Tinea capitis profunda B35.02

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Celsus Kerion; Kerion Celsi; tinea profunda; trichophytia capillitii; trichophytia profunda

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Inflammatory maximum variant of tina capitis, accompanied by abscess-like, with furunculoid granulomas. Primarily caused by animal pathogenic (zoophilic) dermatophytes. S.u. Tinea. The disease is often misdiagnosed, so that the clientele often consists of insufficiently pretreated cases.

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Trichophyton mentagrophytes, Trichophyton verrucosum.

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Occurs mainly in children.

Clinical features
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Itchy or moderately painful, 0.5-5.0 cm large, usually well defined, cushion-like raised, purulent, highly red inflammatory plaques or nodules. The inflammatory nodules are often interspersed with follicular pustules. A confluence of pustules is rarer. Pus can be emptied under pressure. Hairs are missing in the lesion or exist only sparsely. Hairs that still exist can be easily and usually painlessly extracted (preparation of a native preparation for fungal detection).

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Clinical picture, native and cultural fungal detection. Possibly histological detection of the fungi in serial PAS sections. S.u. Mycoses.

Differential diagnosis
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  • Alopecia areata: No itching, no signs of inflammation, no scaling of the surface.
  • Boils: Highly painful, acute; originating from a follicle; no multiple pustules on the surface, clearly fluctuating.
  • Folliculitis decalvans: Eminently chronic course of the disease, usually over years; scarred alopecia. Highly red skin lesions with mostly atrophic shiny centre. Peripheral follicular papules, later pustular transformation and crust formation. Irregularly shaped scar foci with small spots of irreversible hair loss result. Formation of tuft hairs.
  • Folliculitis sclerotisans nuchae: occurring almost exclusively in coloured men; usually localised in the neck. Hard, dark red, semi-spherical, shiny nodules of varying size, pierced by terminal or vellus hairs, which may confluent. Further bulging, sclerotic hardening of the skin in between.

External therapy
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As a first step, a local shave is recommended as well as a consistent local treatment with griseofulvin cream(e.g. Gricin) or topical broad-spectrum antifungals such as amorolfin cream(Loceryl), ketoconazole cream(e.g.Nizoral), terbinafine cream(e.g. Lamisil), Ciclopirox ointment(e.g. Batrafen), Clotrimazole ointment(e.g. Canesten) or bifonazole cream(e.g. Mycospor). The externals should be applied to the inflammatory lesion as thick as the back of a knife. Then cover with a gauze compress and fix with a tubular bandage. The dressing is changed daily (if necessary 2 times/day). The ointment residues can be carefully absorbed with olive oil. Hair washing with a mild syndet (e.g. Dermowas) is possible.

Internal therapy
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Absolutely necessary. Systemic antimycotics are recommended over a period of 8-12 weeks, at best 10-14 days beyond the clinical healing stage. S.u. Tinea capitis.

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Scarred healing.

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One rarely encounters untreated "classic clinical pictures". Either glucocorticoid exteriors have been applied for a longer period of time without success, surgical intervention (incisions) or multiple antibiotic or combined treatments have been applied.

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  1. Nenoff P et al (2014) Mycology - An Update Part 2: Dermatomycoses: Clinical picture and diagnostics. YYG 12: 749-778


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020