title: [Generalized exanthematous pustular dermatophytid, a rare clinical presentation of dermatophytid reaction].
abstract: BACKGROUND
  Dermatophytids are immunologically mediated dermatologic presentations secondary to sensitization to a dermatophyte infection. They are most frequently associated with toe-web intertrigo and usually present as localized, palmar, pruriginous vesicular eruptions. We report three original cases of generalized exanthematous pustular dermatophytid associated with kerions.
  
  
  METHODS
  Two boys aged 11 and 6 years, and one girl aged 6 years initially presented with kerion secondary to Trichophyton tonsurans (case 1), Trichophyton soudanense (case 2) and Trichophyton mentagrophytes (case 3), respectively. Two to three days after initiation of griseofulvin treatment, all patients presented with a pustular eruption extending from the head to the trunk, associated in one case with fever of 39°C and inflammatory chondritis. Samples obtained from the pustular lesions were sterile, serum inflammatory markers were within the normal range and skin lesions resolved on oral corticosteroid treatment (prednisone 0.75 mg/kg, case 1) or high-potency topical steroids (cases 2 and 3) given as an adjunct to griseofulvin treatment (19 to 23 mg/kg/d).
  
  
  CONCLUSIONS
  Dermatophytids occur during the acute phase of infection or within a few days of treatment initiation. Lesions are remote from the infection site, contain no dermatophyte, and resolve after treatment of the infection. We report three original cases of generalized exanthematous pustular dermatophytid, associated in one case with fever and inflammatory chondritis. The main differential diagnosis is acute generalized exanthematous pustulosis secondary to antifungal drugs. Differences in clinical presentation between the two enable the appropriate diagnosis to be made as well as continued use of the antifungal medication needed to cure the patient. General or topical steroids may also be used in combination.
authors: Service de dermatologie, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
authors: L
authors: L
authors: Ronjat
authors: Service de dermatologie, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, université Paris Descartes-Sorbonne Paris Cité, 24, boulevard du Montparnasse, 75015 Paris, France. Electronic address: marie.ferneiny@nck.aphp.fr.
authors: M
authors: M
authors: Ferneiny
authors: Service de dermatologie, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, université Paris Descartes-Sorbonne Paris Cité, 24, boulevard du Montparnasse, 75015 Paris, France.
authors: S
authors: S
authors: Hadj-Rabia
authors: Service de dermatologie, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, université Paris Descartes-Sorbonne Paris Cité, 24, boulevard du Montparnasse, 75015 Paris, France.
authors: O
authors: O
authors: Boccara
authors: Service de dermatologie, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, université Paris Descartes-Sorbonne Paris Cité, 24, boulevard du Montparnasse, 75015 Paris, France.
authors: C
authors: C
authors: Bodemer
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000209:etiology*; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000209:etiology; D006118:Griseofulvin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008302:Mali / Q000208:ethnology; D010007:Osteochondritis / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D011565:Psoriasis / Q000175:diagnosis; D012675:Senegal / Q000208:ethnology; D014006:Tinea Capitis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D014249:Trichophyton / Q000302:isolation & purification
chemical_list: D000935:Antifungal Agents; D006118:Griseofulvin; D011241:Prednisone
keywords: Dermatophyte; Dermatophytid; Dermatophytide; Dermatophytie; Exanthème pustuleux généralisé; Generalized exanthematous pustulosis; Kerion; Kérion; Teigne; Tinea capitis