Objective. Tinea capitis is a common problem in the inner city, outpatient population. It is known that some children were being admitted for treat- ment of the kerion type of tinea capitis. The purpose of this study was to determine why these children were being admitted and whether hospitalization was justified. Design. A retrospective study of all children hospitalized at Children's Hospital of Wisconsin between January 1990 and December 1992 with the diagnosis of tinea capitis was performed. Results. Twenty-nine children who were hospitalized with tinea capitis were identified. In 10 cases, tinea capitis was the primary reason for admission, in 19 patients it was a secondary diagnosis. All of the patients with a primary diagnosis of tinea capitis were presumed to have a secondary bacterial infection of the kerion; however, this was not verified by the workup of any patient. Numerous deviations from optimal treatment were noted in both groups of patients. Although tinea capitis had been correctly diagnosed before admission in seven primary tinea capitis patients, only two of these patients received oral griseofulvin. The patients in whom tinea capitis was a secondary diagnosis also had a number of therapeutic deficiencies including failure to prescribe griseofulvin (16%), failure to administer griseofulvin with a fatty food or meal (58%), and failure to prescribe a sporicidal shampoo (63%). Conclusions. Although all patients were assumed to have a secondary bacterial infection, this could not be documented. With the possible exception of one patient all the symptoms described by the patients could be explained by the highly inflammatory nature of a kerion. A better understanding of the degree of inflammation that may accompany a kerion, as well as its proper treatment, may prevent unnecessary hospitalization of children.
The article "Kerion Caused by Trichophyton verrucosum" by Stocker et al. (Pediatrics 59:912, June 1977) represents a case report in need of addition. The authors state that "Kerion is the clinical term for a deep . . . boggy skin infection caused by various fungi," but end their discussion by pointing out the immunological basis of kerion. Would not the authors consider kerion to be the clinical term for a deep, boggy infection caused by an allergic reaction to various fungi?
A 12-year-old girl developed a severe inflammatory fungal infection of the scalp caused by Trichophyton verrucosm. The infection resulted in scarring alopecia. The natural history, differential diagnosis, pathogenesis, and treatment of this infection of the skin are reviewed.