, the seton was inserted through the remaining tract in a double-strand fashion, this double-strand elastic seton was then tied over itself without excessive tension. The wound was covered with absorptive dressing.Results:All the wounds in 8 patients healed primarily. All patients were followed up for 6 months and showed no recurrence after surgery.Conclusions:Perifolliculitis capitis abscedens et suffodiens scalp is a rare chronic suppurative skin disease, its etiology and pathogenesis are unclear, but related with follicular atresia, bacterial infection, immune factors, sex hormones, smoking and obesity. The treatment is difficult, including antibiotics, vitamin A acid, biological agents, photodynamic, laser and surgery. The disease is stubborn and refractory. The technique of wide surgical excision and loose setons drainage is an effective method for PCAS.

Clinical analysis of 20 pediatric patients with kerion / 中华全科医师杂志

Twenty pediatric patients with kerion were treated in Department of Dermatology, Affiliated Hospital of Jining Medical University from January 2014 to June 2020. The general information, clinical manifestations, laboratory test results, treatment and prognosis were retrospectively analyzed. There were 13 males and 7 females aged from 2 to 10 years. Thirteen patients had a history of contact with animals, 4 had contact with parents with tinea. All patients had alopecia, 6 cases presented with inflammatory mass, 14 presented with abscessus; some patients had regional lymphadenopathy and febrile. Four cases were misdiagnosed as abscesses caused by bacterial infection and underwent incision leading to deep ulcers. A total of 13 fungal strains were isolated, including 4 strains of Microsporum gypseum, 3 strains of Trichophyton rubrum, 2 strains of Microsporum canis, the others were Trichophyton tonsurans and Trichophyton mentagrophytes and Fusarium. All patients were treated with fluconazole, concomitantly with topical antifungals and He-Ne laser, 19 of whom were cured. It is suggested that kerion characterized by inflammatory lesions is likely to be misdiagnosed. Fungal examination can confirm the diagnosis of kerion, and fluconazole is effective for treatment.

Tiña Capitis en niños / Tinea capitis in children

La tiña capitis (TC) es una infección por dermatofitos con una alta prevalencia en la población pediátrica. Su epidemiología ha cambiado en las últimas décadas debido a la creciente migración poblacional alrededor del mundo. Se han identificado factores de riesgo ambientales y propios del huésped, relacionados al desarrollo de esta infección. Las manifestaciones clínicas son variables y dependen del agente causal. La dermatoscopia y la luz de Wood son herramientas útiles para la aproximación diagnóstica, sin embargo, la confirmación de la infección se basa en las pruebas micológicas. El aislamiento del agente causal permite orientar el tratamiento antifúngico adecuado, siendo estos eficaces y seguros en población pediátrica. El tratamiento se centra en la terapia antimicótica sistémica en combinación con medidas locales. El objetivo del manuscrito es hacer una revisión actualizada sobre el enfoque clínico y terapéutico de la TC en población pediátrica.

Tinea capitis (TC) is a dermatophyte infection with a high prevalence in the pediatric population. Its epidemiology has changed in recent decades due to increasing population migration worldwide. Environmental and host-specific risk factors have been identified which are with the development of this infection. The clinical manifestations are variable and depend on the causal agent. Dermatosco- py and Wood's lamp are useful tools for the diagnostic approach; however, the confirmation of in fection is based on mycological tests. The identification of the causal agent allows guiding the appro priate antifungal treatment, which is specific and safe in the pediatric population. Treatment focuses on systemic antifungal therapy combined with local measures. The objective of this paper is to carry out an updated review of the clinical and therapeutic approach to TC in the pediatric population.

Nervio occipital mayor: trayecto, relaciones anatómicas e implicancias clínicas de sus posibles sitios de atrapamiento / Great occipital nerve: course, anatomical relations and clinical implications of their potential entrapment sites

RESUMEN: El nervio occipital mayor (NOM) se forma del ramo dorsal del nervio espinal C2 y asciende entre la musculatura cervical posterior para inervar la piel del cuero cabelludo. Diversos autores han descrito su recorrido, sin embargo, es escasa la información referente a la relación que presenta este nervio con el músculo oblicuo inferior de la cabeza (OIC) y su trayecto intramuscular. El objetivo de este estudio fue determinar el recorrido y relaciones que el NOM estableció en el intervalo existente entre los músculos OIC y músculo trapecio (T). Para ello, se midieron las distancias verticales y horizontales a la altura de la protuberancia occipital externa y línea mediana, y se dividió al músculo OIC en tercios para observar variaciones del recorrido de este nervio. Junto con medir el diámetro del NOM, se midieron las distancias vertical y horizontal de este nervio a través de cinco puntos de referencia muscular y un punto de referencia vascular. Estos puntos musculares fueron: a) sobre el vientre del músculo OIC (punto 1); b) en la cara profunda del músculo semiespinoso de la cabeza (SEC) (punto 2); c) en la cara superficial del músculo SEC (punto 3); d) en la cara profunda del músculo T (punto 4); y e) en la cara superficial del músculo T (punto 5). A este se sumó el punto 6, en el cual se establecieron las distancias vertical y horizontal con la arteria occipital a la altura de la cara superficial del músculo T. Para ello se disecaron 18 cabezas (36 triángulos suboccipitales) de cadáveres adultos brasileños pertenecientes al laboratorio de Anatomía de la Universidade Federal de Alagoas (UFAL), Maceió, Brasil. Las distancias verticales y horizontales obtenidas respecto de los seis puntos fueron: 63,67 y 27,15 mm (punto 1); 53,89 y 21,44 mm (punto 2); 30,61 y 14,49 mm (punto 3); 20,39 y 22,8 mm (punto 4); 5,86 y 33,46 mm (punto 5); 5,99 y 35,56 mm (punto 6), respectivamente. En relación al músculo OIC, el NOM se ubicó en un 72,22 % de las muestras en el tercio medio de este músculo, 19,44% en su tercio lateral y un 8,33 % en su tercio medial. Todos estos hallazgos deben ser considerados al momento de diagnosticar correctamente posibles atrapamientos del NOM en la región cervical profunda, siendo además, una contribución para el éxito de procedimientos quirúrgicos de esta región.

SUMMARY: The great occipital nerve (GON) is formed from the dorsal branch of the C2 spinal nerve and ascends between the posterior cervical musculature to innervate the skin of the scalp. Various authors have described its course, however, there is little information regarding the relationship that this nerve presents with the obliquus capitis inferior (OCI) and its intramuscular path. The objective of this study was to determine the route and relationships that the GON established in the interval between the OCI muscles and the trapezius muscle (T). For this, the vertical and horizontal distances were measured at the height of the external occipital protuberance and median line, and the OCI muscle was divided into thirds to observe variations in the path of this nerve. Along with measuring the diameter of the GON, the vertical and horizontal distances of this nerve were measured through five muscle reference points and one vascular reference point. These muscle points were: a) on the belly of the OCI muscle (point 1); b) in the deep face of the semispinalis capitis muscle (SCM) (point 2); c) on the surface of the SCM (point 3); d) on the deep face of the T (point 4); and e) on the surface face of the T (point 5). To this was added point 6, in which the vertical and horizontal distances were established with the occipital artery at the height of the superficial face of the T. For this, 18 heads (36 suboccipital triangles) of Brazilian adult corpses belonging to the Anatomy laboratory of the Universidade Federal de Alagoas (UFAL), Maceió, Brazil, were dissected. The vertical and horizontal distances obtained with respect to the six points were: 63.67 and 27.15 mm (point 1); 53.89 and 21.44 mm (point 2); 30.61 and 14.49 mm (point 3); 20.39 and 22.8 mm (point 4); 5.86 and 33.46 mm (point 5); 5.99 and 35.56 mm (point 6), respectively. In relation to the OCI, the GON was located in 72.22 % of the samples in the middle third of this muscle, 19.44 % in its lateral third and 8.33 % in its medial third. All these findings should be considered when correctly diagnosing possible entrapments of GON in the deep cervical region, being a contribution to the success of surgical procedures in this region.

Tinea capitis: dermoscopy and calcium fluorescent microscopy as highly efficient and precise diagnostic tools

Abstract Tinea capitis comprising of tinea favosa and kerion is mostly seen in school-aged children. Some tinea capitis often presented with insignificant findings under the naked eyes are easily overlooked. The authors describe an unusual case of tinea capitis caused by Trichophyton violaceum. The patient was an 8-year-old girl, with a history of pruritus on the scalp for more than one year. A diagnosis of tinea capitis was confirmed by clinical examination aided by dermoscopy, calcium fluorescent microscopy and culture. Comma and corkscrew hairs are two specific dermoscopic patterns of tinea capitis. The patient was treated with systemic itraconazole, topical application with 1% naftifine 0.25% ketoconazole cream followed after daily hair wash with 2% ketoconazole shampoo for 8 weeks.

Pseudomycetoma of the scalp caused by Microsporum canis

Abstract Pseudomycetoma is an extremely rare deep mycosis, caused by dermatophytic fungi that penetrate the tissue from infected follicles of tinea capitis. Both clinically and histopathology are similar to eumycetoma, being distinguished through the isolation of the fungus, which in the case of pseudomycetoma can be Microsporum spp. or Trichophyton spp. genre. We present a 24-year-old man with an exuberant tumor in the occipital region with fistula, whose histopathological examination evidenced grains composed of hyaline hyphae and the culture for fungi isolated the agent Microsporum canis. Combined treatment of surgical excision followed by oral griseofulvin for two years was performed, with resolution of the condition.