儿童脓癣20例临床分析

Clinical analysis of 20 pediatric patients with kerion

回顾性分析2014年1月至2020年6月济宁医学院附属医院皮肤科诊治的20例儿童脓癣患者的临床资料,包括一般资料、临床表现、实验室检查、治疗及转归。20例患者年龄2~10岁,男13例,女7例。有动物接触史者13例,父母患有浅部真菌感染者4例。20例患者均有脱发,6例临床表现为炎性肿块,14例为痈样脓肿,部分伴有淋巴结肿大和发热。4例曾误诊为细菌感染所致脓肿并予以切开引流致深在溃疡。培养分离病原菌13株,其中石膏样小孢子菌4株、红色毛癣菌3株、犬小孢子菌2株、断发毛癣菌1株、絮状表皮癣菌1株、须癣毛癣菌1株、镰刀霉菌1株。20例均给予氟康唑口服,局部外用抗真菌药物联合氦氖激光照射治疗。治愈19例,遗留不同程度疤痕和秃发。提示脓癣常表现为炎性皮损,临床易误诊,真菌学检查有助于诊断,治疗可选用氟康唑。

Twenty pediatric patients with kerion were treated in Department of Dermatology,Affiliated Hospital of Jining Medical University from January 2014 to June 2020.The general information,clinical manifestations,laboratory test results,treatment and prognosis were retrospectively analyzed.There were 13 males and 7 females aged from 2 to 10 years.Thirteen patients had a history of contact with animals,4 had contact with parents with tinea.All patients had alopecia,6 cases presented with inflammatory mass,14 presented with abscessus;some patients had regional lymphadenopathy and febrile.Four cases were misdiagnosed as abscesses caused by bacterial infection and underwent incision leading to deep ulcers.A total of 13 fungal strains were isolated,including 4 strains of Microsporum gypseum,3 strains of Trichophyton rubrum,2 strains of Microsporum canis,the others were Trichophyton tonsurans and Trichophyton mentagrophytes and Fusarium.All patients were treated with fluconazole,concomitantly with topical antifungals and He-Ne laser,19 of whom were cured.It is suggested that kerion characterized by inflammatory lesions is likely to be misdiagnosed.Fungal examination can confirm the diagnosis of kerion,and fluconazole is effective for treatment.