SIR, Boggy Pus filled marked Information, along with loss/fall of hair area on Occipital region--- Might B a Case of KERION, caused by Dramatic Immune response to Dermatophyte Fungal/TINEA Infection, commonly found in KERION is Microsporum Canis--- TINEASIS may B transmitted by KERION to Other Family Members N Somtimes by PETS. D/D- - SEBORRHEIC DERMATITIS. - SCALP PSORIASIS. DX- Suspicion is raised due to Typical appearance of a Kerion, as well as Wood lamp examination; Other test including Laboratory Tests for Fungal Infection; N ALONG with a BACTERIAL Swab Should B considered as Secondary Infection with Bacteria is Common. Skin Biopsy to exclude PSORIASIS. Rx- 1stly, Oral N Topical Antibiotics must B needed to Control da Bacterial Infection, Along with, Oral Antifungals like Terbinafine, Griseofulvin or Itraconazole R Useful for at least 6 - 8Wks, As Bcoz, Topical Antifungals R Not Effective due to deep invasion of Fungus into Hair Follicles. - Topical Antifungals, Terbinafine, Luliconazole, or Amorolfin Cream/lotion. - Ketoconazole (+ ZPTO) Shampoo. - Personal Hygiene should be maintained, stictly. Thanks.
Good answers from CUROFIANS. It's KERION case. We can diagnosis the KERION by Cicatrical alopecia, lymphadenopathy and scales with secondary infection ...produce Boggy and pus filled inflammation with swelling...... Good presentation by Dr. Dhara. Here,I am adding few more points... The guidelines of treatment in the KERION are.... First should be treated by oral antifungals . Topicals are not at all useful, due to deep invasion of fungus. Before going to treatment, confirm the fungal elements in the lesion. By doing ... WOODS lamp examination KOH mounting... Culture sensitivity Remove the pus, debris and scabs superficially. Should not go deep or should not do surgical excision. Preferable oral antifungal in this case is Itraconazole...100 mg for 4 weeks. Short course of antibiotics are beneficial. Keratolytic antifungal shampoo is good choice in this cäse. Personal hygiene and good Nutrition will improve the health and respond to treatment well.
Kerion . Result of the hosts response to a fungal ringworm infection of the hair follicles of the scalp that can be accompanied by secondary bacterial infection . Raised spongy lesion and typically occurs in children . Painful inflammatory reaction with deep suppurative infection on the scalp . Follicles may be discharging pus . Usually caused by dermatophyte such as trichophyton n microsporum . Treatment griseofulvin or terbinafine for a sustained duration of at least 6 to 8 weeks .
Kerion Ketoconazole Shampoo Tab Terbenafine 250mg OD×8weeks Tab Levocetrizine5 mg BD×3weeks Tab Coamoxyclav 625mg TDS×7days Luliconazole lotion to apply locally Maintain personal hygiene
Tinea capital - kerion type. Seb capital doesn't ooze or crust but form yellowish, greesy flakes attached to hair shafts all over scalp , not limited to occipital region.
Dr Josh, Thanks for remembering especially about the link. I had a rude reply to that post ascribing as self advertisement. But the fact is that those interested may go through the article. Second intention is to share with my Curofy family. Unfortunately such news seem to be beyond tolerance of some Curofians. Any way U can type any of my article's name in Google search and read it as the article are open a cess type. My Best to you. wishes
Most Probably it's a case of KERION, typically on Occipital region.
Kerion with seb dermatitis Need properly treatment
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Friends today again I am discussing about a skin. Problem known as Seborrhoeic dermatitis. What is seborrhoeic dermatitis? Seborrhoeic dermatitis is a common, chronic or relapsing form of eczema/dermatitis that mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk . There are infantile and adult forms of seborrhoeic dermatitis. It is sometimes associated with psoriasis (sebopsoriasis). Seborrhoeic dermatitis is also known as seborrhoeic eczema. Dandruff (also called ‘pityriasis capitis’) is an uninflamed form of seborrhoeic dermatitis. Dandruff presents as bran-like scaly patches scattered within hair-bearing areas of the scalp. What causes seborrhoeic dermatitis? The cause of seborrhoeic dermatitis is not completely understood. It is associated with proliferation of various species of the skin commensal Malassezia, in its yeast (non-pathogenic) form. Its metabolites (such as the fatty acids oleic acid, malssezin, and indole-3-carbaldehyde) may cause an inflammatory reaction. Differences in skin barrier lipid content and function may account for individual presentations. Who gets seborrhoeic dermatitis? Infantile seborrhoeic dermatitis affects babies under the age of 3 months and usually resolves by 6–12 months of age. Adult seborrhoeic dermatitis tends to begin in late adolescence. Prevalence is greatest in young adults and in the elderly. It is more common in males than in females. The following factors are sometimes associated with severe adult seborrhoeic dermatitis: Oily skin (seborrhoea) Familial tendency to seborrhoeic dermatitis or a family history of psoriasis Immunosuppression: organ transplant recipient, human immunodeficiency virus (HIV) infection and patients with lymphoma Neurological and psychiatric diseases: Parkinson disease, tardive dyskinesia, depression, epilepsy, facial nerve palsy, spinal cord injury and congenital disorders such as Down syndrome Treatment for psoriasis with psoralen and ultraviolet A (PUVA) therapy Lack of sleep, and stressful events. What are the clinical features of seborrhoeic dermatitis? Infantile seborrhoeic dermatitis Infantile seborrhoeic dermatitis causes cradle cap (diffuse, greasy scaling on scalp). The rash may spread to affect armpit and groin folds (a type of napkin dermatitis). There are salmon-pink patches that may flake or peel. It is not especially itchy, so the baby often appears undisturbed by the rash, even when generalised. Infantile seborrhoeic dermatitis Adult seborrhoeic dermatitis Seborrhoeic dermatitis affects scalp, face (creases around the nose, behind ears, within eyebrows) and upper trunk. Typical features include: Winter flares, improving in summer following sun exposure Minimal itch most of the time Combination oily and dry mid-facial skin Ill-defined localised scaly patches or diffuse scale in the scalp Blepharitis: scaly red eyelid margins Salmon-pink, thin, scaly, and ill-defined plaques in skin folds on both sides of the face Petal or ring-shaped flaky patches on hair-line and on anterior chest Rash in armpits, under the breasts, in the groin folds and genital creases Superficial folliculitis (inflamed hair follicles) on cheeks and upper trunk Extensive seborrhoeic dermatitis affecting scalp, neck and trunk is sometimes called pityriasiform seborrhoeide. How is seborrhoeic dermatitis diagnosed? Seborrhoeic dermatitis is diagnosed by its clinical appearance and behaviour. As malassezia are a normal component of skin flora, their presence on microscopy of skin scrapings is not diagnostic. Skin biopsy may be helpful but is rarely indicated. Histological findings specific to seborrhoeic dermatitis are superficial perivascular and perifollicular inflammatory infiltrates, psoriasiform hyperplasia, and parakeratosis around follicular openings. What is the treatment for seborrhoeic dermatitis? Treatment of seborrhoeic dermatitis often involves several of the following options. Keratolytics can be used to remove scale when necessary, eg salicylic acid, lactic acid, urea, propylene glycol Topical antifungal agents are applied to reduce malassezia eg ketoconazole, or ciclopirox shampoo or and/or cream. Note, some strains of malassezia are resistant to azole antifungals. Try zinc pyrithione or selenium sulphide Mild topical corticosteroids are prescribed for 1–3 weeks to reduce the inflammation of an acute flare Topical calcineurin inhibitors (pimecrolimus cream, tacrolimus ointment) are indicated if topical corticosteroids are often needed, as they have fewer adverse effects on facial skin. In resistant cases in adults, oral itraconazole, tetracycline antibiotics or phototherapy may be recommended. Low dose oral isotretinoin has also been shown to be effective for severe or moderate seborrhoeic dermatitis. Scalp treatment Medicated shampoos containing ketoconazole, ciclopirox, selenium sulfide, zinc pyrithione, coal tar, and salicylic acid, used twice weekly for at least a month and if necessary, indefinitely. Steroid scalp applications reduce itching, and should be applied daily for a few days every so often. Calcineurin inhibitors such as tacrolimus can be used as steroid alternatives. Coal tar cream can be applied to scaling areas and removed several hours later by shampooing. Combination therapy is often advisable. Face, ears, chest and back Cleanse the affected skin thoroughly once or twice each day using a non-soap cleanser. Apply ketoconazole or ciclopirox cream once daily for 2 to 4 weeks, repeated as necessary. Hydrocortisone cream can also be used, applied up to twice daily for 1 or 2 weeks. Occasionally a more potent topical steroid may be prescribed. Topical calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment may be used instead of topical steroids. A variety of herbal remedies are commonly used, but their efficacy is uncertain. Management in infants Regular washing of the scalp with baby shampoo or aqueous cream is followed by gentle brushing to clear the scales. GRAPHITES 30-Graphites is an effective Homeopathic medicine for seborrheic dermatitis where the scales on the scalp are accompanied by intense itching. ... 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