Journal Information
Vol. 112. Issue 2.
Pages 169-170 (February 2021)
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Vol. 112. Issue 2.
Pages 169-170 (February 2021)
Practical Dermoscopy
DOI: 10.1016/j.adengl.2020.12.025
Open Access
Erythematous Scaly Plaque
Placa eritemato descamativa
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P. Vilas Boas
Corresponding author
Pedro.22.pvb@gmail.com

Corresponding author.
, I. Hernández-Aragües, O. Baniandrés-Rodríguez
Servicios de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Case Description

A 73-year-old woman with a history of systemic lupus erythematosus (SLE), predominantly affecting the joints, and palmoplantar pustulosis visited our department with a plaque of alopecia on the scalp that had appeared a year earlier, coinciding with an episode of SLE (Fig. 1).

Figure 1.

Alopecia plaque with diffuse scaling and underlying erythema.

(0.15MB).

[[?]]What is your Diagnosis?

Diagnosis

Tinea capitis.

Comment

We report the case of a 73-year-old woman with a history of alopecia plaques that had appeared a year earlier. The plaques of alopecia have poorly demarcated edges and intense, thick desquamation. A polarized-light dermoscopy study revealed abundant comma hairs (arrow) and curly hairs (*) associated with broken hairs (arrow tip) and intense desquamation (Fig. 2).

Figure 2.

Dermoscopy showing comma hairs (arrow) and curly hairs (*) associated with broken hairs (arrow tip).

(0.16MB).

The presence of these dermatoscopic structures led to the clinical suspicion of tinea capitis, which was subsequently confirmed from a culture of scales from the lesion, from which Microsporum canis was isolated. Treatment was instated with itraconazole at a dosage of 100 mg per day for a month, with resolution of the lesions.

Comma hairs and broken hairs were initially reported as markers for tinea capitis due to Microsporum canis.1 Subsequent publications described corkscrew hairs in infections by Microsporum and in infections by Trichophyton.2,3

The main differential diagnoses include other scaly erythematous skin disorders, such as seborrheic dermatitis, psoriasis, lupus erythematosus discoides, and lichen planopilaris. Lupus discoides is characterized by the presence of red spots and follicular plugs, which subsequently evolve into the loss of follicular ostia. Lichen planopilaris is characterized by erythema and perifollicular hyperkeratosis that evolves into erythematous areas without follicular ostia.4 Psoriasis of the scalp is characterized by its vascular pattern on dermatoscopic examination, with forked or looped vessels.5

Tinea capitis is characterized by broken hairs, comma hairs and corkscrew hairs associated with desquamation of the scalp. This pattern is useful for the differential diagnosis with other scaly erythematous disorders of the scalp, such as lupus discoides or psoriasis.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
M. Slowinska, L. Rudnicka, R.A. Schwartz, E. Kowalska-Oledzka, A. Rakowska, J. Sicinska, et al.
Comma hairs: a dermatoscopic marker for tinea capitis: a rapid diagnostic method.
J Am Acad Dermatol., 59 (2008), pp. S77-79
[2]
R. Hughes, C. Chiaverini, P. Bahadoran, J.-P. Lacour.
Corkscrew hair: a new dermoscopic sign for diagnosis of tinea capitis in black children.
Arch Dermatol., 147 (2011), pp. 355-356
[3]
R. Arenas, E. Torres, M. Amaya, E.R. Rivera, A. Espinal, M. Polanco, et al.
[Emergence of Microsporum audouinii and Trichophyton tonsurans as causative organisms of tinea capitis in the Dominican Republic].
Actas Dermosifiliogr., 101 (2010), pp. 330-335
[4]
B. Duque-Estrada, B.D. Estrada, C. Tamler, C.T. Sodré, C.B. Barcaui, F.B.C. Pereira.
Dermoscopy patterns of cicatricial alopecia resulting from discoid lupus erythematosus and lichen planopilaris.
An Bras Dermatol., 85 (2010), pp. 179-183
[5]
G.-W. Kim, H.-J. Jung, H.-C. Ko, M.B. Kim, W.J. Lee, S.J. Lee, et al.
Dermoscopy can be useful in differentiating scalp psoriasis from seborrhoeic dermatitis.
Br J Dermatol., 164 (2011), pp. 652-656

Please cite this article as: Vilas Boas P, Hernández-Aragües I, Baniandrés-Rodríguez O. Placa eritemato descamativa. Actas Dermosifiliogr. 2021;112:169–170.

Copyright © 2020. AEDV
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