A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope

Abstract

IntroductionTinea capitis is a scalp infection caused by different fungi. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. The association of clinical and dermatoscopic findings in suspected cases of tinea capitis may help the identification of the etiological agent, facilitating precocious, specific treatment.Materials and methodWe report a prospective descriptive analytical study of 34 children with tinea capitis. We performed a trichoscopic examination of all patients; only six children were able to have the mycological culture.ResultsTrichoscopy was abnormal in all 34 patients; it showed hair shaft abnormalities and, in some cases, scalp disorders too. We found that the comma and corkscrew appearance was found in microsporic tinea capitis, V-shaped hair was mainly seen in inflammatory tinea capitis, scales and follicular keratosis in non-inflammatory tinea capitis, and crusts and follicular pustules in inflammatory tinea capitis. Finally, erythema was seen in trichophytic and inflammatory tinea capitis.ConclusionWe propose a classification of trichoscopic signs of tinea capitis. This classification will enable rapid diagnosis and prediction of the type of fungus before mycological culture, thus a faster and more adapted management.Our study shows the importance of trichoscopy in the diagnosis and monitoring of tinea capitis. We suggest further prospective studies with a larger number of patients with tinea capitis, having performed mycological culture, to confirm this classification.

Trichoscopy of Tinea Capitis: A Systematic Review

“…Comma hairs are formed due to subsequent cracking and bending of a hair shaft filled with hyphae [10]. The frequency of comma hairs varied between 13% and 100% (mean value: 51%) of patients with tinea capitis [6,9,[12][13][14][15][16][17][18][19][20][21][22][23][24]. They were also occasionally detected in patients with alopecia areata and trichotillomania [16].…”

“…Their formation results from incomplete, transverse fractures along the hair shaft [31]. Zigzag hairs were only described in patients with ectothrix-type fungal infection with an incidence rate between 5% and 49% (mean value: 21%) [6,9,13,15,[18][19][20][21]24]. They were also reported in patients with alopecia areata [41].…”

“…In contrast to comma hairs, no hair shaft shortening is observed [42]. Very few studies reported bent hairs in tinea capitis, with an incidence rate between 4% and 71% (mean value: 27%) [6,19,20,42]. They were only observed in patients with ectothrix-type fungal infection [37,43].…”

“…Clinically, tinea capitis is characterized by the presence of hair loss areas with coexistent scaling, inflammation or pustules [4]. Mycological examination is considered to be the gold standard diagnostic method in tinea capitis [6]. However, trichoscopy may be useful in making a correct diagnosis before culture results are available [6].…”

“…Mycological examination is considered to be the gold standard diagnostic method in tinea capitis [6]. However, trichoscopy may be useful in making a correct diagnosis before culture results are available [6]. It has been reported, that trichoscopy, an easy to perform, non-invasive method [7,8], is characterized by a higher sensitivity compared with direct examination (94% vs 49.1%) in diagnosis of tinea capitis [9].…”