The association between pyoderma gangrenosum (PG) and painful vaso-occlusive crisis (VOC) in sickle cell disease (SCD) patients is a rare clinical entity, rarely reported in the literature (it is the 3rd published case). It illustrates a critical therapeutic dilemma: corticosteroids, the standard treatment for PG, exacerbate the vaso-occlusive crises of sickle cell disease. Its interest is also educational, aiming to alert clinicians to this association. The novelty lies in the description of a complex and successful management of a PG flare-up during an active vaso-occlusive crisis, a poorly documented scenario. This case thus provides a practical model for managing this therapeutic paradox and paves the way for considering a potential shared inflammatory pathophysiology between the two diseases. A 23-year-old female of Senegalese origin presented with persistent, hyperalgesic VOC involving the coastal region and limb pain. The symptom progression was marked by the appearance of sero-hemorrhagic bullous lesions, which evolved into irregular-bordered ulceronecrotic lesions affecting the limbs (anterior thighs). The patient’s history revealed similar episodes over the past seven years (since 2017). Bacteriological examination of the fluid was sterile. Consequently, a diagnosis of pyoderma gangrenosum (PG) was made. Treatment with corticosteroids, combined with local wound care and monthly transfusion exchanges, led to favorable outcomes. Managing pyoderma gangrenosum (PG) in patients with sickle cell disease (SCD) is challenging because corticosteroid therapy, the treatment of choice for PG, often triggers vaso-occlusive crises (VOCs). Therefore, recognizing this association is crucial.

Infantile hemangiomas (IH) are benign vascular tumors characterized by endothelial cell proliferation. Most IH are small and regress spontaneously without requiring treatment. However, depending on their size or location, some IH can cause significant complications, particularly segmental cervicofacial IH, hepatic IH, and subglottic IH. Infants with segmental facial IH are at risk of developing PHACES syndrome (20–30% of cases). The diagnosis of PHACES syndrome is based on the presence of a segmental infantile hemangioma larger than 5 cm associated with one major criterion or two minor criteria (Table 1). Ulceration is the most common complication, affecting approximately 16% of patients. It can cause pain, bleeding, secondary infection, functional impairment, and unsightly scarring. The discovery of propranolol has revolutionized treatment over the last decade. Propranolol can be administered on an outpatient basis in most infants, with the most commonly used dosage being 1–2 mg/kg/day in divided doses. Other more selective beta-blockers such as atenolol may be considered. Laser therapy may also be used for residual hemangiomas with fibro-adipose tissue remnants. Surgery is indicated for disfiguring hemangiomas or those resistant to multiple treatments. We report the case of a 3‑month‑old infant admitted to the neonatal unit of the Albert Royer Children's Hospital for ulceration of the mandibular region extending to the peri‑auricular area, measuring 10 cm in length, with a fibrinous and necrotic base, bordered by an angiomatous plaque and associated with almost complete destruction of the lower lip and right earlobe. This ulceration was associated with sternal agenesis, suggesting PHACES syndrome. She was treated with propranolol at 2 mg/kg/day for 6 months. Complications such as ulceration, secondary infection, and disfigurement were noted. This clinical case highlights the importance of early diagnosis of IH to avoid complications. Spontaneous regression is possible, but for high‑risk forms, oral propranolol remains the first‑line treatment.

Introduction : l’objectif de ce travail était de déterminer la fréquence, les formes cliniques et les complications des épidermolyses bulleuseshéréditaires (EBH) à Dakar.Méthodologie : nous avons mené une étude transversale descriptive avec un recueil des données à partir des dossiers médicaux de patients suivispour EBH au service de dermatologie de l’hôpital d’Enfants Albert Royer sur une période de 11 ans.Résultats : 36 patients ont été enregistrés soit une fréquence hospitalière de 0,16% et un sex ratio de 0,6. Les formes cliniques étaient : dystrophiquedans 44%, simple dans 33%, jonctionnelle dans 17%, associé à une aplasie cutanée congénitale dans 6% (syndrome de Bart), de type syndromede Kindler dans 6%. Les complications étaient retrouvées dans 39% dont des infections dans 28%, des troubles hémodynamiques dans 17% et descomplications digestives dans 11%. Un décès était enregistré dans 11% suite aux infections et à l’anémie.Conclusion : Nous avons rapporté une série de 36 cas d’épidermolyse bulleuse héréditaire représentant une fréquence hospitalière de 0,16%. Laforme clinique la plus fréquente est la forme dystrophique. Les complications sont surtout infectieuses et hémodynamiques. Soulignons l’importance du suivi de ces malades à cause du risque de cancer cutané associé au pronostic à long terme des cicatrices dans les formes dystrophiques.

Background: Dermatoses are skin disorders characterized by elementary dermatological lesions that enable a diagnosis to be made [1]. Depending on their cause, they are grouped into infectious, inflammatory, tumoral, allergic and other dermatoses. It is in this context that we set out to determine the prevalence of dermatological conditions in consultations at the dermatology department of the Cheihk Anta Diop University Hospital in Dakar (CHUCAD). Materials and Methods: This was a prospective descriptive study conducted from January 1, 2023 to October 31, 2023 in the dermatology department of the Cheihk Anta Diop University Hospital in Dakar. All patients with a clinical and/or histological diagnosis who consulted our department were included in our study. Results: A total of 421 patients were included in our study period. The mean age was 27.54 ±12.4 years, with extremes of 2 and 74 years. The majority of patients were female (249 or 59.14%) or male (172 or 40.86%). The distribution of dermatological conditions was as follows: Inflammatory dermatoses in 210 cases (49.88%), infectious dermatoses in 118 cases (28.03%), tumoral dermatoses in 33 cases (7.84%), allergic dermatoses in 31 cases (7.36%) and other dermatoses in 47 cases (11.16%). Reasons for consultation were dominated by acne in 101 cases (23.99%), eczema in 48 cases (11.40%), scabiosis and pityriasis versicolor in 27 cases (6.41%). Voluntary cosmetic artificial depigmentation was found in 34 cases (8.08%), of which 23 patients (67.65%) had acne. In terms of treatment, dermocorticoids were prescribed in 28.74% of cases, followed by local retinoids in 28.03%. As for general treatment, antibiotics were most commonly used in 95 cases (22.57%), followed by analgesics in 11 cases (2.61%) and corticoids in 10 cases (2.38%). Conclusion: Dermatological conditions are common in both the general population and students. The prevalence of each dermatosis depends on the study setting and environment.

Introduction:Kasabach-Merritt phenomenon (KMP) is a rare and life-threatening disease, characterized by the profound thrombocytopenia and consumptive coagulopathy associated with vascular tumors. In sub-Saharan Africa, KMP-related data are scarce and it poses significant challenges in management, particularly due to limited availability of treatment resources. We report 2 cases of KMP observed in a sub-Saharan Africa country (Dakar, Senegal). Case Presentation:Case 1: a 45-day-old male infant was admitted for a tumor lesion located in the axillary fold that has been evolving since birth. The lesion had rapidly become aggressive, inflammatory, and purpuric. Blood tests showed normocytic normochromic anemia with severe thrombocytopenia and high D-dimer levels. The diagnosis of a kaposiform hemangioendothelioma complicated by a KMP was retained. Treatment with betamethasone was initiated, but death occurred 6 days later secondary to cerebral hemorrhage. Case 2: a 2-month-old female infant was admitted for a rapidly aggressive, inflammatory, infiltrating tumor lesion on the face that had been progressing for 1 month. Blood tests showed normocytic normochromic anemia with severe thrombocytopenia and high D-dimer levels. The diagnosis of a KMP was retained. Treatment with corticosteroids, then combined with vincristine, was administered. The outcome was favorable with a considerable regression of the mass and improvement in biological parameters after 6 months. Conclusion:To our knowledge, we report the first case report on KMP in sub-Saharan Africa, particularly in pediatric dermatology in Dakar. Besides their rarity, these cases highlight the challenges in the management of KMP in a country with limited therapeutic resources.

Darier and Ferrand’s dermatofibrosarcoma (DFSP) is a rare cutaneous mesenchymal tumor characterized by a high potential for local recurrence and a low risk of metastasis. We report an unusual case of DFSP located on the scalp of a 63-year-old female patient with a history of hypertension. The lesion, which had been evolving for six years, presented with a polymorphic clinical appearance, mimicking benign tumors. The diagnosis was confirmed by histopathological examination, and a wide surgical excision with safety margins was performed. This case highlights the importance of heightened vigilance regarding atypical skin lesions, particularly in rare locations such as the scalp, and the need for a multidisciplinary approach to optimize therapeutic outcomes.

Background: Immuno-allergic dermatoses have been highly increasing for a decade in African settings. They are the first chief complaint of dermatological conditions in Senegal. Our objective was to describe their epidemiological, clinical, and etiological patterns. Methodology: We conducted a looking-forward descriptive study for 1 year ranging from April 2020 to April 2021 in the Dermatology Department of Aristide LeDantec Hospital in Dakar. We recruited both inpatients and outpatients. Results: Among 5633 patients received for consultation, 149 cases were pooled accounting for a prevalence of 2,6%. The mean age was 31,42 years old. Atopic dermatosis was the first immuno-allergic dermatosis representing 66,4%. They were followed by toxidermia in 16,1% of cases, contact dermatitis in 12,75% of cases, and urticaria in 4,69%. For patients with atopic dermatosis, a respiratory prick test was carried out in 14,1% of patients with a positivity in 57,1% of cases. Of the patients with urticaria and/or angioedema, the main triggering factor was drug use in 57,14% of cases. In our study, antibiotics were the first drug-related toxidermia in our patients accounting for 41,7% of cases. They were followed by herbal therapy in 29,2% of cases and paracetamol in 16,7% of cases. Conclusion: To date, immuno-allergic dermatoses constitute the first chief complaint in our structure and are by far dominated by atopic dermatitis. Automedication and herbal therapy are public health concerns. By causing toxidermia, often in their most serious patterns, they can have a vital prone-threat involvement.

Background: The COVID-19 pandemic has had a considerable impact on chronic disease monitoring. Previous work has asserted that people living with HIV (PLHIV) are at risk of developing COVID-19 and have difficulty accessing care and antiretroviral (ARV) treatment. The aim of this study was to determine the prevalence of HIV/COVID-19 co-infection and vaccination and to assess the impact of the pandemic on the follow-up of PLHIV and on their psychosocial and economic lives. Materials and Methods: This was a cross-sectional, multicenter study conducted from August 16, 2021, to October 10, 2021, at two dermatology departments of Dakar. We included all PLHIV followed at these two services during the study period. Results: We identified 57 cases of PLHIV. The hospital frequency was 6.44%, the mean age was 46, and the sex ratio was 0.54. The prevalence of COVID-19 infection was 14.1%. All cases had a mild clinical form of COVID-19, outpatient management, complete remission, and no deaths were noted during the follow-up. Viral load was available and undetectable in 25%. All patients co-infected with HIV/COVID-19 were on antiretroviral therapy. The prevalence of PLHIV vaccinated against COVID-19 was 31.6%. During the COVID-19 pandemic, 28.1% of cases missed their appointments. 96.5% of cases accessed to ARV treatment. However, 3.5% of PLHIV stopped their ARV treatment for reasons unrelated to the COVID-19 pandemic. Opportunistic infections were present in 31.6% of cases, with a significant impact on psychological (64.9%), social (45.6%), and economic (71.9%) well-being, as well as on quality of life in 59.6% of cases. Conclusion: The COVID-19 pandemic and its health measures have had a major impact on the follow-up and quality of life of people living with HIV. The reinforcement of therapeutic education, barrier measures, and COVID-19 vaccination seem to contribute to improving the quality of life of PLHIV. Key words: HIV, COVID-19, Psychosocial impact

Background: Dermatological manifestations are frequent and often constitute a circumstance of HIV discovery in 70% of cases [1]. They are observed in 83% of patients with AIDS and at an early stage in 75% [2,3,4,5]. The objective of this study was to describe the epidemiological, clinical, therapeutic, and evolutionary aspects of skin manifestations during HIV infection in children. Materials and Methods: We conducted a cross-sectional, multicentric, descriptive study over a period of ten years in two dermatology departments and one pediatric department in Dakar, Senegal. We included all HIV-seropositive children aged 0–15 years with mucosal cutaneous manifestations. A dermatologist and a specialist in the medical care of HIV performed the diagnosis of cutaneous manifestations. Data entry and analysis were performed with the SPSS software, version 9.05. Results: We collected 206 cases of cutaneous manifestations in 454 children followed for HIV infection. The hospital frequency was 45.3%. The children were male in 115 cases (55.83%) and female in 91 cases (44.17%), giving a sex ratio of 1.26. The mean age of the patients was sixty months, with extremes of one month to fourteen years. A mycotic dermatosis origin was noted in 47.37%, ringworm in 22.37%, dermatophytosis in 8.58%, oral candidiasis in 6.58%, seborrheic dermatitis in 6.58%, and perleche in 3.29%. Bacterial skin diseases were represented by furunculosis in 1.97%, and impetigo in 7.24%. Viral dermatoses included molluscum contagiosum in 10.53%, shingles in 9.21%, warts in 9.87%, and chickenpox in 3.95%. As for parasitic dermatoses, scabies was noted in 8.55, followed by larva migrans in 0.66% and cutaneous leishmaniosis in 0.66%. Immuno-allergic dermatoses accounted for 25% and included prurigo in 94.3%, atopic dermatitis in 1.90%, and fixed pigmented erythema in 1.90%. Conclusion: Cutaneous manifestations are a common discovery during HIV infection in children. They are marked by a predominance of infectious dermatoses in sub-Saharan Africa. Key words: skin diseases; HIV; children; Dakar

Introduction: Systemic diseases (SD) include all non-organ-specific autoimmune and/or inflammatory disorders. In children, their severity is related to severe visceral damage and iatrogenic complications of treatment. This study aimed to determine the epidemiological, clinical evolutionary aspects of systemic diseases in children. Methodology: A cross-sectional, analytic study was carried out in the Dermato-pediatrics Department of the Albert Royer Hospital in Dakar from January 2020 to June 2022 (30 months). We included all children aged 0 to 16 years followed up for systemic autoimmune disease. Results: We collected 18 cases of systemic diseases in children, representing a hospital frequency of 0.36%. The SD were of the lupus type in 7 cases, dermatomyositis in 4 cases, scleroderma in 3 cases, mixed connectivity’s in 3 cases and APLS in 1 case. The sex ratio was 0.12. The mean age of the children was 10 years [4-14 years]. In lupus, lesions were acute in 5 cases, subacute in 1 case and chronic in 1 case. In dermatomyositis, the cutaneous manifestations were: periorbital erythredema, ulcer-necrotic lesions, atrophic lesions of photo-exposed areas, non-erosive cheilitis, a non-scarring alopecia, Gottron papules, poikiloderma and calcinosis. Dermatomyositis was associated with extracutaneous muscular, articular, cardiovascular and pulmonary involvement. In scleroderma, cutaneous manifestations included sclerodactyly, Raynaud's phenomenon and cutaneous sclerosis. Visceral involvement included rhythm disturbances and pulmonary fibrosis. Necrotic ulcers and cyanosis of the extremities were the circumstances in which APLS was discovered. The association lupus-dermatomyositis represented (66.7%) and lupus-APLS (33.3%). Corticosteroid therapy was administered in 38.8% of cases. The outcome was favorable in 27.77% (n=5), with death noted in 3 cases. Conclusion: Systemic autoimmune diseases of children are rare disorders. They are characterized by their clinical polymorphism and the severity of visceral damage. Early treatment and therapeutic education of parents can improve prognosis.

Introduction:Bart's syndrome is an uncommon inherited congenital disorder associating congenital cutaneous aplasia of the extremities and inherited epidermolysis bullosa. Bilateral and symmetrical involvement of the limbs is exceptionally described on black skin. In most cases, the diagnosis is clinical; however, the management remains very difficult and the extended forms are a real therapeutic challenge. We report 2 cases of Bart's syndrome observed in a sub-Saharan African country (Senegal, Dakar).Case Presentation:It was about 2 premature female and male newborns. On physical examination, the girl presented with a total absence of skin on the limbs, associated with cutaneous detachment of the trunk representing a detached and detachable skin surface of 46%; the boy underwent a total absence of skin of more than 50% of the skin surface. The diagnosis of Bart's syndrome was set based on the typical clinical aspect. The blood count and CRP were normal for the girl whereas it revealed some disorders for the boy. The 2 newborns were urgently admitted to an incubator, and the intensive care was started with hyperhydration, anti-staphylococcal prophylaxis, and daily dermatological care with antiseptic baths and fatty dressings.Conclusion:Bart's syndrome is an uncommon genodermatosis characterized by a clinical triad associating congenital cutaneous aplasia of the extremities, inherited epidermolysis bullosa suspected in the presence of bubbles, and areas of cutaneous fragility and nail deformity. All types of which can be associated with this syndrome. The easy clinical diagnosis but the difficult management encumber the vital prognosis of our cases.

Angio eccrine hamartoma (EAH) is a rare, benign tumoral lesion composed of eccrine glands and vascular structures in the mid dermis. We report on two observations in Dakar. Observation 1: A four-month-old infant was seen for an erythematous plaque, rounded, with a smooth surface, asymptomatic, localized to the right thigh, evolving for three months. The clinical appearance suggested a spitz tumour. Cutaneous histology confirmed the diagnosis of angioeccrine hamartoma. Observation 2: The second case was concerned with a ten-month-old infant received for an erythematous, atrophic plaque, localized at the level of the inter-gluteal fold, evolving since birth. This clinical aspect was suggestive of a sclero-atropic lichen. Cutaneous histology confirmed the diagnosis of angioeccrine hamartoma. Discussion: We reported two observations of HAE original by the rarity and the clinical presentations leading to confusion with a nevus of Spitz and the sclero-atrophic lichen. Cutaneous histology was of considerable contribution.

Objectives:Although the foot remains the main localization of mycetomas, extrapodal attacks, which are rarely studied, are also possible and occur either initially or following an extension. The objectives were to describe the epidemiological, clinical and etiological features of extrapodal mycetomas in Senegal.Methodology:Cross-sectional and retrospective study with multicentric enrollment in four reference department, two of which are in dermatology and two in orthopedics and traumatology. We included the files of patients with extrapodal mycetoma followed from January 2000 to December 2020. The data were analysed with SPSS software. Any p less than or equal to 0.05 was statistically significant.Results:We collected 82 cases representing 39% of mycetoma cases (n = 210). The average age was 41.9. The sex ratio was 3.1. Professionally, most patients were active farmers in 51% of cases (n = 33), pastoralists and housewives in 9 % (n = 6) respectively. The mean duration of evolution was 7.5 years. Exclusively extrapodal topographies were noted in 84% of cases (n = 69). Foot and extrapodal locations were concomitant in 16% of cases (n = 13). Mycetoma foci were distributed as follows: 59 in the trunk, 47 in the lower limbs, 9 in the upper limbs, 1 in the scalp and 1 in the neck. The etiology was actinomycotic in 46% of cases (n = 38), fungal in 38% (n = 31). It was not specified in 16% of cases (n = 13). Bone involvement occurs after 5 years (p = 0.001) unrelated to the etiology (p = 0.6).Conclusion:Extrapodal mycetomas are secondary to direct inoculation. However, extension to bone is exclusively due to diagnostic delay. Periodic consultations in endemic areas combined with training of resident health personnel are necessary for early diagnosis in order to improve the prognosis.

Background: Previous studies in Africa have shown severity of toxidermia with a risk of mortality and mucosal synechia. Our objective was to study the epidemiological, clinical, etiological and evolutionary aspects of toxidermia in Dakar. Methods: A cross-sectional retrospective study was conducted at the Department of Dermatology of the Hospital Le Dantec from January 2001 to December 2015. She identified all of the toxidermia cases of hospitalization in this department. The diagnosis was based on the French criteria for drug accountability. Results: Two hundred cases of toxidermia were recorded. The hospital frequency was 9.2%. The sex ratio was 0.61. The average age was 33 years. Clinical forms of bullous toxidermia were Stevens Johnson/Lyell in 54% (n = 108), erythema multiforme in 3% (n = 6), and fixed pigmented erythema in 2% (n = 4). Mucosal involvement was noted in 56.5% (n = 113). Visceral involvement was noted in 15% (n = 30) with respiratory involvement in 24 cases of SSJ/NET and 6 cases of DRESS. The drugs identified were antibiotics in 38,7% (n = 53), analgesics in 15,3% (n = 21), anti-comitials in 13,1% (n = 18), antiretrovirals in 11,7% (n= 16), antituberculosis drugs in 9,5%% (n = 13) and medicinal plants in 11,7% (n = 16). The outcome was favorable in 62.5% (n = 125). Death was noted in 12%. Conclusion: Toxidemia in Dakar are characterized by predominance in severe clinical forms in young adults and mortality was related to infectious and hydro electrolyte complications.

Subcutaneous or furunculoid myiasis is an ectoparasitosis caused by the cutaneous or subcutaneous carriage of larvae of various diptera. The causal agent is most often Cordylobia Anthropophaga in tropical areas. We report an observation of multiple subcutaneous myiasis in an infant. The toddler was 2 months old, with no previous history of myiasis and was up to date with vaccinations. He was treated for furunculoid lesions evolving for 5 days. The dermatological examination revealed three inflammatory nodules centred by a whitish orifice without fluid discharge, located on the thorax, the back and the buttocks. The rest of the clinical examination was unremarkable. A maggot was extracted by bi-digital compression of a nodule in the thorax. The diagnosis of furunculoid myiasis was set. The treatment consisted of manual extraction of the maggots and local care. The evolution was favourable after two weeks, labelled by a complete healing of the lesions. Our case is particular because of the occurrence of subcutaneous myiasis in an infant and its misleading clinical presentation simulating multiple furuncles.

Introduction: The general objective was to determine the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of connectivitis in the dermatology department of the CHU Aristide Le Dantec. Patients and methods: This was a retrospective and descriptive study conducted in the Dermatology Department of the University Hospital Center (UHC) Aristide Le Dantec (HALD) of Dakar between January 2009 and December 2019. Their diagnoses were retained according to the international criteria validated in the course of connectivites Results: We identified 290 cases of connectivitis. Systemic scleroderma was the most frequent in 34.42% (n=94), followed by systemic lupus in 25.86% (n=75), mixed connectivities in 22,06% (n=64) and dermatomyositis in 19,32% (n=56). Cancer was associated with dermatomyositis in 11 cases and with systemic scleroderma in 3 cases. The mean age of our patients was 38.23 years. The sex ratio was 4.2 and the mean duration of evolution was 25 months. Dermatological manifestations were constant, found in all patients. In systemic lupus, they were dominated by discoid lupus lesions found in 40% and hypochromic spots (86%) in systemic scleroderma. In dermatomyositis, skin lesions were dominated by periorbital erythroedema (66.07%). Joint manifestations were found in 56.89% of cases (n= 165), muscular manifestations in 41.37% of cases (n= 120) and pleuropulmonary manifestations in 31.3% of cases (n=91). Neuropsychiatric manifestations were noted in 5.17% of cases (n=15). All our patients were treated with corticosteroid therapy and 12.06% of them had received immunosuppressive treatment, the most commonly used molecules being methotrexate (3.44%) and cyclophosphamide (8.27%). Hydroxychloroquine was prescribed in 59.31% of patients, while D-penicillamine was prescribed in 42.06% of patients, 100% of whom were treated for systemic scleroderma. The main complications encountered were infectious complications in 83 cases (28.6%). Visceral complications, a type of visceral insufficiency, were noted in 4.13% of cases. Conclusion: Our study demonstrates the frequency of connectivitis in the dermatology department. Its particularity was the predominance of systemic scleroderma over lupus which was classically the first connectivite in dermatology services. The delay in diagnosis noted is correlated with visceral attacks; hence the importance of a better knowledge of these affections for an early management.

We report the case of a 03-month-old female infant with no specific history, who was admitted in the Pediatric Department for an abdominal tumor that has evolved for 01 month. The physical examination noticed a large hepatomegaly and multiple raspberry-like papulo-nodules located on the trunk, scalp and limbs. The alpha-fetoprotein level was 842 ng/ml (42 times normal). The abdominal ultrasound and the CT scan made it possible to retain the diagnosis of diffuse miliary hemangiomatosis with liver damage. A favorable evolution was noted with propanolol and corticosteroids after a follow-up of 04 months.

A 9-year-old girl presented a large inflammatory cup-shaped scalp lesion with alopecia surrounded by pustules, dander, and suppuration associated with an occipital inflammatory lymphadenopathy for 1 month. Wood’s light exam was positive as well as KOH mount showing ectothrix type hair involvement. Hair and pus culture on Sabouraud dextrose agar (SDA) added with chloramphenicol and supplemented with cycloheximide isolated a dermatophyte species identified as Microsporum audouinii according to the colonies features. Species identification was confirmed by matrix-assisted laser desorption-ionization–time of flight mass spectrometry (MALDI–TOF MS) and the patient was treated for kerion celsi with terbinafine tablets 125 mg per day associated with a ketoconazole-based shampoo. The evolution was favorable, with hair regrowth after 2 months.