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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.



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.


  • Comma hair (white arrow)

  • “Morse” hair (black arrows)

  • Zigzag hair (red arrows)

  • Broken hair with cast (yellow arrows)


  • Comma hairs (red circles)

  • Corkscrew hairs (black circles)

  • Broken hairs with different lengths (black arrows)


Tinea Capitis


  • Dermoscopic examination/trichoscopy allows for fast, noninvasive diagnosis of tinea capitis.

    • Clinical differential diagnosis includes dissecting cellulitis and discoid lupus.

    • Alopecia areata is excluded by the intense inflammatory changes.

  • 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.

      • Peripilar casts: white concentric scales surrounding the hair shafts.


  • 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.



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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