Black-dot tinea capitis

Abstract

A 4-year-old African American boy was seen because of an itchy, scaly scalp and patches of hair loss. Several months earlier, another A physician had diagnosed the problem as ringworm of the scalp and initiated treatment with a topical antifungal cream and ketoconazole 2% shampoo (Nizoral), which had limited success. Physical examination revealed about 12 dime- to quarter-sized patches of hair loss and a scaly scalp studded with multiple black dots (figure 1). Microscopic examination of a potassium hydroxide preparation of scalp scrapings demonstrated large-spore endothrix fungus within hair shafts diagnostic of tinea capitis (figure 2).