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Case Report

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

by
Teerapong Rattananukrom
1,
Isaías Uh-Sánchez
2,
Carlos Atoche-Dieguez
3,
Nixma Eljure
3,
Carlos Garcia-Rementeria
4 and
Roberto Arenas
5,*
1
Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
2
Servicio de Dermatología, Hospital General Dr. Adolfo López Mateos, Mexico City 01030, Mexico
3
Centro Dermatológico de Yucatán, Mérida 97000, Mexico
4
Southwestern Dermatology, Oklahoma City, OK 73139, USA
5
Mycology Section, “Dr. Manuel Gea Gonzalez” General Hospital, Mexico City 14080, Mexico
*
Author to whom correspondence should be addressed.
J. Fungi 2025, 11(2), 103; https://doi.org/10.3390/jof11020103
Submission received: 17 September 2024 / Revised: 19 December 2024 / Accepted: 2 January 2025 / Published: 29 January 2025
(This article belongs to the Section Fungal Pathogenesis and Disease Control)
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Abstract

Kerion is a form of inflammatory tinea capitis, a fungal infection caused by various zoophilic, geophilic, and anthropophilic pathogens. Erythema nodosum (EN), a form of septal panniculitis, can be considered a dermatophyte id reaction that occurs outside the primary site of dermatophyte infection. The association between EN and kerion is rarely reported, with most cases following Trichophyton mentagrophytes scalp infections. Here, we describe three cases of EN associated with kerion caused by T. mentagrophytes, successfully treated with itraconazole or griseofulvin plus prednisone. Additionally, we conducted a narrative review of the literature, identifying 23 reported cases of EN associated with kerion on PubMed. The most commonly reported fungus was T. mentagrophytes (78.25%). In 52.17% of cases, patients developed EN after initiating antifungal treatment, with a mean onset time of 11.58 days (SD 7.3). Griseofulvin remains a mainstay treatment. The mean time for EN resolution was 8.31 days (SD 4.15), and the median duration of treatment for kerion leading to a complete response was 6 weeks (IQR 6–8). Scarring alopecia is a common sequela following kerion, and the use of corticosteroids has been recommended as adjunct therapy to minimize the risk of scarring.
Keywords: erythema nodosum; griseofulvin; itraconazole; kerion; scarring alopecia; tinea capitis; Trichophyton mentagrophytes erythema nodosum; griseofulvin; itraconazole; kerion; scarring alopecia; tinea capitis; Trichophyton mentagrophytes

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MDPI and ACS Style

Rattananukrom, T.; Uh-Sánchez, I.; Atoche-Dieguez, C.; Eljure, N.; Garcia-Rementeria, C.; Arenas, R. Erythema Nodosum Associated with Kerion: A Case Series and Narrative Review of the Literature. J. Fungi 2025, 11, 103. https://doi.org/10.3390/jof11020103

AMA Style

Rattananukrom T, Uh-Sánchez I, Atoche-Dieguez C, Eljure N, Garcia-Rementeria C, Arenas R. Erythema Nodosum Associated with Kerion: A Case Series and Narrative Review of the Literature. Journal of Fungi. 2025; 11(2):103. https://doi.org/10.3390/jof11020103

Chicago/Turabian Style

Rattananukrom, Teerapong, Isaías Uh-Sánchez, Carlos Atoche-Dieguez, Nixma Eljure, Carlos Garcia-Rementeria, and Roberto Arenas. 2025. "Erythema Nodosum Associated with Kerion: A Case Series and Narrative Review of the Literature" Journal of Fungi 11, no. 2: 103. https://doi.org/10.3390/jof11020103

APA Style

Rattananukrom, T., Uh-Sánchez, I., Atoche-Dieguez, C., Eljure, N., Garcia-Rementeria, C., & Arenas, R. (2025). Erythema Nodosum Associated with Kerion: A Case Series and Narrative Review of the Literature. Journal of Fungi, 11(2), 103. https://doi.org/10.3390/jof11020103

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