An Undetected Case of Tinea Capitis in an Elderly Woman Affected by Dermatomyositis: How Trichoscopy Can Guide to the Right Diagnosis

Trichoscopic Evaluation of Tinea Capitis

Tinea capitis is a widespread fungal infection that is even more common in rural areas of the world predominantly among children. The diagnosis of the infection and the identification of the responsible dermatophyte are determined by potassium hydroxide mount microscopy, Wood's lamp examination and mycological culture of the skin scrapings and hair samples. Nevertheless, this conventional setting has several limitations such as lack of availability, low sensitivity and specifity, and particularly prolonged turnaround time for fungal culture. Trichoscopy is a well-proven practical and beneficial aid to faciliate the diagnosis of scalp and hair disorders. Studies performed during the last 15 years revealed several characteristic trichoscopic findings of non-inflammatory tinea capitis namely comma hairs, corkscrew hairs, Morse code-like hairs and zigzag hairs. Thereby, trichoscopy has proved itself in the establishment of prompt diagnosis of TC, identification of the responsible fungus enabling to appropiate treatment on time, and evaluating treatment response by screening the clearance of the trichoscopic features.

Hair Disorders in Autoimmune Diseases

Alopecia is a common feature in several autoimmune diseases. With a wide spectrum of clinical presentations, it may manifest with a scarring or non-scarring nature, in a diffuse, patchy, or localized pattern. We as dermatologists have the opportunity of assessing patients with hair loss who may have an underlying undiagnosed autoimmune disorder. This review aimed to describe the main clinical, trichoscopic, and histopathological features of hair disorders associated with autoimmune diseases.

Patchy Alopecia in a Patient with Rheumatoid Arthritis: A Practical Application of Trichoscopy

Trichoscopy is an efficient, convenient, and accurate diagnostic dermatological procedure which is widely used in the examination of patients with skin diseases. Herein, we report a 56-year-old woman with a long-term history of rheumatoid arthritis complaining of pruritic patchy alopecia on her scalp who was referred for biopsy to exclude cutaneous lupus erythematosus. Taking advantage of trichoscopy, we were able to quickly diagnose tinea capitis. Following administration of the proper treatment the disease resolved completely.

Two Erratic Cases of Tinea Capitis in Adults: Utility of Trichoscopy

Tinea capitis (TC) is a common infectious disease throughout the world, mainly seen in children, but it can occur in adults. Even if mycological examination is essential to confirm the diagnosis, it has been proved that trichoscopy is a very effective useful tool in the screening of TC. Herein, we report two cases of adult TC with atypical clinical presentations causing a diagnostic delay of several years.

Trichoscopy of Tinea Capitis: A Systematic Review

INTRODUCTION

An increased incidence of tinea capitis has been observed over the last few decades. Trichoscopy is a non-invasive, in-office method helpful in establishing the correct diagnosis in patients with hair loss and inflammatory hair disorders. The objective was to review and analyze current data on the trichoscopy of tinea capitis.

METHODS

A systematic review of the literature was conducted using the PubMed, EBSCO and Scopus databases. The search terms included 'tinea capitis' combined with 'trichoscopy', 'dermatoscopy', 'dermoscopy', 'videodermatoscopy' or 'videodermoscopy'.

RESULTS

Of 326 articles, 37 were considered eligible for the quantitative analysis. The most characteristic (with a high predictive value) trichoscopic findings of tinea capitis included comma hairs (51%), corkscrew hairs (32%), Morse code-like hairs (22%), zigzag hairs (21%), bent hairs (27%), block hairs (10%) and i-hairs (10%). Other common, but not characteristic, trichoscopic features were broken hairs (57%), black dots (34%), perifollicular scaling (59%) and diffuse scaling (89%). Morse code-like hairs, zigzag hairs, bent hairs and diffuse scaling were only observed in Microsporum tinea capitis (8/29, 28%; 6/29, 21%; 4/29, 14% and 4/29, 14%, respectively). In Trichophyton tinea capitis, corkscrew hairs were more commonly detected compared to Microsporum tinea capitis (21/38, 55% vs 3/29, 10%).

CONCLUSION

The presence of characteristic trichoscopic features of tinea capitis is sufficient to establish the initial diagnosis and introduce treatment before culture results are available. Trichoscopy may be useful in distinguishing between Microsporum and Trichophyton tinea capitis.