Intended for healthcare professionals

Student Practical skills

Tinea capitis: a painful scalp lesion

BMJ 2010; 340 doi: https://doi.org/10.1136/sbmj.b4938 (Published 20 January 2010) Cite this as: BMJ 2010;340:b4938
  1. Adam Duckworth, foundation year 2 doctor1,
  2. Ingrid Salvary, consultant dermatologist2
  1. 1Norfolk and Norwich University Hospital, Norwich NR4 7UY
  2. 2James Paget University Hospital, Great Yarmouth, Norfolk NR31 6LA

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A 9 year old girl presents to the emergency department with a painful lesion on her scalp. It was initially a small, erythematous, scaly, pruritic eruption but gradually increased in size over the previous six weeks despite several courses of antibiotics from her general practitioner. Physical examination showed a girl in good health, with a 15 cm by 15 cm extremely tender, boggy inflammatory mass on the crown of her head accompanied by localised alopecia (hair loss) and cervical lymphadenopathy (fig 1). She is apyrexial with a white cell count 16.5×109/l and C reactive protein 28 mg/l.

Scalp lesion

Questions

  • (1) What is your working clinical diagnosis?

  • (2) What organism is most likely to be responsible?

  • (3) What investigations would you like to perform?

  • (4) What is the treatment?

Answers

(1) This is an example of a fungal kerion, which is an inflammatory reaction to tinea capitis (scalp ringworm). The differential diagnosis of a kerion includes scalp abscess and dissecting cellulitis. The differential diagnosis of non-inflammatory tinea capitis is seborrhoeic dermatitis, atopic dermatitis, impetigo, and pustular or plaque psoriasis.

(2) The predominant pathogen …

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