Tinea Capitis with Eyebrow Involvement: Dermoscopy Clinched the Diagnosis

A 56-year-old female without any comorbidities presented to the dermatology outpatient department with loss of hair on the scalp and eyebrow, along with frontal hairline recession for the past 6 months. The patient had been diagnosed with alopecia areata from a private clinic and received oral and topical steroids for the last 5 months with no significant improvement. On examination, there was a patchy loss of hair, mostly confined to the frontal region of the scalp and lateral madarosis of the left eyebrow. [Figure 1] Ill-defined erythema and scaling were present on the face. Differential diagnosis of alopecia areata, frontal fibrosing alopecia, and tinea capitis were considered [Table 1]. On trichoscopic examination (Heine delta 20T, polarized mode) of the scalp, multiple black dots, corkscrew hair, and comma hair were seen along with perifollicular scaling and background erythema. [Figure 2a] Eyebrow trichoscopy revealed multiple bar code-like hairs (irregularly interrupted hair with pale and dark areas). [Figure 2b] Potassium hydroxide mount from the eyebrow and scalp hair revealed multiple spores and septate hyphae, and skin scrapings from the face showed multiple septate hyphae. A diagnosis of tinea capitis with eyebrow involvement and tinea faciei was made. The patient was treated with oral griseofulvin 500 mg once daily and topical ketoconazole 2% lotion for 6 weeks.Figure 1: Frontal hairline recession along with lateral madarosis of the left eyebrow. Diffuse scaling and erythema on the faceTable 1: Trichoscopic features of combined scalp and eyebrow alopeciaFigure 2: (a) shows trichoscopy of the scalp, revealing multiple black dots, corkscrew hairs, comma hairs, perifollicular scaling, and background erythema (Heine Delta 20T, polarized mode, 10×). (b) displays trichoscopy of the eyebrow, demonstrating multiple bar code like hairs (indicated by red arrows; Heine Delta 20T, polarized mode, 10×)Tinea capitis is a dermatophytic infection of the scalp hair commonly seen in children. Tinea capitis in adults has been reported in postmenopausal females and has been hypothesized to be due to the involution of sebaceous glands during menopause, attributed to the low levels of estrogen.[1] Involvement of eyebrow hair is rare but has been reported previously in isolation or associated with scalp involvement. Trichoscopy of eyebrow hair can reveal features similar to those of scalp involvement in the form of corkscrew, comma, bar code, or morse code hair.[2,3] The commonest causative agent is Microsporum canis and responds well to oral griseofulvin.[4] In our case, the patient was an elderly female with no comorbidities who had been misdiagnosed as alopecia areata, likely due to the eyebrow involvement. Hence, trichoscopy plays an important role in distinguishing hair loss due to tinea capitis from alopecia areata, even on uncommon sites like the eyebrow. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies.