Lesson of the week: Unnecessary surgical treatment of fungal kerions in children

Children with suspected kerion or scalp abscess should be assessed first by a dermatologist The incidence of tinea capitis in children living in inner cities in the United Kingdom is rising and is reaching epidemic proportions in London. The organism responsible for the infection is also changing. There has been a dramatic increase in infection with Trichophyton tonsurans , particularly among Asian and Afro-Caribbean patients. Fungal infections of the scalp can cause kerions—pus filled inflammatory swellings that may look like bacterial abscesses. Many children with scalp infections who present at accident and emergency departments are being triaged to surgical teams rather than dermatology units. We report two children who underwent incision and drainage of their kerions under local and general anaesthesia. This treatment was unnecessary and inappropriate and carried the risks associated with general anaesthesia and surgery. We recommend that children who present at emergency departments with boggy, pus filled swellings on the scalp should be seen first at dermatology units, where appropriate investigations and antifungal treatment can be instigated. ### Case 1 An 11 year old white boy presented to the accident and emergency department. He had had a scaly eruption affecting the right parietal area of the scalp for six weeks. He had been prescribed potent topical …