Trichoscopic changes in tinea capitis before and after treatment

A 5-year-old male child presented to our outpatient department with an itchy patch of hair loss on the frontotemporal region of the scalp. On examination, a solitary alopecic patch of size 4 x 4 cm was present in the frontotemporal scalp region, as shown in Figure 1a. Trichoscopic examination revealed hair shaft features such as black dots, comma hairs, cork-screw hairs, and zig-zag hairs, as shown in Figure 1b.

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Figure 1: (a) Single patch of hair loss measuring 4 x 4 cm in the frontotemporal scalp region. (b) Trichoscopic shows hair shaft features such as black dots (red circle), comma hairs (blue arrow), cork-screw hairs (black arrow), and zig-zag hairs (orange circle).

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A potassium hydroxide (KOH) mount test of the affected hairs was performed, which was positive, showing branched fungal hyphae. Fungal culture was not performed as the diagnosis was established clinically and supported by trichoscopic and KOH mount findings. A diagnosis of tinea capitis was made. The patient, weighing 13 kg, was treated with oral griseofulvin syrup (125 mg/5 mL) at a dose of 20 mg/kg/day along with ketoconazole 2% shampoo for 4 weeks. At 4 weeks, the patient showed significant clinical improvement, with noticeable hair regrowth [Figure 2a] and resolution of hair shaft abnormalities on trichoscopic, including perifollicular scaling [Figure 2b]. Trichoscopic can be used as a non-invasive, bedside diagnostic and follow-up tool, helping reduce our reliance on time-consuming tests such as fungal culture.

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Figure 2: (a) Shows hair regrowth. (b) Resolution of hair abnormalities with perifollicular scaling.

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