BH30 Dermoscopic evaluation of a case of successfully treated kerion

Abstract Data on dermoscopy of kerion are extremely scarce. Negative dermoscopy findings may be observed in up to 30% of patients with tinea capitis, and it is common (around 75% of patients) to get only crusts on dermoscopy of kerion. No follow-up dermoscopy data are available in the literature. A 4-year-old boy was brought in with a history of an erythematous boggy swelling over the right side of his scalp associated with hair loss, recurrent pustules, pain and itching. He had received multiple courses of oral antibiotics without any significant relief. Dermoscopy revealed a diffuse erythematous background, areas of hair loss, yellowish-white crusts and scales, pustules, broken hairs and erosion. A pus swab and scraping from the lesion did not show any organisms. Culture of the plucked hair sample was suggestive of Trichophyton verrucosum. He was diagnosed with kerion and started on terbinafine 1% cream and oral terbinafine 125 mg (based on his weight) for 6 weeks. A follow-up post-treatment revealed complete clearance of the infection; however, there was associated scarring and hair loss. Dermoscopy revealed significant resolution of the erythematous background, which was replaced by a predominant brownish background, multiple regrowing hairs, adnexal openings and scarring alopecia with mild patchy erythema. There was complete resolution of the pustules, crusts, scales and erosion on dermoscopy after the treatment. Follow-up dermoscopy is an important tool in assessing the treatment response in this serious infection. The disappearance of erythema, pustules, crusts, scales and erosion signified an adequate treatment response in our patient.