- Research article
- Open Access
- Open Peer Review
A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope
© The Author(s). 2018
- Received: 4 September 2018
- Accepted: 4 November 2018
- Published: 28 December 2018
Tinea 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 method
We 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.
Trichoscopy 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.
We 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.
- Tinea capitis
- Clinical subtype
Tinea capitis (TC) is the most common dermatophytosis in children [1, 2]. In some situations, the appearance and clinical context are not obvious requiring mycological confirmation. However, the culture results can take 4 weeks to be available, which may hinder the management of these patients and increase the risk of contamination . In these cases, trichoscopy can guide the diagnosis. Therefore, dermoscopic signs specific to TC must be well established.
We carried out a 6-month prospective descriptive analytical study between January and June 2017, gathering the various dermoscopic signs found in children with alopecic plaques suspected of TC. We classified them according to the clinical patterns of microsporic TC, trichophytic TC, or inflammatory TC, in order to find a correlation between the dermoscopic signs and the clinical subtype. The data were saved on Excel and analyzed on the SPSS Statistics version 20 software.
Total number of cases of TC
8.42 years (3–14)
(n = 12)
(n = 8)
(n = 26)
(n = 16)
(n = 10)
Bar code-like hair
These results seem interesting when considering the choice of probabilistic treatment, especially with the emergence of species more sensitive to terbinafine than to griseofulvin. As reported in the guidelines of management of TC in England, the first-line treatment is terbinafine for trichophytic tinea, which is an allylamine that acts on the cell membrane and is fungicidal, and griseofulvin for microsporic tinea, which is a fungistatic drug that inhibits nucleic acid synthesis, arrests cell division at metaphase, and impairs synthesis of the cell wall [8, 9]. However, these studies require a broader validation; in particular, some studies have not confirmed the correlations between dermoscopic signs and the type of pathogen [10–12].
Limitations of the study
Mycological confirmation (direct examination and culture) was not available for all patients. The authors classified patients according to the clinical pattern, in microscopic TC, trichophytic TC, or inflammatory TC, in order to make a correlation between the dermoscopic signs and the clinical subtype.
In conclusion, trichoscopy is a simple, fast, and inexpensive method for diagnosing and monitoring TC in children. However, mycology remains the gold standard for diagnostic confirmation, which is also inexpensive but can take a long time. Confirmation of our results by dermoscopy/mycology correlation in large studies will allow us to treat patients only on the basis of the dermoscopic signs.
The authors declare no funding.
Availability of data and materials
All the authors contributed to: the interpretation of data for the work; drafting the work or revising it critically for important intellectual content; the final approval of the version to be published; and the agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ethics approval and consent to participate
The study has been approved by the ethics committee of Faculty of Medicine of Fez.
An informed consent to participate in the study was obtained from the legal guardians.
Consent for publication
Written informed consent was obtained from the patients’ legal guardians for publication of this study and any accompanying images. A copy of the written consents is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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