Different Trichoscopic Features of Tinea Capitis and Alopecia Areata in Pediatric Patients

Background. Diagnosis of patchy hair loss in pediatric patients is often a matter of considerable debate among dermatologists. Trichoscopy is a rapid and noninvasive tool to detect more details of patchy hair loss. Like clinical dermatology, trichoscopy works parallel to the skin surface and perpendicular to the histological plane; like the histopathology, it thus allows the viewing of structures not discovered by the naked eye.Objective. Aiming to compare the different trichoscopic features of tinea capitis and alopecia areata in pediatric patients.Patients and Methods. This study included 40 patients, 20 patients with tinea capitis and 20 patients with alopecia areata. They were exposed toclinical examination, laboratory investigations (10% KOH and fungal culture), and trichoscope examination.Results. Our obtained results reported that, in tinea capitis patients, comma shaped hairs, corkscrew hairs, and zigzag shaped hairs are the diagnostic trichoscopic features of tinea capitis. While in alopecia areata patients, the most trichoscopic specific features were yellow dots, exclamation mark, and short vellus hairs.Conclusion. Trichoscopy can be used as a noninvasive tool for rapid diagnosis of tinea capitis and alopecia areata in pediatric patients.

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Indian Dermoscopic Study of One Thirty Eight Cases of Alopecia Areata

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i02/05 ◽

2018 ◽

Vol 3 (02) ◽

Author(s):

Rahul Kumar Sharma, Divya Sharma, Rajendra Kumar Sharma

Keyword(s):

Alopecia Areata ◽

Smart Phone ◽

Cotton Wool ◽

Exclusion Criteria ◽

Dermatology Clinic ◽

Exclamation Mark ◽

Single Feature ◽

Males And Females ◽

Vellus Hairs ◽

Difficult Cases

Alopecia areata (AA) is a type of non-scarring alopecia first described by Cornelius Celsus, characterized by hair loss without any clinical inflammatory signs and affecting both males and females equally. The activity of AA is by the presence of black dots, broken hair, and tapering, furthermore black dots and yellow dots are equated to severity of AA. Aim - To study dermoscopic features of untreated cases of alopecia areata. Study subjects-All the patients who attended the dermatology clinic from March 2015 to March 2017 with the clinical diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria. Study period - Two year (from March 2015 to March 2017). Methodology - All the patients who attended the dermatology clinic from March 2015 to March 2017 with the diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria were recruited for the study. Trichoscopy was performed with DL4 dermatoscope. The images were further magnified with smart phone. Results - We got various dermoscopic signs in different combinations in our study. Yellow dots were seen in 10 cases, White dots in cotton wool pattern were seen in 3 cases, Black dots were seen in 25 cases, Dermoscopic coudability sign was demonstrated in 38 cases, Pigtail hairs were present in 2 cases, five cases showed short vellus hairs, Short broken hairs were found in 18 cases, Exclamation mark hairs were very common and were detected in 131 patients out of 138. Discussion - Single feature is not leading to the diagnosis so we should use combination of features which will help in difficult cases like AA incognito. Dermatoscope is an indispensible valuable tool in trichology practice which helps in prognosticating and making early diagnosis of AA. It also helps to differentiate it from trichotillomania and other causes of alopecia. In our study the incidence of AA was almost similar in both sexes. Our study revealed that exclamation mark hair is very common and sensitive dermoscopic marker of AA.

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Obtaining Hairs for Fungus Culture

Pediatrics in Review ◽

10.1542/pir.3.8.263 ◽

1982 ◽

Vol 3 (8) ◽

pp. 263-263

Keyword(s):

Hair Loss ◽

Tinea Capitis ◽

Fungal Infections ◽

Fungal Culture ◽

Fungus Culture ◽

Scalpel Blade

An observant reader wrote that in two separate articles ("Hair Loss in Children" 3:85, 1981 and "Fungal Infections in Children" 3:41, 1981), the first author recommends that "hairs be scraped with a dull blade to obtain a specimen for culture," while the second author states that "hairs obtained by examination must be epilated, not cut." Dr. Esterly responded with the following clarification: When obtaining hair from patients with tinea capitis for fungal culture, it is important to secure the infected follicular portion of the shaft. In patients with very little hair remaining in the infected patch, it may be impossible to grasp the hair with the forceps or tweezers. Under those circumstances, the root ends can be teased out of the follicular orifices with the tip of a scalpel blade. At times, the hairs are long enough to be epilated with a hemostat or tweezers. In these instances the hairs should be firmly grasped and the follicular portions removed for placement on agar for culture. Cut hairs are not adequate for culture because one misses the infected portion of the hair which is still embedded in the scalp.

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Trichoscopy of Alopecia Areata: Hair Loss Feature Extraction and Computation Using Grid Line Selection and Eigenvalue

Computational and Mathematical Methods in Medicine ◽

10.1155/2020/6908018 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Sunyong Seo ◽

Jinho Park

Keyword(s):

Hair Loss ◽

Alopecia Areata ◽

Eating Habits ◽

Hair Follicles ◽

Smart Device ◽

Light Reflection ◽

Grid Line ◽

Feature Based ◽

Line Selection ◽

Vellus Hairs

Recently, the hair loss population, alopecia areata patients, is increasing due to various unconfirmed reasons such as environmental pollution and irregular eating habits. In this paper, we introduce an algorithm for preventing hair loss and scalp self-diagnosis by extracting HLF (hair loss feature) based on the scalp image using a microscope that can be mounted on a smart device. We extract the HLF by combining a scalp image taken from the microscope using grid line selection and eigenvalue. First, we preprocess the photographed scalp images using image processing to adjust the contrast of microscopy input and minimize the light reflection. Second, HLF is extracted through each distinct algorithm to determine the progress degree of hair loss based on the preprocessed scalp image. We define HLF as the number of hair, hair follicles, and thickness of hair that integrate broken hairs, short vellus hairs, and tapering hairs.

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Nonscarring Alopecia and Hypopigmented Lesions May Be Unusual Signs of Secondary Syphilis

Skin Appendage Disorders ◽

10.1159/000511577 ◽

2021 ◽

pp. 1-3

Author(s):

Magdalena Ciupińska ◽

Justyna Skibińska ◽

Mariusz Sikora ◽

Leszek Blicharz ◽

Maja Kotowska ◽

...

Keyword(s):

Hair Loss ◽

Alopecia Areata ◽

Early Stage ◽

Skin Lesions ◽

Secondary Syphilis ◽

Exclamation Mark ◽

Benzathine Benzylpenicillin

Noncicatricial patchy alopecia of the scalp and focal areas of skin hypopigmentation imply a diagnosis of alopecia areata and vitiligo. We present a case of a 22-year-old patient in whom these symptoms were associated with positive spirochete reactions, which allowed making a diagnosis of syphilitic alopecia coexisting with leukoderma syphiliticum. Skin lesions and hair loss resolved after the treatment with benzathine benzylpenicillin. Trichoscopy in syphilitic alopecia is nonspecific, but the absence of features typical for alopecia areata such as exclamation mark hairs may be important on an early stage of the clinical workup.

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Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study

Dermatology Practical & Conceptual ◽

10.5826/dpc.0904a05 ◽

2019 ◽

pp. 272-277 ◽

Cited By ~ 2

Author(s):

Aurora Alessandrini ◽

Michela Starace ◽

Francesca Bruni ◽

Nicolò Brandi ◽

Carlotta Baraldi ◽

...

Keyword(s):

Differential Diagnosis ◽

Steroid Therapy ◽

Hair Loss ◽

Alopecia Areata ◽

Topical Steroid ◽

Histological Diagnosis ◽

Frequent Pattern ◽

Topical Steroid Therapy ◽

Vellus Hairs ◽

Benign Course

Background: Alopecia areata is a nonscarring hair loss that usually causes round patches of baldness, but alopecia areata incognita (AAI) and diffuse alopecia areata (DAA) can cause a diffuse and acute pattern of hair loss. Objective: To analyze the clinical, trichoscopic, histological, and therapeutic features of AAI and DAA. Methods: The study was designed to include data of patients with histological diagnosis of AAI and DAA enrolled in our Hair Disease Outpatient Consultations. Results: DAA had a greater involvement of the parietal and anterior-temporal regions, while AAI manifested itself mainly in the occipital-parietal regions. The most frequent pattern was empty yellow dots, yellow dots with vellus hairs, and small hair in regrowth, but the presence of pigtail hair was found almost exclusively in those with AAI. In cases of DDA, the finding of dystrophic hair and black dots was more frequent. The most frequent trichoscopic sign in both diseases was the presence of empty yellow dots, which, however, were described in a higher percentage in cases of DAA. The diseases have a benign course and are responsive to topical steroid therapy. Conclusions: Trichoscopy is very important for the differential diagnosis between the 2 diseases and to select the best site for biopsy. In the presence of diffuse hair thinning, these entities must be considered.

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Serum Interleukin-15 in Alopecia Areata and its correlation with dermoscopic findings

QJM ◽

10.1093/qjmed/hcab093.011 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Naziha Hafez Khafagy ◽

Marwa Salah El Din Zaki ◽

Aya Mahmoud Hussein

Keyword(s):

Hair Loss ◽

Alopecia Areata ◽

Serum Levels ◽

Common Finding ◽

Control Group ◽

University Hospitals ◽

Exclamation Mark ◽

Significant Difference ◽

Initial Onset ◽

And Control

Abstract Background Alopecia areata is an autoimmune hair loss which frequently starts in childhood. Its presentation had an extreme variability not only in the time of initial onset but also in the duration, extent, and pattern of hair loss during any given episode of active loss. Moreover, the course of disease is unpredictable, with spontaneous regrowth of hair occurring in 80% of patients within the first year and sudden relapse at any given time. Due to the clinical variability and unpredictable nature of spontaneous regrowth, diagnosis and management may be difficult and challenging. Objective The aim of this study is to evaluate the serum levels of IL-15 in active alopecia areata and correlate them with disease severity and activity according to dermoscopic findings. Methods This case-control study were conducted in Dermatology, Venereology and Andrology department, Ain Shams University Hospitals included 30 patients with different clinical variants of AA, the diagnosis was made via clinical examination and dermoscopic findings. In addition, 30 apparently healthy individuals of matched age and sex as a control group were included in the study. Results Dermoscopic examination among cases showed that the most common dermoscopic findings in patients were vellus hair and yellow dots, while the least common finding was exclamation mark hairs. On comparing serum IL-15 in patients and control groups, it was found that serum levels of IL-15 in patients were significantly higher than those in the control group. There was no statistically significant difference in serum IL-15 levels between patients with negative and positive pull test, nail involvement, or body involvement. Similarly, no statistically significant difference in serum IL-15 levels in patients with various subjective disease activity was detected. However, there was a highly significant difference between serum IL-15 levels in different SALT score groups, with the highest levels being in the S3 group. There was a highly significant difference between IL-15 levels in patients with and without black dots. Also, there was significant difference between IL-15 in patients with and without broken hair, and exclamation mark hair. There was no significant difference in level of IL-15 among patients with and without yellow dots, and with and without vellus hair. Conclusion On the basis of the current study, we can conclude that IL-15 is significantly elevated in AA patients when compared to the control subjects. It is also a possible marker of AA severity. It is positively correlated with dermoscopic findings in AA patients, so dermoscopic findings can be useful in evaluating severity of alopecia areata.

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To Study Dermoscopic Findings in Alopecia Areata

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i1330579 ◽

2020 ◽

pp. 29-35

Author(s):

Kovi Sneha ◽

Jayakar Thomas

Keyword(s):

Clinical Diagnosis ◽

Hair Loss ◽

Alopecia Areata ◽

Liquid Paraffin ◽

Skin Lesions ◽

Acute Stage ◽

Hair Follicles ◽

The Body ◽

Cross Sectional ◽

Exclamation Mark

Introduction: Alopecia areata is a common chronic autoimmune inflammatory disease that involves hair follicles, characterized by hair loss on the scalp and/or body without scarring. Clinically, the disease presents as smooth, patchy hair loss with various patterns - diffuse or reticulate alopecia, ophiasis, ophiasis inversus, alopecia totalis (loss of hair all the scalp), or alopecia universalis (loss of hair all over the body). Clinical diagnosis of AA is made based on typical pattern of hair loss and the presence of characteristic exclamation mark hair in microscopy. Invasive (punch biopsy) techniques are often required in some cases where the clinical diagnosis is not straight forward Biopsy shows peribulbar lymphocytic infiltrates in a “swarm of bee pattern” which is characteristic of the acute stage of the disease. Dermoscopy is an imaging instrument that immensely magnifies surface features of skin lesions. It works on the principle of illumination and transillumination of skin with different light sources and studying it with a high magnification lens. Dry dermoscopy was done with heine delta 20 dermoscope which was followed by wet dermoscopy. Liquid paraffin was used as the immersion media. It is a noninvasive, repeatable, recordable bedside investigation. Objective: To study dermoscopic findings in alopecia areata. Materials and Methods: Study Design: Cross sectional study; Study Area: Skin Outpatient Department, Sree Balaji Medical College and Hospital; Study Population: All patients with hair loss, attending skin OPD, who are clinically diagnosed as Alopecia Areata; Study Method: Observational study; Sample Size: 30. Results: Clinically, the disease presents as smooth, patchy hair loss with various patterns. Dermoscopy is useful for diagnosis of AA clinically by the presence of cadaverized hairs (black dots), circle hair, coudablity hair, exclamation mark hairs (tapering hairs), broken hairs, yellow dots and clustered short vellus hairs in the hair loss areas. The results wear tabulated.

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Tinea capitis mimicking alopecia areata

Our Dermatology Online ◽

10.7241/ourd.20211.10 ◽

2021 ◽

Vol 12 (1) ◽

pp. 40-43

Author(s):

Saber Dooqaei Moqadam ◽

Ramina Mofarrah ◽

Kousar Jahani Amiri ◽

Fatemeh Montazer ◽

Anahita Barqi ◽

...

Keyword(s):

Inflammatory Response ◽

Hair Loss ◽

Alopecia Areata ◽

Tinea Capitis ◽

Clinical Signs ◽

Punch Biopsy ◽

Causative Organism ◽

Clinical Appearance ◽

Clinical Benefits ◽

Host Inflammatory Response

Tinea capitis (TC) is the most common dermatophyte scalp infection in children and an unusual dermatophytosis in adults. The clinical appearance of tinea capitis is highly variable and depends on the causative organism, type of hair invasion, and degree of the host inflammatory response. The commonly observed features are patchy hair loss with varying degrees of scaling and erythema. The clinical signs may be subtle and diagnosis may be challenging. We report the case of an adult patient with tinea capitis mimicking alopecia areata. The patient was initially diagnosed with alopecia areata and completed one month of treatment without clinical benefits. In view of no clinical signs of tinea capitis, a biopsy was performed. A scalp punch biopsy revealed an endothrix dermatophytosis. The patient’s medication was switched to 250 mg terbinafine daily for 8 weeks and 2% ketoconazole shampoo. The patient completed two months of therapy with maintenance of hair regrowth and resolution of symptoms and scales.

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