Newly described features resulting from high-magnification dermoscopy of tinea capitis

Abstract

Importance: Recent studies have reported "comma hairs" as a typical dermoscopic feature of tinea capitis observed at low magnification (×10). The aim of this study was to evaluate the dermoscopic aspects of tinea capitis at high magnification (×150) and its diagnostic role.

Observations: Five children (2 boys and 3 girls; aged 4-10 years) with multiple scaly patches of alopecia underwent scalp dermoscopy, direct microscopic examinations, and mycological cultures of skin scrapings. Using low magnification (×30), typical comma hairs, "Morse code-like" hairs, and "zigzag" hairs were observed. When using high magnification (×150), additional features were horizontal white bands that appear as empty bands that are likely related to localized areas of fungal infection. These horizontal white bands are usually multiple and may cause the hair to bend and break. We also identified a new dermoscopic feature consisting of translucent, easily deformable hairs that look weakened and transparent and show unusual bends; they are likely the result of a massive fungal invasion involving the whole hair shaft. Direct microscopic examination showed fungal infection and results of mycological culture were positive for Microsporum canis in all cases.

Conclusions and relevance: The identification of new findings using higher-magnification dermoscopy may enhance the diagnosis of tinea capitis and be of help to better understand some pathogenetic mechanisms.