Bent Hairs Research Articles

Trichoscopic Evaluation of Focal Non-Cicatricial Alopecia in Egyptian Children.

Dermoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible to the naked eye. Trichoscopy is useful for the diagnosis and follow-up of hair and scalp disorders. The aim of the present study was to evaluate the causes of focal non-cicatricial alopecia in Egyptian children and to assess the importance of the trichoscope in the diagnosis of each disease. This study was done with 200 Egyptian pediatric patients aged from 2 to 18 years who suffered from focal non-cicatricial alopecia. Clinical and dermoscopic evaluations were performed on all patients, and informed consent was obtained from their parents. The most prevalent diagnoses were alopecia areata (42%) and tinea capitis (40.5%), followed by trichotillomania (8%) and tractional alopecia (7%). Congenital triangular alopecia (1.5%) and patchy androgenetic alopecia (1%) were less common. Trichoscopy revealed distinct features in alopecia areata cases, such as short vellus hair, exclamation mark hair, black dots, broken hair, pigtail hair, and upright regrowing hair. The most common trichoscopic features of tinea capitis were comma hair, corkscrew hair, broken hair, bent hair, zigzag hair, morse code hair, perifollicular scaling, and diffuse scaling. These findings contribute to understanding the etiology and clinical presentation of childhood alopecia, facilitating accurate diagnosis and appropriate management. The routine use of trichoscopy in the clinical evaluation of scalp and hair disorders enhances diagnostic capabilities beyond simple clinical inspection. Trichoscopy reveals disease features that contribute to accurate diagnosis and improved management.

Trichoscopic and Clinico-Morphological Evaluation of Tinea Capitis

Abstract Introduction: Tinea capitis (TC) is a common fungal infection of the scalp, especially in children. Trichoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the hair with the visualization of morphologic features that are often imperceptible to the naked eye. Aim: This study aimed to evaluate the usefulness of trichoscopy in clinical diagnosis and to study various clinico-morphological patterns of TC. Materials and Methods: This cross-sectional, observational study included 140 clinically diagnosed cases of TC seen during a period of 1 year (April 2021 to March 2022). All patients were evaluated using a dermoscope (DermLite DL4 Multispectral 3 Gen, San Juan Capistrano, CA, USA,10×). Results: The prevalence rate of TC in this study was 2.69 per thousand population. The most common clinical variant was gray patch followed by kerion and black dot, and the most common etiological agent was Trichophyton tonsurans. The characteristic trichoscopic features were as follows: comma hairs (80%), followed by corkscrew hairs (68.6%), bent hairs (54.2%), zigzag hairs (35.7%), and morse code-like hairs (15%). Other findings included scaling (89.2%), followed by black dot (67.1%), broken hairs (42.8%), and crusting and pustules (32.1% each). Comma and corkscrew-shaped hairs were most common in the black dot type, whereas zigzag, bent hairs, and morse code hairs were common in the gray patch type of TC. There was a significant association between trichoscopic findings and type of TC. Conclusion: Trichoscopy can be considered a novel tool for rapid diagnosis and selection of the appropriate therapy and in the monitoring of treatment efficacy in TC.

Dermoscopic Findings and Assessment of Treatment Response in Patients with Tinea Incognito: A Pilot Study.

Tinea incognito presents with atypical, widespread, and recurrent lesions. Dermoscopy can aid its rapid diagnosis. This study aimed at assessing dermoscopic features and response to treatment in patients with tinea incognito. An evaluation of 62 patients with tinea of glabrous skin (Group A (cases)-31 steroid modified and Group B (controls)-31 treatment naïve) was done. Clinical, dermoscopic, and mycological evaluations were done for both groups at baseline, 2, and 4 weeks of terbinafine therapy. Clinical severity (Clinical Assessment Severity Score (CASS) and Visual Analogue Scale (VAS)) and frequency of various dermoscopic changes were compared at 0 and 4 weeks between cases and controls, using unpaired Student's t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test. Baseline dermoscopic features for both groups were significantly different with respect to frequency of broken hair, bent hair, micropustules and Morse code hair. Earliest feature to resolve with treatment was micropustules at 2 weeks. Significant reduction in frequency of morphologically altered hair was evident at 4 weeks. Telangiectasia, dotted vessels, I-hair, and broken hair persisted for a longer period of time. Terbinafine for 4 weeks was an effective treatment, producing complete cure in 73% of cases and 93% of controls. Persistent dermoscopic changes at 2 weeks were found to be associated with treatment failure at 4 weeks, highlighting the role of dermoscopy in identifying patients requiring prolonged treatment. Dermoscopy can be used as a diagnostic and monitoring tool for tinea of glabrous skin.

P106 A dermoscopic finding of Tinea capitis caused by Microsporum canis

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesTinea capitis is a relatively common disease, and the mycological examination is the gold standard for diagnosis. However, the probability of false negative on the KOH test is up to 40% and culture examination takes a long time for diagnosis. The characteristic pattern of dermoscopy not only aids in diagnosis, but also enables early treatment.MethodsWe evaluated six patients who were diagnosed with tinea capitis through clinical and dermoscopic findings. The images of the lesions were taken with a digital camera (Nikon, HB-42) and photographed with dermoscopy (Dermlite Foto 2 Pro) from the patients. The pictures were obtained by taking multiple focal points with dermoscopy. The comma, corkscrew, Morsecode-like, zig-zag, and bent hairs were observed as the main findings.ResultsThe dermoscopic finding was seen with overlapping of various findings in each of the patients. Upon dermoscopy, the most common findings were the corkscrew hair (66%) and the bent hair (66%). The comma hair (33%) and the proximal white shaft hair (33%) were less frequently observed and zigzag hair and Morse-code like hair were not seen in six patients. In the photograph taken with a camera, findings considered to be dermoscopic features such as corkscrew hair or comma hair were not observed.ConclusionIt is important for dermatologists to consider that abnormal findings in dermoscopy can play an important role in diagnosing Tinea capitis. And it will help in early treatment and prevent the progression of complications. Here in, we report specific dermoscopic findings which can narrow down the differential diagnosis.

A Case Report of Tinea Capitis in Children: Utility of Trichoscopy

Background: Tinea capitis (TC) is the most prevalent pediatric superficial dermatophyte infection. Scalp dermoscopy or “trichoscopy” represents a valuable, noninvasive technique for the evaluation of patients with hair loss due to TC. Purpose: To characterize trichoscopic findings in children with clinical findings suggestive of TC. Case: A 13-year-old boy was presented with a scaled plaque on his scalp that had appeared 1 month earlier. A physical examination revealed a scaly, nonerythematous, rounded lesion in the parietal area of the head. Wood’s lamp yielded a blue fluorescence. Microscopic morphology from fungal culture found the typical spindle-shaped macroconidia of Microsporum canis. Trichoscopy showed mainly comma hair, corkscrew hair, morse code hair, bent hair, and zig zag hair. The patient was started on oral griseofulvin 20 mg/kg/day and antifungal shampoo for 8 weeks. The patient was cured after two months of treatment and trichoscopy returned to normal. Discussion: Fungal culture remains the gold standard in TC diagnosis, but it needs time. Trichoscopy can be an additional tool to help evaluate the diagnosis, aetiology, and follow up of this disorder. The presence of characteristic trichoscopic features (comma hairs, corkscrew hairs, Morse code-like hairs, zigzag hairs, bent hairs, block hairs, and i-hairs) is predictive of TC. The present analysis confirmed that trichoscopy is a useful method in differentiating between Microsporum and Trichophyton TC, which is important from the perspective of a different therapeutic approach. Conclusion: Trichoscopy is not only of value in the diagnosis of TC but also for the etiologic agent and follow-up after treatment in this case.

Trichoscopy of Tinea Capitis: A Systematic Review.

IntroductionAn increased incidence of tinea capitis has been observed over the last few decades. Trichoscopy is a non-invasive, in-office method helpful in establishing the correct diagnosis in patients with hair loss and inflammatory hair disorders. The objective was to review and analyze current data on the trichoscopy of tinea capitis.MethodsA systematic review of the literature was conducted using the PubMed, EBSCO and Scopus databases. The search terms included ‘tinea capitis’ combined with ‘trichoscopy’, ‘dermatoscopy’, ‘dermoscopy’, ‘videodermatoscopy’ or ‘videodermoscopy’.ResultsOf 326 articles, 37 were considered eligible for the quantitative analysis. 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%). Other common, but not characteristic, trichoscopic features were broken hairs (57%), black dots (34%), perifollicular scaling (59%) and diffuse scaling (89%). 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). In Trichophyton tinea capitis, corkscrew hairs were more commonly detected compared to Microsporum tinea capitis (21/38, 55% vs 3/29, 10%).ConclusionThe presence of characteristic trichoscopic features of tinea capitis is sufficient to establish the initial diagnosis and introduce treatment before culture results are available. Trichoscopy may be useful in distinguishing between Microsporum and Trichophyton tinea capitis.

Trichoscopy in hair disorders in darker skin: An approach to diagnosis

Introduction: Trichoscopy is a non-invasive technique that shows promising results in the diagnosis and assessment of response to treatment in various types of alopecias. Besides diagnosing alopecia, it is helpful in choosing an ideal biopsy site. Here authors have attempted to describe trichoscopic findings of healthy scalp and compare hair shaft abnormalities, follicular and interfollicular features and vascular patterns of common non-cicatricial and cicatricial alopecias in skin of color. Summary: Trichoscopy of androgenetic alopecia shows hair diameter diversity, brown and white peripilar sign. Exclamatory hairs and coudability hairs are characteristics of alopecia areata. 'i' hair and pigtail hair indicates good prognosis in alopecia areata. Mace hair sign and burnt matchstick sign are newer findings of trichotillomania. Tinea capitis shows comma hairs, corkscrew hairs. Morse-code like hairs, zigzag hairs and bent hair are specific for tinea capitis. Traction alopecia shows anisotrichosis and hair casts with follicular drop outs in severe disease. Trichoteiromania shows trichoptilosis and broom hairs. Lichen planopilaris (LPP) and discoid lupus erythematosus show 'targetoid' and speckled patterns of blue-grey dots respectively. Perifollicular tubular scaling is characteristic in LPP. Frontal fibrosing alopecia presents as absent follicular openings and follicular plugging. Follicular tufting with starburst fibrotic bands is definitive of folliculitis decalvans. Pseudopelade of Brocq presents with loss of follicular ostia with prominent honeycomb pigmentation.

Two recessive rex coat mutants in the guinea pig.

Two rex type coat mutants of the guinea pig were found to display monogenic recessive inheritance at independent loci. The mutant alleles were designated rex (rx) and waved (wv). Both genes modify the normal smooth coat to a more upright, somewhat unkempt pelage. Macroscopically, the two rexes are scarcely distinguishable. Microscopically, however, small differences are apparent in the degree of coat modification. The hairs of rex show a greater curvature than normal and have irregular secondary bends and twists and variable diameter; so do those of waved, but to a lesser degree. The vibrissae of rex are curved or bent and may break off; those of waved are a mixture of straight, curved, and bent hairs.