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General Instructions
For each case, there is a short history along with a clinical and an unmarked dermoscopic image.
Study the unmarked dermoscopic image and try to identify the global and local dermoscopic features.
Make your diagnosis.
Next, turn the page and the dermoscopic image will be presented again, this time marked with all the salient dermoscopic findings.
On the same page you will also find the diagnosis along with a detailed discussion and a few pearls for your review.
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CASE 1 HISTORY
This is a 72-year-old woman who complains of progressive patches of alopecia associated with pain for 6 months. Treatment with topical steroids produced no improvement.
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DERMOSCOPIC CRITERIA
Comma hairs (red circles)
Corkscrew hairs (black circles)
Broken hairs with different lengths (black arrows)
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Dermoscopic examination/trichoscopy allows for fast, noninvasive diagnosis of tinea capitis.
Dermoscopy shows different types of broken hairs that are characteristic of tinea capitis.
Dermoscopic criteria for diagnosis include:
Comma-shaped hair: broken, very short hair that bends like a comma.
Corkscrew hair (in patients with curly hair): broken and coiled hair resembling a corkscrew.
Black dots (in patients with black hair): follicular openings are black created by broken hair shafts at or below follicular openings.
Morse hair/Morse code–like hair (aka bar-code hairs): irregularly broken and curved or angulated hairs. Light color is seen where the hairs bend.
Zigzag hair: broken, short Z-shaped hairs.
Broken hair with peripilar casts.
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Use dermoscopy to select specific hairs suitable for microscopic examination or culture.
All of the distorted hairs reflect the presence of dermatophyte infection.
Lymphadenopathy (submandibular, occipital, or postauricular) in the setting of alopecia and/or scaling suggests tinea capitis.
You can start treatment based on dermoscopic findings.
Dermoscopic examination is also useful when screening possible contacts.
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CASE 2 HISTORY
A 14-year-old girl had a history of tinea capitis successfully treated with systemic antifungals. Three months later she developed diffuse hair shedding and mild thinning.
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