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Skin is the first line of defense and encounters a variety of microbes. Some pathogenic strains are often the cause of a broad range of infections of the skin and other body systems. These conditions can affect people of all ages and may have different causes, including genetic factors, infections, autoimmune reactions, environmental factors, and lifestyle choices.
Gram-positive Staphylococcus spp. and Streptococcus spp. are responsible for many of the most common skin infections. However, many...
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Can Trichoscopy Suggest the Agent in Tinea Capitis?

Luna Azulay-Abulafia1, Gabriela Giraldelli1, Ana Luisa Alves1

  • 1Dermatology Department, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.

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Summary

Trichoscopy offers a faster alternative to traditional tinea capitis (Tc) diagnosis. Specific patterns like Morse code hairs aid in identifying fungal agents, unlike nonspecific findings.

Keywords:
DermoscopyHair diseasesTinea capitis

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Area of Science:

  • Dermatology
  • Mycology
  • Medical Diagnostics

Background:

  • Traditional diagnosis of tinea capitis (Tc) relies on mycological examination and culture, which have lengthy turnaround times (4-6 weeks).
  • Trichoscopy, a non-invasive examination of hair and scalp, shows potential as an adjunct diagnostic tool for Tc.
  • Identifying specific trichoscopic patterns associated with different causative agents could expedite diagnosis and treatment.

Purpose of the Study:

  • To evaluate the association between specific trichoscopic patterns and the etiological agents of tinea capitis (Tc).
  • To determine if trichoscopy can differentiate between common Tc fungal pathogens, *Microsporum canis* (*M. canis*) and *Trichophyton tonsurans* (*T. tonsurans*).
  • To assess the utility of trichoscopy as a rapid diagnostic method for Tc, especially in resource-limited settings.

Main Methods:

  • A retrospective, cross-sectional study of 110 patient records with suspected Tc was conducted.
  • 31 patients underwent trichoscopy, followed by direct mycological examination (10% KOH) and fungal cultures.
  • Statistical analysis (Fisher's exact test) was used to correlate trichoscopic findings with confirmed etiological agents (*M. canis*, *T. tonsurans*).

Main Results:

  • Nonspecific trichoscopic findings like perifollicular desquamation and broken hairs were observed.
  • Morse code (barcode-like) whitish sheaths were more frequently associated with *M. canis* infections.
  • Comma hairs and black dots were more common in *T. tonsurans* infections.

Conclusions:

  • Trichoscopy findings can suggest the pathophysiology of tinea infection based on parasitism type (ectothrix vs. endothrix).
  • Specific trichoscopic patterns, such as Morse code hairs, comma hairs, and black dots, show potential for differentiating between *M. canis* and *T. tonsurans*.
  • Trichoscopy is a valuable tool for diagnosing tinea capitis, particularly where laboratory facilities are limited.