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Erythema Nodosum Associated with Kerion: A Case Series and Narrative Review of the Literature

Summary

This paper describes a rare condition where patients develop painful red bumps on the shins (erythema nodosum) as a reaction to a severe scalp fungal infection (kerion) caused by Trichophyton mentagrophytes. The authors reviewed 23 similar cases and found that this reaction usually happens during antifungal treatment and resolves within about a week. Treatment with antifungal medications like griseofulvin, sometimes combined with anti-inflammatory steroids, is effective, though scarring of the scalp may remain.

Background

Kerion is a severe inflammatory form of tinea capitis caused by zoophilic, geophilic, and anthropophilic fungal pathogens. Erythema nodosum (EN) is a septal panniculitis that can occur as a dermatophyte id reaction at sites distant from the primary infection. The association between EN and kerion is rarely reported in the medical literature.

Objective

To describe three cases of erythema nodosum associated with kerion caused by Trichophyton mentagrophytes and conduct a narrative review of the literature to characterize the epidemiology, clinical presentation, and treatment outcomes of this rare association.

Results

The literature review identified 23 cases of EN associated with kerion. T. mentagrophytes was the most common causative organism (78.25%). Fifty-two percent of cases developed EN after initiating antifungal treatment with mean onset of 11.58 days. Griseofulvin was the primary treatment, with mean EN resolution in 8.31 days and median kerion treatment duration of 6 weeks. Focal scarring alopecia was a common sequela in all cases.

Conclusion

EN associated with kerion is a rare complication primarily caused by T. mentagrophytes, often developing after antifungal therapy initiation. Rapid resolution typically occurs with oral griseofulvin or itraconazole treatment. Systemic corticosteroids are recommended as adjunctive therapy to minimize scarring alopecia risk.
  • Published in:Journal of Fungi (Basel),
  • Study Type:Case Series and Narrative Review,
  • Source: PMID: 39997397, DOI: 10.3390/jof11020103
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