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

    September 2024 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
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    TLDR Terbinafine effectively treated kerion celsi despite disrupted immune responses.
    An 18-year-old male with kerion celsi caused by Trichophyton tonsurans exhibited alopecic patches and subcutaneous abscesses. Initial treatment with itraconazole was ineffective, but terbinafine showed good results. Skin biopsy revealed neutrophil, lymphocyte, and histiocyte infiltration with abscesses around dilated hair follicles. Immunostaining indicated decreased human β-defensin 2 (HBD-2) expression in the epidermis, despite increased interleukin-17A (IL-17A) presence around damaged hair follicles. This suggests a disruption in IL-17A-induced antimicrobial peptide expression, leading to severe inflammation and potential scarring.
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