Trichophyton Tonsurans-Induced Kerion Celsi with Decreased Defensin Expression and Paradoxically Increased Interleukin-17A Production

July 2019 in “ The Journal of Dermatology ”

Yoshihiro Gotō, Takahiro Suzuki, Yoko Suzuki, Kazushi Anzawa, Takashi Mochizuki, Takashi Tamura, Koichi Makimura, Masahiro Aoshima, Taisuke Ito, Y. Tokura

TLDR Terbinafine effectively treated kerion celsi despite disrupted immune responses.

The document reported a case of kerion celsi in an 18-year-old male judo practitioner, characterized by alopecic patches and subcutaneous abscesses due to Trichophyton tonsurans infection. Despite initial treatment with oral itraconazole showing no effect, subsequent treatment with terbinafine was effective. A skin biopsy revealed infiltration of neutrophils, lymphocytes, and histiocytes, with abscesses around dilated hair follicles. Immunostaining indicated decreased expression of human β-defensin 2 (HBD-2) in the epidermis, despite an unexpected increase in interleukin-17A (IL-17A) expression around damaged hair follicles. This suggested a disorder in IL-17A-upregulated antimicrobial peptide expression, potentially leading to severe inflammation, tissue damage, and scarring in kerion celsi.

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