断发毛癣菌所致婴儿脓癣并发癣菌疹1例

A case of infant kerion with dermatophytid reaction due to Trichophyton tonsurans

患儿男,5个月,额部发际处红斑3个月。皮肤科检查:前额发际处大片红斑,相互融合、边界较清,红斑内头发稀疏,个别折断或脱失,毛囊性脓疱及皮下脓肿,经真菌镜检、培养及提取DNA做PCR后测序鉴定,确诊为断发毛癣菌致婴儿脓癣,予口服伊曲康唑(33mg/d)及外用2%酮康唑洗剂、1%萘替芬-0.25%酮康唑乳膏等治疗。在治疗中出现头面部多发散在环状鳞屑性丘疹及红斑,诊断脓癣继发癣菌疹,加用泼尼松(5 mg/d)口服,改用1%卢立康唑乳膏。抗真菌药物体外药敏试验证实1%卢立康唑乳膏比1%萘替芬-0.25%酮康唑乳膏抗菌活性更强。伊曲康唑治疗9周、泼尼松治疗5周后皮损完全消退,重新长出新发,无瘢痕秃发形成。停药后随访1a无复发。

A 5-month-old male infant had erythema around frontal hairline for 3 months.Physical examination showed largeerythema with clear boundary, hair loss or broken hair, follicular pustules and skin abscesses.Based on the microscopic exami- nation of the KOH preparation,culture and DNA extracted PCR-sequencing identification,infant kerion due to Trichophyton tonsurans was diagnosed.Treatment of oral itraconazole （33 rag/d）, topical wash with 2% ketoconazole shampoo, then 1% naftifine-0.25 % ketoconazole cream were administrated.During the therapeutic session, sporadic annular scaly papules and er- ythema were appeared over the head and face, which was considered as secondary dermatophytid reaction, be deal with by adding prednisone （5 mg/d） orally and changing topical drug with 1% luliconazole cream. Antifungal susceptibility test in vitro showed that 10% luliconazole cream is superior to 1 % naftifine-0.25% ketoeonazole cream.After 9 weeks treatment of itraconazole and 5 weeks of prednisone,the lesions resolved, and new hair grew back without scarring or alopecia. No recur- rence after treatment was observed with one-year follow-up.