Kerion (inflammatory ringworm): diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Kerion is a severe form of inflammatory ringworm of the scalp caused by dermatophytes. Griseofulvin, terbinafine, itraconazole, corticoids and management in Quebec.\">\n<meta name=\"keywords\" content=\"k\u00e9rion traitement, teigne inflammatoire k\u00e9rion, teigne cuir chevelu enfant, griseofulvine teigne, terbinafine tinea capitis, k\u00e9rion antifongique, k\u00e9rion cortico\u00efdes, tinea capitis Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-spacing:uppercase;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Dermatology & Pediatrics & Infectious Diseases & Family Medicine<\/span>\n <h1>Kerion (inflammatory ringworm of the scalp)<\/h1>\n\n <div class=\"co-intro\">\n Kerion - from the Greek kerion, meaning \u00abhoneycomb\u00bb - is the most severe and inflammatory form of scalp ringworm (tinea capitis), resulting from an intense host immune reaction against the antigens of a dermatophyte invading the hair follicles and perifollicular stroma. It presents as a boggy (soft + fluctuating like a fluid-soaked sponge) + purulent (suppurating) + painful + alopecising inflammatory plaque of the scalp, often accompanied by tender regional cervical adenopathy, fever and altered general condition. Unlike dry ringworm (non-inflammatory tinea capitis - scaly + alopecia), kerion is triggered by a type IV (delayed) hypersensitivity reaction of the host against fungal antigens - this intense inflammatory reaction is itself responsible for follicular damage and the risk of permanent scarring alopecia if treatment is delayed. It affects almost exclusively children of prepubertal age (2-14 years) and constitutes a pediatric dermatological therapeutic emergency. Zoophilic dermatophytes (from animals - Microsporum canis + cats and dogs + Trichophyton verrucosum + cattle) and geophilic dermatophytes (from soil - Microsporum gypseum) are the agents most often responsible for kerion, as they trigger a more intense inflammatory reaction than anthropophilic dermatophytes (Trichophyton tonsurans - transmitted from human to human - more often responsible for dry ringworm). Treatment is based on oral systemic antifungals (griseofulvin + terbinafine + itraconazole) - topical antifungals alone are insufficient, as follicular penetration requires systemic treatment. The addition of systemic corticosteroids is recommended by some experts to accelerate resolution of inflammation and reduce the risk of scarring alopecia.\n <\/div>\n\n <h2>Microbiology, pathophysiology, and clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Etiologic agents, sources of contamination, and pathophysiology of kerion:<\/strong> dermatophytes responsible for scalp ringworm and kerion: anthropophilic dermatophytes (transmitted from human to human - mainly causing dry ringworm): Trichophyton tonsurans : most frequent agent in North America (particularly in African-American and Caribbean communities) \u2192 endothrix ringworm (spores inside the hair \u2192 hair brittle + easily pulled out) \u2192 often dry ringworm \u2192 kerion possible but less frequent + Trichophyton violaceum + Microsporum audouinii (rare) \u2192 zoophilic dermatophytes (transmitted by animals - trigger intense inflammatory reactions \u2192 kerion ++): Microsporum canis: cats + dogs \u2192 most frequent zoophilic agent in Quebec \u2192 teigne ectothrix (spores outside the hair sheath \u2192 brittle hair + fluoresces under Wood's lamp - yellow-green) \u2192 intense inflammatory reaction \u2192 kerion + Trichophyton mentagrophytes : rabbits + guinea pigs + rodents + Trichophyton verrucosum: cattle + horses \u2192 responsible for deep kerions (boggy) + geophilic dermatophytes (originating from the soil - trigger intense inflammatory reactions): Microsporum gypseum: soils \u2192 gardening work + contact with soil \u2192 kerion sometimes + kerion pathophysiology: invasion of hair follicles by the dermatophyte \u2192 penetration into the hair cortex (endothrix) or around the sheath (ectothrix) \u2192 production of keratinolytic enzymes (keratinases + proteases) \u2192 degradation of keratin \u2192 activation of adaptive immunity (CD4+ Th1 T lymphocytes) \u2192 type IV delayed hypersensitivity reaction \u2192 influx of neutrophils \u2192 formation of folliculitis + follicular abscesses \u2192 suppuration \u2192 this immune reaction is initially protective (it eliminates the fungus) but if excessive \u2192 damage to hair follicles \u2192 perifollicular fibrosis \u2192 risk of permanent scarring alopecia if treated late \u2192 kerion represents an immunological battle between the host (intense reaction) and the fungus \u2192 antifungal treatment + corticoids (to moderate the reaction) must be initiated rapidly to preserve viable hair follicles + id reaction (trichophytide) : remote allergic reaction \u2192 vesicular lesions on hands + feet + or trunk \u2192 immune mechanism (no remote infection - no local antifungal treatment at these sites) \u2192 regression with systemic antifungal treatment<\/li>\n <li><strong>Clinical Presentation and Differential Diagnosis:<\/strong> clinical presentation of kerion: single (or multiple) plaque on the scalp \u2192 boggy appearance (soft + fluctuating like a soaked sponge) + suppurating (pus drains on pressure or spontaneously from follicular ostia \u2192 \u00abhoneycomb\u00bb appearance) + erythematous + painful to the touch + alopeciating (alopecia of the plaque + peeling of the hair on the lesion) + crusts + scales + size: 2-10 cm in diameter \u2192 broken hair remains on the plaque (unlike alopecia areata where the scalp is smooth) + location: scalp preferentially \u2192 may involve beard + eyelashes + eyebrows + posterior cervical + suboccipital adenopathies + painful + voluminous \u2192 almost constant in kerion \u2192 may be the first sign leading to consultation + fever + asthenia (in severe forms) + sometimes : id reaction (trichophytide) at a distance + characteristics depending on the agent: Microsporum canis \u2192 yellow-green fluorescence with Wood's lamp (ultraviolet lamp - present in around 50 % of cases of M. canis) \u2192 endothrix of T. tonsurans \u2192 NO fluorescence + paraclinical work-up: direct mycological examination: hair + scales removed \u2192 microscopic examination + potash (KOH) \u2192 visualizes spores around (ectothrix) or inside the hair (endothrix) + culture on Sabouraud agar + actidione + chloramphenicol \u2192 2-4 weeks for identification \u2192 genus + species specification \u2192 guides epidemiology + source + CBC: moderate leukocytosis + sign of systemic inflammation + elevated CRP \u2192 differential diagnosis: bacterial scalp abscess: staphylococcus + streptococcus \u2192 frank pus + without hair breakage \u2192 bacterial culture + furunculosis + bacterial pustular folliculitis \u2192 no diffuse alopecic plaque + alopecia areata (alopecia): non-inflammatory + non-purulent + smooth scalp + no broken hair + no adenopathies + centrifugal extension possible + chickenpox + burn scars <\/ul>\n\n <h2>Antifungal treatment and management<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Treatment \/ appearance<\/th><th>Data, methods and results<\/th><th>Key studies and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Systemic antifungals \u2014 griseofulvin, terbinafine, itraconazole<br><small style=\"font-weight:400;color:#7a8fa0;\">Griseofulvin \u2014 terbinafine \u2014 itraconazole \u2014 fluconazole \u2014 treatment duration \u2014 dosage by weight \u2014 treatment of choice by agent \u2014 follow-up \u2014 mycological test \u2014 fatty foods \u2014 adverse effects<\/small><\/td>\n <td>Systemic antifungal treatment - mainstay of kerion treatment: fundamental reminder: topical antifungals alone are INSUFFICIENT \u2192 do not penetrate hair follicles to the required depth \u2192 oral SYSTEMIC treatment is essential + education: avoid sharing hairbrushes + caps + pillows + during treatment \u2192 no systematic school eviction if treatment initiated (AAP + NICE) \u2192 antifungal shampoo (ketoconazole 2 % or selenium sulfide 2.5 %) \u00d7 2-3\/week as a supplement (reduces fungal load and risk of contamination) \u2192 griseofulvin : historical antifungal + still widely used + pediatric approved \u2192 mechanism: inhibition of fungal tubulin polymerization \u2192 mitosis arrest + dosage: micronized griseofulvin 20-25 mg\/kg\/d PO in 1-2 doses \u2192 max 1 g\/d \u2192 or ultramicronized griseofulvin 10-15 mg\/kg\/d \u2192 take with a fatty meal (increased absorption \u00d7 2) \u2192 duration: 6-12 weeks (up to 4 weeks after clinical and mycological cure) \u2192 efficacy: cure rate 80-95 % for M. canis + less effective for T. tonsurans (sometimes requires higher doses or longer duration) \u2192 adverse effects: photosensitivity + headache + GI disorders + drug interactions (CYP3A4 inducing enzyme \u2192 reduces efficacy of hormonal contraceptives + warfarin + ciclosporin) + contraindication: pregnancy (teratogenic) \u2192 porphyrias \u2192 lupus erythematosus; terbinafine: 2nd-generation antifungal \u2192 mechanism: inhibition of squalene epoxidase \u2192 stops ergosterol synthesis + accumulation of toxic squalene \u2192 fungicide \u2192 superior to griseofulvin for T. tonsurans \u2192 pediatric dosage: 35 kg: 250 mg\/d \u2192 duration: 4-6 weeks \u2192 superior to griseofulvin in terms of treatment duration (shorter) \u2192 Chen 2001 - Journal of the American Academy of Dermatology: terbinafine superior to griseofulvin for T. tonsurans + shorter duration \u2192 terbinafine is now recommended as 1st-line for T. tonsurans in the USA (AAP 2021) \u2192 for M. canis \u2192 griseofulvin or itraconazole preferred (terbinafine less effective against Microsporum) \u2192 adverse effects: GI disorders + rash + rarely hepatotoxicity (liver workup if prolonged treatment) \u2192 monitor CBC if prolonged treatment (neutropenia rare); itraconazole : azole \u2192 mechanism: inhibition of fungal cytochrome P450 (14\u03b1-demethylase) \u2192 cessation of ergosterol synthesis \u2192 pediatric dosage: 5 mg\/kg\/d PO in 1 dose \u2192 duration: 4-6 weeks \u2192 effective for Microsporum + Trichophyton \u2192 alternative to griseofulvin if intolerance \u2192 numerous drug interactions (CYP3A4 inhibitor ++ ) \u2192 contraindication: congestive heart failure + taken with meals (capsules) \u2192 fluconazole: triazole + dosage: 6 mg\/kg\/d \u00d7 2-4 weeks \u2192 or pulse protocol (6 mg\/kg\/week \u00d7 4-8 weeks) \u2192 alternative if griseofulvin + terbinafine + itraconazole not available or not tolerated \u2192 less robust data for ringworm + choice according to causative agent (summary): T. tonsurans: terbinafine (1st line AAP) + or griseofulvin (long-term) \u2192 M. canis: griseofulvin + or itraconazole \u2192 T. verrucosum: griseofulvin + or itraconazole<\/td>\n <td>Chen 2001 \u2014 Journal of the American Academy of Dermatology: terbinafine vs griseofulvin + T. tonsurans \u2192 terbinafine superior + shorter duration \u2192 drug of choice for T. tonsurans + AAP (American Academy of Pediatrics) 2021: scalp ringworm guidelines + terbinafine first-line for T. tonsurans + griseofulvin if M. canis + NICE 2018: ringworm guidelines + kerion \u2192 griseofulvin + terbinafine + itraconazole + British Association of Dermatologists (BAD) 2014: tinea capitis guidelines \u2192 kerion \u2192 systemic treatment \u2192 +\/- corticosteroids + Gupta 2005 \u2014 Journal of the American Academy of Dermatology: review of systemic antifungals for pediatric ringworm \u2192 Seebacher 2007 \u2014 Mycoses: kerion \u2192 treatment + epidemiology + INESSS Quebec + RAMQ: griseofulvin reimbursed for tinea capitis + terbinafine 250 mg reimbursed + itraconazole reimbursed + Health Canada: griseofulvin + terbinafine + itraconazole approved <\/tr>\n <tr>\n <td>Systemic corticosteroids, topical care, and supportive measures<br><small style=\"font-weight:400;color:#7a8fa0;\">Prednisone - methylprednisolone - cicatricial alopecia prevention - local care - drainage contraindicated - compresses - drying - home monitoring - contamination - animals - sibling screening - antifungal shampoo - return to school<\/small><\/td>\n <td>Systemic corticoids - reduce inflammation and prevent scarring alopecia: role of corticoids in kerion: excessive immune response (type IV hypersensitivity) is itself destructive to hair follicles \u2192 corticoids reduce inflammation + preserve viable follicles \u2192 recommendation: prednisone PO 1-2 mg\/kg\/d \u00d7 7-14 days \u2192 in association with the systemic antifungal \u2192 never as monotherapy (the fungus will continue to proliferate on corticoids alone) \u2192 results: faster regression of kerion + reduced pain + reduced adenopathy + possible reduced risk of scarring alopecia (less solid data) \u2192 Hussain 2007 - Journal of the European Academy of Dermatology and Venereology : corticosteroids + kerion \u2192 reduced inflammation + improved regression \u2192 moderate level of evidence \u2192 BAD 2014 + NICE 2018 guidelines recommend considering systemic corticosteroids in bulky + painful + kerion with risk of scarring alopecia + local management of kerion: DO NOT incise the kerion (nor drain surgically) \u2192 the kerion is NOT a frank bacterial abscess \u2192 incision only aggravates the lesion + risk of bacterial superinfection + soft compresses soaked in an antiseptic solution (saline + or mildly diluted chlorhexidine) \u2192 maintain local hygiene without trauma \u2192 antifungal shampoo (ketoconazole 2 % + or selenium sulfide 2,5 %) \u00d7 2-3\/week \u2192 reduces fungal load + decreases risk of contamination of surroundings \u2192 especially in the first few weeks + secondary bacterial superinfection : possible in highly suppurative kerions \u2192 staphylococcus + streptococcus \u2192 oral antibiotic therapy if documented superinfection (amoxicillin-clavulanate + or cefalexin) \u2192 bacterial culture of pus \u2192 check on cure: check mycological examination at 6-8 weeks \u2192 negative culture = mycological cure \u2192 clinical cure often precedes mycological cure; surrounding and public health measures: look for animal source: M. canis \u2192 cats + dogs \u2192 veterinary examination \u2192 antifungal treatment of animal if affected (miconazole lotion + or veterinary griseofulvin) \u2192 T. verrucosum \u2192 farm animals (cattle + horses) \u2192 veterinary report \u2192 screening of siblings and close contacts: clinical scalp examination + mycological sampling if symptoms \u2192 treatment of symptomatic carriers \u2192 asymptomatic carrier children transmit the fungus but require treatment if mycological confirmation + return to school : AAP + Canadian authorities generally recommend NOT to exclude the child from school once systemic treatment is initiated \u2192 antifungal shampoo during treatment period \u2192 inform school + parents of contacts \u2192 school eviction is excessive and not recommended in most guidelines<\/td>\n <td>Hussain 2007 - Journal of the European Academy of Dermatology and Venereology: systemic corticoids + kerion \u2192 reduced inflammation + accelerated regression + BAD 2014 (British Association of Dermatologists): tinea capitis guidelines \u2192 kerion \u2192 systemic corticoids recommended in severe forms + NICE 2018: tinea capitis + kerion \u2192 systemic treatment + corticoids if severe + AAP 2021: ringworm + back to school \u2192 no exclusion if treatment initiated + Gupta 2005 - JAAD: comprehensive review of childhood ringworm \u2192 sources + treatment + screening + Seebacher 2007 - Mycoses: kerion \u2192 European epidemiology + treatment + Hay 2017 - Mycoses: tinea capitis \u2192 worldwide epidemiology + treatment \u2192 recent review + Public Health Agency of Canada (PHAC): tinea capitis + management in the community + SCD (Canadian Dermatology Society): tinea capitis + kerion recommendations in Canada + INESSS Qu\u00e9bec + RAMQ: griseofulvin + terbinafine + itraconazole + prednisone \u2192 reimbursed in pediatric indications <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>A child with a boggy inflammatory plaque of the scalp with suppuration, cervical adenopathy, and alopecia must be treated urgently with an oral systemic antifungal; topical antifungals alone do not penetrate the hair follicles and are insufficient.<\/strong> the choice of antifungal agent depends on the suspected agent (terbinafine for T. tonsurans \/ griseofulvin or itraconazole for M. canis). The addition of oral prednisone (1-2 mg\/kg\/d \u00d7 7-14 days) accelerates resolution of inflammation and may reduce the risk of permanent scarring. DO NOT incise the kerion - it is not a bacterial abscess. DO NOT use topical corticoids alone - they aggravate fungal growth.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical attention<\/div>\n <p><strong>Child 2-12 years old with boggy (soft + fluctuating) scalp plaque + suppuration + broken hair + plaque alopecia + voluminous + tender cervical lymphadenopathy + fever<\/strong> \u2192 kerion (severe inflammatory ringworm) \u2192 urgent medical consultation \u2192 mycological samples (KOH + culture) \u2192 immediate oral systemic antifungal without waiting for culture: griseofulvin 20-25 mg\/kg\/d if M. canis suspected (contact with cat or dog) OR terbinafine if T. tonsurans \u2192 prednisone 1 mg\/kg\/d \u00d7 7-14 days if significant inflammation \u2192 antifungal shampoo \u00d7 2-3\/week \u2192 DO NOT incise.<\/p>\n <p><strong>Child treated for kerion for 4 weeks with no clinical improvement\u2014persistent inflammation + new suppuration + increasing hair loss<\/strong> \u2192 treatment failure \u2192 check compliance (griseofulvin with fatty meals?) \u2192 reassess mycological culture for species identification + antifungal \u2192 if M. canis non-responder \u2192 increase griseofulvin dose \u2192 or switch to itraconazole \u2192 if T. tonsurans \u2192 terbinafine \u2192 pediatric dermatological consultation \u2192 risk of scarring alopecia if prolonged delay.<\/p>\n <p><strong>Child with kerion + diffuse vesicular rash on palms + soles + or trunk without infection of these sites<\/strong> \u2192 id reaction (trichophytide) \u2192 remote allergic reaction to dermatophyte antigens \u2192 NO remote infection \u2192 NO local antifungal treatment of id lesions \u2192 trichophytide regresses with systemic treatment of kerion \u2192 antihistamines if intense pruritus \u2192 medical consultation for confirmation.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron physicians diagnose kerion clinically (boggy, suppurative, alopecic plaque + cervical lymphadenopathy in children), prescribe mycological samples (KOH + culture), initiate appropriate systemic antifungal treatment based on the suspected agent (griseofulvin + terbinafine + itraconazole), add systemic corticosteroids if the kerion is large or severe, advise on surrounding measures (animal contact + siblings + hygiene), and refer to a pediatric dermatologist if the case is complex or resistant. Consultations are available at several service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for medical or dermatological advice. Kerion is a therapeutic emergency \u2014 delayed treatment carries the risk of permanent scarring alopecia. An oral systemic antifungal is essential \u2014 topical treatments alone are insufficient.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>K\u00e9rion (teigne inflammatoire) : diagnostic et traitement | Clinique Omicron Dermatologie & P\u00e9diatrie & Infectiologie & M\u00e9decine de famille K\u00e9rion (teigne inflammatoire du cuir chevelu) Le k\u00e9rion \u2014 du grec kerion, signifiant \u00ab nid d’abeilles \u00bb \u2014 est la forme la plus s\u00e9v\u00e8re et la plus inflammatoire de teigne du cuir chevelu (tinea capitis), r\u00e9sultant… <a href=\"https:\/\/cliniqueomicron.ca\/en\/kerion\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Kerion (inflammatory ringworm): diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"K\u00e9rion (teigne inflammatoire) : | Brossard | Clinique Omicron","_metasync_otto_description":"Le k\u00e9rion est une forme s\u00e9v\u00e8re de teigne inflammatoire du cuir chevelu caus\u00e9e par des dermatophytes. 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\n\t\t\t\t\t\n\n\n\n\nKerion (inflammatory ringworm): diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Kerion is a severe form of inflammatory ringworm of the scalp caused by dermatophytes. Griseofulvin, terbinafine, itraconazole, corticoids and management in Quebec.\">\n<meta name=\"keywords\" content=\"k\u00e9rion traitement, teigne inflammatoire k\u00e9rion, teigne cuir chevelu enfant, griseofulvine teigne, terbinafine tinea capitis, k\u00e9rion antifongique, k\u00e9rion cortico\u00efdes, tinea capitis Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-spacing:uppercase;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Dermatology & Pediatrics & Infectious Diseases & Family Medicine<\/span>\n <h1>Kerion (inflammatory ringworm of the scalp)<\/h1>\n\n <div class=\"co-intro\">\n Kerion - from the Greek kerion, meaning \u00abhoneycomb\u00bb - is the most severe and inflammatory form of scalp ringworm (tinea capitis), resulting from an intense host immune reaction against the antigens of a dermatophyte invading the hair follicles and perifollicular stroma. It presents as a boggy (soft + fluctuating like a fluid-soaked sponge) + purulent (suppurating) + painful + alopecising inflammatory plaque of the scalp, often accompanied by tender regional cervical adenopathy, fever and altered general condition. Unlike dry ringworm (non-inflammatory tinea capitis - scaly + alopecia), kerion is triggered by a type IV (delayed) hypersensitivity reaction of the host against fungal antigens - this intense inflammatory reaction is itself responsible for follicular damage and the risk of permanent scarring alopecia if treatment is delayed. It affects almost exclusively children of prepubertal age (2-14 years) and constitutes a pediatric dermatological therapeutic emergency. Zoophilic dermatophytes (from animals - Microsporum canis + cats and dogs + Trichophyton verrucosum + cattle) and geophilic dermatophytes (from soil - Microsporum gypseum) are the agents most often responsible for kerion, as they trigger a more intense inflammatory reaction than anthropophilic dermatophytes (Trichophyton tonsurans - transmitted from human to human - more often responsible for dry ringworm). Treatment is based on oral systemic antifungals (griseofulvin + terbinafine + itraconazole) - topical antifungals alone are insufficient, as follicular penetration requires systemic treatment. The addition of systemic corticosteroids is recommended by some experts to accelerate resolution of inflammation and reduce the risk of scarring alopecia.\n <\/div>\n\n <h2>Microbiology, pathophysiology, and clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Etiologic agents, sources of contamination, and pathophysiology of kerion:<\/strong> dermatophytes responsible for scalp ringworm and kerion: anthropophilic dermatophytes (transmitted from human to human - mainly causing dry ringworm): Trichophyton tonsurans : most frequent agent in North America (particularly in African-American and Caribbean communities) \u2192 endothrix ringworm (spores inside the hair \u2192 hair brittle + easily pulled out) \u2192 often dry ringworm \u2192 kerion possible but less frequent + Trichophyton violaceum + Microsporum audouinii (rare) \u2192 zoophilic dermatophytes (transmitted by animals - trigger intense inflammatory reactions \u2192 kerion ++): Microsporum canis: cats + dogs \u2192 most frequent zoophilic agent in Quebec \u2192 teigne ectothrix (spores outside the hair sheath \u2192 brittle hair + fluoresces under Wood's lamp - yellow-green) \u2192 intense inflammatory reaction \u2192 kerion + Trichophyton mentagrophytes : rabbits + guinea pigs + rodents + Trichophyton verrucosum: cattle + horses \u2192 responsible for deep kerions (boggy) + geophilic dermatophytes (originating from the soil - trigger intense inflammatory reactions): Microsporum gypseum: soils \u2192 gardening work + contact with soil \u2192 kerion sometimes + kerion pathophysiology: invasion of hair follicles by the dermatophyte \u2192 penetration into the hair cortex (endothrix) or around the sheath (ectothrix) \u2192 production of keratinolytic enzymes (keratinases + proteases) \u2192 degradation of keratin \u2192 activation of adaptive immunity (CD4+ Th1 T lymphocytes) \u2192 type IV delayed hypersensitivity reaction \u2192 influx of neutrophils \u2192 formation of folliculitis + follicular abscesses \u2192 suppuration \u2192 this immune reaction is initially protective (it eliminates the fungus) but if excessive \u2192 damage to hair follicles \u2192 perifollicular fibrosis \u2192 risk of permanent scarring alopecia if treated late \u2192 kerion represents an immunological battle between the host (intense reaction) and the fungus \u2192 antifungal treatment + corticoids (to moderate the reaction) must be initiated rapidly to preserve viable hair follicles + id reaction (trichophytide) : remote allergic reaction \u2192 vesicular lesions on hands + feet + or trunk \u2192 immune mechanism (no remote infection - no local antifungal treatment at these sites) \u2192 regression with systemic antifungal treatment<\/li>\n <li><strong>Clinical Presentation and Differential Diagnosis:<\/strong> clinical presentation of kerion: single (or multiple) plaque on the scalp \u2192 boggy appearance (soft + fluctuating like a soaked sponge) + suppurating (pus drains on pressure or spontaneously from follicular ostia \u2192 \u00abhoneycomb\u00bb appearance) + erythematous + painful to the touch + alopeciating (alopecia of the plaque + peeling of the hair on the lesion) + crusts + scales + size: 2-10 cm in diameter \u2192 broken hair remains on the plaque (unlike alopecia areata where the scalp is smooth) + location: scalp preferentially \u2192 may involve beard + eyelashes + eyebrows + posterior cervical + suboccipital adenopathies + painful + voluminous \u2192 almost constant in kerion \u2192 may be the first sign leading to consultation + fever + asthenia (in severe forms) + sometimes : id reaction (trichophytide) at a distance + characteristics depending on the agent: Microsporum canis \u2192 yellow-green fluorescence with Wood's lamp (ultraviolet lamp - present in around 50 % of cases of M. canis) \u2192 endothrix of T. tonsurans \u2192 NO fluorescence + paraclinical work-up: direct mycological examination: hair + scales removed \u2192 microscopic examination + potash (KOH) \u2192 visualizes spores around (ectothrix) or inside the hair (endothrix) + culture on Sabouraud agar + actidione + chloramphenicol \u2192 2-4 weeks for identification \u2192 genus + species specification \u2192 guides epidemiology + source + CBC: moderate leukocytosis + sign of systemic inflammation + elevated CRP \u2192 differential diagnosis: bacterial scalp abscess: staphylococcus + streptococcus \u2192 frank pus + without hair breakage \u2192 bacterial culture + furunculosis + bacterial pustular folliculitis \u2192 no diffuse alopecic plaque + alopecia areata (alopecia): non-inflammatory + non-purulent + smooth scalp + no broken hair + no adenopathies + centrifugal extension possible + chickenpox + burn scars <\/ul>\n\n <h2>Antifungal treatment and management<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Treatment \/ appearance<\/th><th>Data, methods and results<\/th><th>Key studies and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Systemic antifungals \u2014 griseofulvin, terbinafine, itraconazole<br><small style=\"font-weight:400;color:#7a8fa0;\">Griseofulvin \u2014 terbinafine \u2014 itraconazole \u2014 fluconazole \u2014 treatment duration \u2014 dosage by weight \u2014 treatment of choice by agent \u2014 follow-up \u2014 mycological test \u2014 fatty foods \u2014 adverse effects<\/small><\/td>\n <td>Systemic antifungal treatment - mainstay of kerion treatment: fundamental reminder: topical antifungals alone are INSUFFICIENT \u2192 do not penetrate hair follicles to the required depth \u2192 oral SYSTEMIC treatment is essential + education: avoid sharing hairbrushes + caps + pillows + during treatment \u2192 no systematic school eviction if treatment initiated (AAP + NICE) \u2192 antifungal shampoo (ketoconazole 2 % or selenium sulfide 2.5 %) \u00d7 2-3\/week as a supplement (reduces fungal load and risk of contamination) \u2192 griseofulvin : historical antifungal + still widely used + pediatric approved \u2192 mechanism: inhibition of fungal tubulin polymerization \u2192 mitosis arrest + dosage: micronized griseofulvin 20-25 mg\/kg\/d PO in 1-2 doses \u2192 max 1 g\/d \u2192 or ultramicronized griseofulvin 10-15 mg\/kg\/d \u2192 take with a fatty meal (increased absorption \u00d7 2) \u2192 duration: 6-12 weeks (up to 4 weeks after clinical and mycological cure) \u2192 efficacy: cure rate 80-95 % for M. canis + less effective for T. tonsurans (sometimes requires higher doses or longer duration) \u2192 adverse effects: photosensitivity + headache + GI disorders + drug interactions (CYP3A4 inducing enzyme \u2192 reduces efficacy of hormonal contraceptives + warfarin + ciclosporin) + contraindication: pregnancy (teratogenic) \u2192 porphyrias \u2192 lupus erythematosus; terbinafine: 2nd-generation antifungal \u2192 mechanism: inhibition of squalene epoxidase \u2192 stops ergosterol synthesis + accumulation of toxic squalene \u2192 fungicide \u2192 superior to griseofulvin for T. tonsurans \u2192 pediatric dosage: 35 kg: 250 mg\/d \u2192 duration: 4-6 weeks \u2192 superior to griseofulvin in terms of treatment duration (shorter) \u2192 Chen 2001 - Journal of the American Academy of Dermatology: terbinafine superior to griseofulvin for T. tonsurans + shorter duration \u2192 terbinafine is now recommended as 1st-line for T. tonsurans in the USA (AAP 2021) \u2192 for M. canis \u2192 griseofulvin or itraconazole preferred (terbinafine less effective against Microsporum) \u2192 adverse effects: GI disorders + rash + rarely hepatotoxicity (liver workup if prolonged treatment) \u2192 monitor CBC if prolonged treatment (neutropenia rare); itraconazole : azole \u2192 mechanism: inhibition of fungal cytochrome P450 (14\u03b1-demethylase) \u2192 cessation of ergosterol synthesis \u2192 pediatric dosage: 5 mg\/kg\/d PO in 1 dose \u2192 duration: 4-6 weeks \u2192 effective for Microsporum + Trichophyton \u2192 alternative to griseofulvin if intolerance \u2192 numerous drug interactions (CYP3A4 inhibitor ++ ) \u2192 contraindication: congestive heart failure + taken with meals (capsules) \u2192 fluconazole: triazole + dosage: 6 mg\/kg\/d \u00d7 2-4 weeks \u2192 or pulse protocol (6 mg\/kg\/week \u00d7 4-8 weeks) \u2192 alternative if griseofulvin + terbinafine + itraconazole not available or not tolerated \u2192 less robust data for ringworm + choice according to causative agent (summary): T. tonsurans: terbinafine (1st line AAP) + or griseofulvin (long-term) \u2192 M. canis: griseofulvin + or itraconazole \u2192 T. verrucosum: griseofulvin + or itraconazole<\/td>\n <td>Chen 2001 \u2014 Journal of the American Academy of Dermatology: terbinafine vs griseofulvin + T. tonsurans \u2192 terbinafine superior + shorter duration \u2192 drug of choice for T. tonsurans + AAP (American Academy of Pediatrics) 2021: scalp ringworm guidelines + terbinafine first-line for T. tonsurans + griseofulvin if M. canis + NICE 2018: ringworm guidelines + kerion \u2192 griseofulvin + terbinafine + itraconazole + British Association of Dermatologists (BAD) 2014: tinea capitis guidelines \u2192 kerion \u2192 systemic treatment \u2192 +\/- corticosteroids + Gupta 2005 \u2014 Journal of the American Academy of Dermatology: review of systemic antifungals for pediatric ringworm \u2192 Seebacher 2007 \u2014 Mycoses: kerion \u2192 treatment + epidemiology + INESSS Quebec + RAMQ: griseofulvin reimbursed for tinea capitis + terbinafine 250 mg reimbursed + itraconazole reimbursed + Health Canada: griseofulvin + terbinafine + itraconazole approved <\/tr>\n <tr>\n <td>Systemic corticosteroids, topical care, and supportive measures<br><small style=\"font-weight:400;color:#7a8fa0;\">Prednisone - methylprednisolone - cicatricial alopecia prevention - local care - drainage contraindicated - compresses - drying - home monitoring - contamination - animals - sibling screening - antifungal shampoo - return to school<\/small><\/td>\n <td>Systemic corticoids - reduce inflammation and prevent scarring alopecia: role of corticoids in kerion: excessive immune response (type IV hypersensitivity) is itself destructive to hair follicles \u2192 corticoids reduce inflammation + preserve viable follicles \u2192 recommendation: prednisone PO 1-2 mg\/kg\/d \u00d7 7-14 days \u2192 in association with the systemic antifungal \u2192 never as monotherapy (the fungus will continue to proliferate on corticoids alone) \u2192 results: faster regression of kerion + reduced pain + reduced adenopathy + possible reduced risk of scarring alopecia (less solid data) \u2192 Hussain 2007 - Journal of the European Academy of Dermatology and Venereology : corticosteroids + kerion \u2192 reduced inflammation + improved regression \u2192 moderate level of evidence \u2192 BAD 2014 + NICE 2018 guidelines recommend considering systemic corticosteroids in bulky + painful + kerion with risk of scarring alopecia + local management of kerion: DO NOT incise the kerion (nor drain surgically) \u2192 the kerion is NOT a frank bacterial abscess \u2192 incision only aggravates the lesion + risk of bacterial superinfection + soft compresses soaked in an antiseptic solution (saline + or mildly diluted chlorhexidine) \u2192 maintain local hygiene without trauma \u2192 antifungal shampoo (ketoconazole 2 % + or selenium sulfide 2,5 %) \u00d7 2-3\/week \u2192 reduces fungal load + decreases risk of contamination of surroundings \u2192 especially in the first few weeks + secondary bacterial superinfection : possible in highly suppurative kerions \u2192 staphylococcus + streptococcus \u2192 oral antibiotic therapy if documented superinfection (amoxicillin-clavulanate + or cefalexin) \u2192 bacterial culture of pus \u2192 check on cure: check mycological examination at 6-8 weeks \u2192 negative culture = mycological cure \u2192 clinical cure often precedes mycological cure; surrounding and public health measures: look for animal source: M. canis \u2192 cats + dogs \u2192 veterinary examination \u2192 antifungal treatment of animal if affected (miconazole lotion + or veterinary griseofulvin) \u2192 T. verrucosum \u2192 farm animals (cattle + horses) \u2192 veterinary report \u2192 screening of siblings and close contacts: clinical scalp examination + mycological sampling if symptoms \u2192 treatment of symptomatic carriers \u2192 asymptomatic carrier children transmit the fungus but require treatment if mycological confirmation + return to school : AAP + Canadian authorities generally recommend NOT to exclude the child from school once systemic treatment is initiated \u2192 antifungal shampoo during treatment period \u2192 inform school + parents of contacts \u2192 school eviction is excessive and not recommended in most guidelines<\/td>\n <td>Hussain 2007 - Journal of the European Academy of Dermatology and Venereology: systemic corticoids + kerion \u2192 reduced inflammation + accelerated regression + BAD 2014 (British Association of Dermatologists): tinea capitis guidelines \u2192 kerion \u2192 systemic corticoids recommended in severe forms + NICE 2018: tinea capitis + kerion \u2192 systemic treatment + corticoids if severe + AAP 2021: ringworm + back to school \u2192 no exclusion if treatment initiated + Gupta 2005 - JAAD: comprehensive review of childhood ringworm \u2192 sources + treatment + screening + Seebacher 2007 - Mycoses: kerion \u2192 European epidemiology + treatment + Hay 2017 - Mycoses: tinea capitis \u2192 worldwide epidemiology + treatment \u2192 recent review + Public Health Agency of Canada (PHAC): tinea capitis + management in the community + SCD (Canadian Dermatology Society): tinea capitis + kerion recommendations in Canada + INESSS Qu\u00e9bec + RAMQ: griseofulvin + terbinafine + itraconazole + prednisone \u2192 reimbursed in pediatric indications <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>A child with a boggy inflammatory plaque of the scalp with suppuration, cervical adenopathy, and alopecia must be treated urgently with an oral systemic antifungal; topical antifungals alone do not penetrate the hair follicles and are insufficient.<\/strong> the choice of antifungal agent depends on the suspected agent (terbinafine for T. tonsurans \/ griseofulvin or itraconazole for M. canis). The addition of oral prednisone (1-2 mg\/kg\/d \u00d7 7-14 days) accelerates resolution of inflammation and may reduce the risk of permanent scarring. DO NOT incise the kerion - it is not a bacterial abscess. DO NOT use topical corticoids alone - they aggravate fungal growth.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical attention<\/div>\n <p><strong>Child 2-12 years old with boggy (soft + fluctuating) scalp plaque + suppuration + broken hair + plaque alopecia + voluminous + tender cervical lymphadenopathy + fever<\/strong> \u2192 kerion (severe inflammatory ringworm) \u2192 urgent medical consultation \u2192 mycological samples (KOH + culture) \u2192 immediate oral systemic antifungal without waiting for culture: griseofulvin 20-25 mg\/kg\/d if M. canis suspected (contact with cat or dog) OR terbinafine if T. tonsurans \u2192 prednisone 1 mg\/kg\/d \u00d7 7-14 days if significant inflammation \u2192 antifungal shampoo \u00d7 2-3\/week \u2192 DO NOT incise.<\/p>\n <p><strong>Child treated for kerion for 4 weeks with no clinical improvement\u2014persistent inflammation + new suppuration + increasing hair loss<\/strong> \u2192 treatment failure \u2192 check compliance (griseofulvin with fatty meals?) \u2192 reassess mycological culture for species identification + antifungal \u2192 if M. canis non-responder \u2192 increase griseofulvin dose \u2192 or switch to itraconazole \u2192 if T. tonsurans \u2192 terbinafine \u2192 pediatric dermatological consultation \u2192 risk of scarring alopecia if prolonged delay.<\/p>\n <p><strong>Child with kerion + diffuse vesicular rash on palms + soles + or trunk without infection of these sites<\/strong> \u2192 id reaction (trichophytide) \u2192 remote allergic reaction to dermatophyte antigens \u2192 NO remote infection \u2192 NO local antifungal treatment of id lesions \u2192 trichophytide regresses with systemic treatment of kerion \u2192 antihistamines if intense pruritus \u2192 medical consultation for confirmation.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron physicians diagnose kerion clinically (boggy, suppurative, alopecic plaque + cervical lymphadenopathy in children), prescribe mycological samples (KOH + culture), initiate appropriate systemic antifungal treatment based on the suspected agent (griseofulvin + terbinafine + itraconazole), add systemic corticosteroids if the kerion is large or severe, advise on surrounding measures (animal contact + siblings + hygiene), and refer to a pediatric dermatologist if the case is complex or resistant. Consultations are available at several service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for medical or dermatological advice. Kerion is a therapeutic emergency \u2014 delayed treatment carries the risk of permanent scarring alopecia. An oral systemic antifungal is essential \u2014 topical treatments alone are insufficient.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>K\u00e9rion (teigne inflammatoire) : diagnostic et traitement | Clinique Omicron Dermatologie & P\u00e9diatrie & Infectiologie & M\u00e9decine de famille K\u00e9rion (teigne inflammatoire du cuir chevelu) Le k\u00e9rion \u2014 du grec kerion, signifiant \u00ab nid d’abeilles \u00bb \u2014 est la forme la plus s\u00e9v\u00e8re et la plus inflammatoire de teigne du cuir chevelu (tinea capitis), r\u00e9sultant… <a href=\"https:\/\/cliniqueomicron.ca\/en\/kerion\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Kerion (inflammatory ringworm): diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"K\u00e9rion (teigne inflammatoire) : | Brossard | Clinique Omicron","_metasync_otto_description":"Le k\u00e9rion est une forme s\u00e9v\u00e8re de teigne inflammatoire du cuir chevelu caus\u00e9e par des dermatophytes. Griseofulvine, terbinafine, itraconazole, cortico\u00efdes et...","_metasync_otto_keywords":"","_metasync_otto_og_title":"K\u00e9rion (teigne inflammatoire) : | Brossard | Clinique Omicron","_metasync_otto_og_description":"Le k\u00e9rion est une forme s\u00e9v\u00e8re de teigne inflammatoire du cuir chevelu caus\u00e9e par des dermatophytes. Griseofulvine, terbinafine, itraconazole, cortico\u00efdes et...","_metasync_otto_twitter_title":"K\u00e9rion (teigne inflammatoire) : | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"Le k\u00e9rion est une forme s\u00e9v\u00e8re de teigne inflammatoire du cuir chevelu caus\u00e9e par des dermatophytes. 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