Friday, December 31, 2004

8 yo boy with lesion on wrist

History: The patient is an 8 yo boy with a one week history of an expanding lesion on the right wrist. He plays in a sandbox that is frequented by stray cats. He's been using clotrimazole cream for three days.
Physical Exam: There is a 2 cm diameter plaque on the right wrist. The periphery appears to be vesicular and possibly a bit scaly. No other lesions.
Lab: KOH equivocal - hard to interpret because of cream artifact.
Diagnosis: ? Kerion of glabrfous skin.
I plan to stop the cream, repeat KOH in a few days and have obtained a fungal culture. Will biopsy if still uncertain and process is progressing.

Follow-up of Jan 3, 2005. The patient was seen again and the KOH prep repeated. Today, this was markedly positive (no cream artifact) Dx: Kerion of Glabrous Skin. Usually caused by M. canis. See below for references.

2.5 cm lesion right wrist Posted by Hello

1: Alteras I, Feuerman EJ, David M, Segal R.
The increasing role of Microsporum canis in the variety of dermatophytic
manifestations reported from Israel.
Mycopathologia. 1986 Aug;95(2):105-7.
PMID: 3762660 [PubMed - indexed for MEDLINE]

2: Powell FC, Muller SA.
Kerion of the glabrous skin.
J Am Acad Dermatol. 1982 Oct;7(4):490-4.
PMID: 6216270 [PubMed - indexed for MEDLINE]

1 comment:

  1. Classical case of zoophilic dermatophytosis. I would treat it with oral terbinafine. 1 week dosage would be sufficient.


We welcome your comments. We endeavor to serve your patients and you. If you want us to respond, please add your name and email address. Some people have trouble uploading comments. In that case, please send comments directly to Thank you.