Clinically, tinea capitis is characterized by the presence of hair loss areas with coexistent scaling, inflammation or pustules. Adults (especially elderly individuals) may be occasionally affected. The disease is most commonly observed in children between 3 and 7 years of age. Nevertheless, tinea capitis is mainly caused by Microsporum and Trichophyton species, its etiological agents differ according to the geographical distribution. During the last few decades, an increased prevalence of the disease with a remarkable change in the pattern of the causative dermatophytes among different countries has been observed, probably due to immigration, emigration, traveling and changes in the level of surveillance. Tinea capitis is a cutaneous fungal infection or dermatophytosis of the scalp. Trichoscopy may be useful in distinguishing between Microsporum and Trichophyton tinea capitis. The presence of characteristic trichoscopic features of tinea capitis is sufficient to establish the initial diagnosis and introduce treatment before culture results are available. In Trichophyton tinea capitis, corkscrew hairs were more commonly detected compared to Microsporum tinea capitis (21/38, 55% vs 3/29, 10%). 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). Other common, but not characteristic, trichoscopic features were broken hairs (57%), black dots (34%), perifollicular scaling (59%) and diffuse scaling (89%).
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%). Of 326 articles, 37 were considered eligible for the quantitative analysis.
The search terms included ‘tinea capitis’ combined with ‘trichoscopy’, ‘dermatoscopy’, ‘dermoscopy’, ‘videodermatoscopy’ or ‘videodermoscopy’.
MethodsĪ systematic review of the literature was conducted using the PubMed, EBSCO and Scopus databases. The objective was to review and analyze current data on the trichoscopy of tinea capitis. Trichoscopy is a non-invasive, in-office method helpful in establishing the correct diagnosis in patients with hair loss and inflammatory hair disorders. An increased incidence of tinea capitis has been observed over the last few decades.
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