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Onychomycosis has been reported in very rare cases&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> It is characterised by highly inflammatory lesions&#44; especially in children&#44; who frequently develop kerion celsi&#46; Besides children&#44; it is frequently isolated from adolescents and immunosuppressed individuals&#46; In the early stage of infection&#44; the skin lesions may be confused with impetigo&#44; which delays diagnosis&#46; We now proceed to present 2 cases diagnosed in our microbiology laboratory in the span of 3 months&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Girl aged 3 years that presented with an inflammatory and suppurative lesion with onset 2 months prior that was diagnosed as kerion celsi&#46; At onset&#44; the patient developed lesions in the mouth and nose that were treated with topical antibiotics due to suspected impetigo&#46; Subsequently&#44; the patient developed additional erythematous plaques with a honey-coloured crust in the parieto-occipital region&#44; which were treated with topical mupirocin and oral amoxicillin-clavulanic acid&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the unfavourable response to treatment&#44; she was referred to the dermatology department&#44; where she received a diagnosis of tinea capitis and started topical treatment with a terbinafine cream and a sertaconazole nitrate gel&#46; The relevant findings of the history were a past episode of tinea corporis in the father and the presence of a pet guinea pig in the household that also had skin lesions&#46; Two weeks later&#44; the lesions had progressed into abscesses &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The abscesses were actively drained every 48<span class="elsevierStyleHsp" style=""></span>h&#44; with collection of a sample of the exudate and dystrophic hairs for submission to the microbiology laboratory&#46; The patient received a prescription for a new course of treatment with oral itraconazole &#40;62&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; and a miconazole&#47;hydrocortisone cream for 3 weeks&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Girl aged 8 years referred to the dermatology department for assessment of a bald plaque in the scalp more than 1 month after onset of symptoms &#40;lesions initially developed in the left breast and spread to the scalp over time&#41;&#46; During the history taking&#44; she reported that her pet guinea pigs had developed bald patches before she contracted the disease&#46; A sample was collected for culture and the patient received treatment with terbinafine at a dose of 125<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 1 month combined with topical administration of a terbinafine cream in the morning and a mometasone furoate and acetylsalicylic acid cream at night&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The microbiology laboratory processed the samples of both patients &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In both cases&#44; 15 days after submission the laboratory report indicated the presence of a fungus initially identified as a <span class="elsevierStyleItalic">Trichophyton</span> species&#46; The definitive identification as <span class="elsevierStyleItalic">Arthroderma benhamiae</span> was achieved by the analysis of the sequence of the internal transcribed spacer &#40;ITS&#41; region of ribosomal RNA&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Arthroderma benhamiae</span> usually causes mild infections that respond to topical treatment with ciclopirox&#44; imidazole or terbinafine&#46; However&#44; cases with more extensive involvement and tinea capitis require treatment with oral antifungals&#46; In patients with kerion celsi&#44; early diagnosis and prompt initiation of treatment are of the essence due to the risk of scarring hair loss&#46; There are few studies on the use of different antifungals to treat infections by this fungus&#46; Most authors report use of terbinafine&#44; griseofulvin&#44; itraconazole or fluconazole for a minimum of 4&#8211;6 weeks&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> with favourable outcomes&#46; Epidemiological data&#44; such as the presence of pets&#44; especially guinea pigs&#44; are important clues for suspecting and correctly diagnosing this fungal skin infection&#46;</p></span>"
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