Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(4):e2023203 1

Trichoscopy Unmasking Tinea Capitis  
in Elderly Individuals 

Theodosia Gkentsidi1, Chryssoula Papageorgiou1, Konstantinos Lallas1, Aimilios Lallas1, 
Zoe Apalla2

1 First Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

2 State Dermatology Department, Hippokratio General Hospital, Thessaloniki, Greece

Citation: Gkentsidi T, Papageorgiou C, Lallas K, Lallas A, Apalla Z. Trichoscopy Unmasking Tinea Capitis in Elderly Individuals. 
Dermatol Pract Concept. 2023;13(4):e2023203. DOI: https://doi.org/10.5826/dpc.1304a203

Accepted: March1, 2023; Published: October 2023

Copyright: ©2023 Gkentsidi et al. This is an open-access article distributed under the terms of the Creative Commons  
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Zoe Apalla, MD, PhD, Hippokratio General Hospital, Thessaloniki, Greece, 124, Delfon street, 54643,  
Thessaloniki, Greece. Tel. +306972916729, E-mail address: zoimd@yahoo.gr

Case Presentation

A 84-year-old female presented with a 2-year history of gradual 

hair loss and alopecia. Previous diagnoses included psoriasis 

and lichen planopilaris unsuccessfully treated with topical ste-

roids and systemic cyclosporine (current treatment), accord-

ingly. Clinical examination revealed erythematous and scaly 

plaques on the scalp, with associated alopecia  (Figure 1A). 

Zigzag, comma, pig-tail and broken hairs in trichoscopy 

were highly suggestive of tinea capitis (Figure  1B)[1].  

Microscopic examination showed parasitism of the hair 

shafts (Figure 1C)[2]. As expected, the Morse-code sign was 

not visible due to the white-colored hairs and M. Canis was 

identified in the culture. Complete response was achieved af-

ter 1-month treatment with systemic itraconazole. 

Teaching Point

Trichoscopy is essential in early recognition of tinea capitis.



2 Image Letter | Dermatol Pract Concept. 2023;13(4):e2023203

References

1. Rudnicka L, Rakowska A, Olszewska M. Trichoscopy: how it 

may help the clinician. Dermatol Clin. 2013;31(1):29-41. DOI: 

10.1016/j.det.2012.08.011. PMID: 23159174.

Figure 1. (A) Clinical examination of the scalp revealed erythematous and scaly plaques on the scalp, with 
associated alopecia; (B) Dermoscopy reveals zigzag, comma, pig-tail and broken hairs; (C) Microscopic ex-
amination showing parasitism of the hair shafts.

2. Pihet M, Le Govic Y. Reappraisal of Conventional Diagnosis for 

Dermatophytes. Mycopathologia. 2017;182(1-2):169-180. DOI: 

10.1007/s11046-016-0071-y. PMID: 27718160.