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

Abstract

Dermatomyositis (DM) is an autoimmune disease that primarily affects the skin and muscles, but may also have a systemic involvement. The frequency of scalp involvement in DM varies from 28 to 82% and is often encountered as part of a DM flare. However, it frequently presents as a treatment-resistant disease, and patients reporting no improvement with conventional therapies require further investigation. We report a case of tinea capitis (TC) in a 79-year-old woman affected by DM with scalp involvement which did not respond to conventional therapies. Thanks to trichoscopy we could detect “comma hairs,” “zigzag hairs,” and “pigtail hairs” at scalp examination, made the right diagnosis of TC, and instituted the best treatment without delay.

Two erratic cases of tinea capitis in adults: Utility of trichoscopy

“…When scaling is present in the scalp of adult patients, physicians are more likely to suspect common papulosquamous conditions, such as psoriasis, seborrheic dermatitis, and lichen planopilaris. [ 6 7 ] In our cases, the clinical manifestation was not suggestive of TC and only the presence of typical trichoscopic signs of tinea encouraged us to carry out a mycological examination. Dermoscopy is a simple and inexpensive method that has been suggested to aid the clinical recognition of TC showing specific criteria.…”

“…Dermoscopy is a simple and inexpensive method that has been suggested to aid the clinical recognition of TC showing specific criteria. [ 3 4 5 6 7 8 9 ] The aspects described are mainly:[ 6 7 8 9 ] the comma hairs which represent broken hairs; the corkscrew hairs which are broken coiled hairs so they are a variation of the comma hairs in cases of curly hair or the result of a specific type of fungal parasitism; the bar-code hairs, hairs with multiple white bands, related to localized areas of fungal infection, with normal-looking hair keratin between them; the zigzag hairs; and the black dots which represent cadaverized hairs. In conclusion, even if mycological examination is essential to confirm the diagnosis of tinea, herein we insist that T is a very effective useful tool in the screening of TC, particularly in adult and atypical forms.…”

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

“…Thanks to its simplicity, convenience, and the known diagnostic criteria for TC, trichoscopy can be used as an immediate and accurate diagnostic tool in the dermatological setting. Broken hairs, comma hairs, corkscrew hairs, interrupted hairs (Morse-code hairs), zigzag hairs, scaling, pustules, and crusts are the most common and specific findings in trichoscopy of TC [ 5 , 6 , 7 ]. Following suspicion, the KOH test can be used to confirm the diagnosis so the treatment can immediately be instituted.…”

“…Trichoscopy examination revealed scant scalp scaling alongside comma-shaped, corkscrew, and zigzag hairs, pustules, and also peripilar casts (Fig. 2 ) [ 5 , 6 , 7 ]. According to the trichoscopic findings, TC was considered and a KOH smear test was performed immediately, which revealed spores and hyphae of dermatophyte inside the hair shafts (Fig.…”

Hair Disorders in Autoimmune Diseases

“…The most common trichoscopic findings are enlarged tortuous capillaries and peripilar casts. Additionally, hair tufting, interfollicular scales, bushy capillaries, vascular lake-like structures, and interfollicular and perifollicular pigmentation can occur [31,35,36] (shown in Fig. 2b-c).…”