Introduction

Tinea capitis is a fungal infection of the scalp caused by a group of fungi known as dermatophytes.¹ In some cases, the infection can trigger an intense immune response, leading to inflammation and the formation of pus-filled, swollen lesions. The more severe form of the condition is called kerion. While kerion most commonly affects the scalp, it can also appear on other areas such as the neck and shoulders.²

Early diagnosis and treatment of kerion are crucial to prevent unnecessary pain, scarring, and long-term damage. If left untreated, kerion can lead to a range of complications, and some are mild while others are more serious. This article explores those potential outcomes and emphasises the importance of timely medical intervention.

Background: Understanding Kerion

As mentioned in the introduction, Kerion is a type of scalp infection caused by fungal organisms, most commonly dermatophytes such as Trichophyton and Microsporum species. These fungi thrive in warm, moist environments, which makes areas like the scalp, neck, and face particularly vulnerable. The infection begins when the fungus invades hair follicles, triggering an intense immune response that results in inflammation, swelling, pus formation, and sometimes even hair loss.³

Kerion is more commonly seen in children, but it can also occur in adults, particularly in tropical regions or settings where hygiene is poor. Because it is an infectious condition, kerion is contagious and can spread through direct skin-to-skin contact or by sharing contaminated personal items like combs, hats, towels, and bedding. Practising good personal hygiene and avoiding the sharing of grooming tools are essential in preventing transmission.³

Diagnostic Tools and Treatment Options

Kieron can be easily mistaken for other conditions, such as psoriasis or eczema; they share lots of the same features. However, medical professionals have several tests which can be carried out to distinguish it from other similar conditions.³

Woods’s Lamp Examination

A Wood’s lamp examination is often used as an initial step when a healthcare provider suspects kerion. A Wood’s lamp uses long-wave ultraviolet (UV) light to highlight certain fungal or bacterial skin infections, making some organisms glow under the light. For the test to be accurate, the skin should be clean, and the examination should take place in a dark room, free of natural or artificial light.⁴

Under UV light, healthy skin typically appears slightly blue, with white fluorescence over thicker areas, yellow in oilier zones, and purple in dehydrated areas.⁴ If the kerion is caused by a fungus like Microsporum, the infected areas may fluoresce blue-green or yellow-green. However, not all fungal species fluoresce, so a Wood’s lamp is not a definitive diagnostic tool, but it can provide useful clues.⁴

Sample Collection and KOH Test

To ensure a more precise diagnosis, a healthcare professional might carefully take a sample by scraping the affected area. This is then treated with potassium hydroxide (KOH) to dissolve keratin and reveal fungal elements under a microscope. While quick, this test doesn’t specify the fungal species.³

Fungal Culture

A more precise method is fungal culture, which involves incubating the sample in a nutrient medium for several weeks. Once growth occurs, lab techniques like staining or biochemical testing can identify the exact fungal organism and its characteristics. Although slower, this method is considered the gold standard for diagnosis and guides targeted treatment.⁵

Complications of Untreated Kerion

Permanent Hair Loss (Scarring Alopecia)

A potential issue caused by untreated kerion is scarring alopecia, which is a type of hair loss that results from the destruction of hair follicles. Hair loss from scarring alopecia can be permanent, as hair follicles are damaged, leaving bald patches around the individual’s body. Scarring alopecia comes in two different forms: primary and secondary. Primary scarring alopecia is caused by an inflammatory or autoimmune disease that directly targets and kills hair follicles, while secondary scarring alopecia results from skin damage or injury, for example, a burn. Scarring alopecia from untreated kerion is primary, as it is due to inflammation.⁶

Secondary Bacterial Infection

Areas of the body affected by Kerion are especially vulnerable to secondary bacterial infections. These occur when bacteria, such as Staphylococcus aureus, take advantage of the broken skin and a weakened immune system. Open, oozing patches are particularly at risk for becoming superinfected, leading to painful complications like cellulitis or abscesses. Symptoms of a secondary infection can include fever, swelling, increased pain, and redness or discharge from the affected site. In some cases, treatment may require antibiotics and even surgical drainage to fully resolve the infection and prevent further spread.⁷

Spread of Infection

Overall, leaving kerion untreated can make the infection much worse. Without proper treatment, it can spread to other parts of your body and even to other people. This increases pain and discomfort, raises the risk of permanent hair loss, and makes the individual more likely to develop a secondary bacterial infection. Over time, the condition can become harder to manage and more distressing for the person affected.⁷

Pain and Discomfort

When a kerion goes untreated, the individual may experience ongoing pain due to the throbbing inflammation and constant itchiness. This discomfort can make it difficult to concentrate during daily activities and may even interfere with getting a good night's sleep. Over time, the persistent irritation can really take a toll on a person’s overall well-being and quality of life.⁸

Psychological and Social Impact

This condition can take a significant toll on a person's mental health, especially because of its unusual appearance. When it affects a highly visible area, like the neck or face, it can be even more distressing. Children may become targets of bullying or teasing, which can deeply affect their self-esteem and emotional well-being. Adults, on the other hand, might feel embarrassed or self-conscious, leading to feelings of social anxiety or isolation. Over time, this can contribute to low self-confidence and even depression. If the condition worsens and results in hair loss, the emotional impact can be even greater. Hair is often closely tied to personal identity and appearance, so losing it can be traumatic. Overall, the psychological effects of this condition are just as important to address as the physical symptoms^.8

Prevention and Early Intervention

First and foremost, it is important to recognise early signs of tinea capitis, such as dry, scaly rashes, itchiness, and swollen, red patches, before it progresses to kerion. With tinea capitis and kerion, treatment involves tackling the root cause, which is the fungus. To do so, oral antifungals are prescribed by healthcare professionals to kill the fungus and prevent it from growing.⁹ Common oral antifungal medications used to treat kerion are fluconazole, griseofulvin, itraconazole, and terbinafine. The medicine prescribed to the individual depends on many things, such as the location of the Kerion or the age of the individual, for example.⁹

As a preventative measure, maintaining good personal hygiene is pivotal as this can prevent kerion from escalating or forming in the first place. Important hygiene practices include:¹⁰

•  Washing hands a feet
•  Covering coughs and sneezes
•  Grooming nails
•  Menstrual hygiene
•  Cleaning surroundings (surfaces, toilets, floor)

Also, discouraging sharing personal items such as combs, hats, and towels to minimise the risk of infection is important, so the fungal infection doesn’t spread.¹⁰

Whilst there is no specific vaccination for kerion, getting the vaccination can support overall health and immune function. Maintaining a healthy diet rich in vitamins can also boost immune function and make your body less susceptible to Kerions.¹¹

Summary

In summary, Kerion can have a significant effect on an individual's emotional and physical well-being, which is why it is paramount to recognise early symptoms, diagnose, and treat the infection. Most common early symptoms include inflammation and hair loss, and definitive diagnosis can be done via KOH test or culture sample. A wood lamp can also be used to aid in its diagnosis.

An untreated infection can lead to scarred alopecia, bacterial infection, spreading of the infection, and more pain for the individual. To avoid this from happening, popular treatments include antifungal creams which kill the fungus directly. As a preventive measure, maintaining good personal hygiene is essential, as well as the avoidance of sharing personal items.