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It mostly affects children&#44; generally aged between 3 and 7 years&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and trichoscopy may therefore be a very useful diagnostic tool in this setting because it is quick&#44; reliable&#44; inexpensive&#44; and noninvasive&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> We describe 2 patients with tinea capitis and multiple comma hairs as a characteristic dermoscopic finding&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient was a 9-year-old boy with a 10-month history of lesions on the scalp and face&#46; The boy was originally from a village in Bolivia where he had had frequent contact with animals&#46; Physical examination revealed fine whitish scale on the scalp and several plaques of alopecia with marked hair fragility on the hair pull test&#46; The boy also had several erythematous&#44; scaly plaques with irregular but well-defined borders on his face&#46; There were no palpable lymph nodes in the lateral cervical chains&#46; Dermoscopic evaluation of the hair structures showed multiple broken hairs as well as hairs with a characteristic comma-like shape &#40;uniform thickness and color and marked distal angulation&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Direct examination with potassium hydroxide and microbiological culture confirmed the presence of a zoophilic fungus&#44; identified as <span class="elsevierStyleItalic">Trichophyton verrucosum</span>&#46; The patient was administered oral griseofulvin at a dosage of 20<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d for 8 weeks&#46; At follow-up 4 months later&#44; the lesions had cleared completely&#44; and there was no evidence of residual scarring alopecia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second case is that of a 2-year-old boy from Senegal who was brought in for evaluation of several plaques of alopecia that had been present on the scalp for 6 months&#46; The hair pull test was positive&#46; On dermoscopic examination&#44; there were multiple hairs with a characteristic comma shape &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Direct examination with potassium hydroxide was positive&#44; but no fungi were isolated in the culture&#46; The condition resolved completely with 8 weeks treatment of oral griseofulvin at 15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tinea capitis is a common scalp infection in children&#46; It is caused by different dermatophyte species of the genera <span class="elsevierStyleItalic">Trichophyton</span> and <span class="elsevierStyleItalic">Microsporum</span> and has a prevalence of approximately 1&#37; in developed countries&#46; The condition should be suspected in patients with a single or several small plaques of alopecia accompanied by broken hairs&#44; desquamation&#44; and itching&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The differential diagnosis of hair loss in children should include tinea capitis&#44; alopecia areata&#44; traction alopecia&#44; trichotillomania&#44; and loose anagen syndrome&#44; although in this last case&#44; there is generally diffuse hair loss due to traction and an absence of itching and desquamation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Trichoscopy is also a very useful tool in many of these conditions and offers better diagnostic performance than simple clinical inspection as it can reveal distinctive features<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Characteristic findings in trichotillomania are hairs with a similar diameter&#44; black dots&#44; broken hairs of differing lengths&#44; and coiled hairs &#40;due to traction&#41;&#46; In alopecia areata&#44; dermoscopy shows smaller hair follicles&#44; yellow dots&#44; and exclamation mark hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the 15 cases of tinea capitis evaluated by dermoscopy in the literature&#44; the distinctive features were broken hairs and comma hairs&#46; Comma hairs correspond to hair shafts that have ruptured because of the presence of multiple hyphae&#59; they have a uniform thickness and color and marked distal angulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;8</span></a> Corkscrew hairs were recently proposed as a new dermoscopic marker of tinea capitis in black children&#44; in whom clinical features can occasionally be more difficult to see&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Of the 15 cases published to date of tinea capitis with comma hairs as a distinctive feature&#44; 4 were caused by <span class="elsevierStyleItalic">Microsporum canis</span>&#44; 1 by <span class="elsevierStyleItalic">Microsporum langeronii</span>&#44; 4 by <span class="elsevierStyleItalic">Trichophyton soudanense</span>&#44; 2 by <span class="elsevierStyleItalic">Trichophyton tonsurans</span>&#44; and 1 by <span class="elsevierStyleItalic">Trichophyton violaceum</span>&#46; The causative dermatophyte was not identified in 3 cases&#46; None of the cases were due to <span class="elsevierStyleItalic">T&#160;verrucosum</span>&#44; which was the fungus isolated in our first case&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; we have described 2 cases of tinea capitis with comma hairs&#44; a possible dermoscopic marker of this condition&#46; We consider that trichoscopy is an effective&#44; quick&#44; cheap&#44; and noninvasive tool that can aid in the diagnosis of tinea capitis&#46;</p></span>"
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        "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">We thank Dr Javier Pem&#225;n&#44; from the Department of Microbiology at Hospital Universitari i Polit&#232;cnic La Fe de Valencia&#44; Spain for his contribution to the first case&#46;</p>"
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Case and Research Letter
Comma Hairs: A New Dermoscopic Marker for Tinea Capitis
Un nuevo marcador dermatoscópico de tinea capitis: «pelos en coma»
P. Hernández-Bela,
Autor para correspondencia
pablohernandezbel@hotmail.com

Corresponding author.
, J. Malvehyb, A. Crockerc, J.L. Sánchez-Carazoa, I. Febrera, V. Alegrea
a Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
b Unidad de Melanoma, Departamento de Dermatología, Hospital Clínic, Barcelona, Spain
c Instituto Dermatológico de Jalisco Dr. José Barba Rubio, Jalisco, Maxico
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It mostly affects children&#44; generally aged between 3 and 7 years&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and trichoscopy may therefore be a very useful diagnostic tool in this setting because it is quick&#44; reliable&#44; inexpensive&#44; and noninvasive&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> We describe 2 patients with tinea capitis and multiple comma hairs as a characteristic dermoscopic finding&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient was a 9-year-old boy with a 10-month history of lesions on the scalp and face&#46; The boy was originally from a village in Bolivia where he had had frequent contact with animals&#46; Physical examination revealed fine whitish scale on the scalp and several plaques of alopecia with marked hair fragility on the hair pull test&#46; The boy also had several erythematous&#44; scaly plaques with irregular but well-defined borders on his face&#46; There were no palpable lymph nodes in the lateral cervical chains&#46; Dermoscopic evaluation of the hair structures showed multiple broken hairs as well as hairs with a characteristic comma-like shape &#40;uniform thickness and color and marked distal angulation&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Direct examination with potassium hydroxide and microbiological culture confirmed the presence of a zoophilic fungus&#44; identified as <span class="elsevierStyleItalic">Trichophyton verrucosum</span>&#46; The patient was administered oral griseofulvin at a dosage of 20<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d for 8 weeks&#46; At follow-up 4 months later&#44; the lesions had cleared completely&#44; and there was no evidence of residual scarring alopecia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second case is that of a 2-year-old boy from Senegal who was brought in for evaluation of several plaques of alopecia that had been present on the scalp for 6 months&#46; The hair pull test was positive&#46; On dermoscopic examination&#44; there were multiple hairs with a characteristic comma shape &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Direct examination with potassium hydroxide was positive&#44; but no fungi were isolated in the culture&#46; The condition resolved completely with 8 weeks treatment of oral griseofulvin at 15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tinea capitis is a common scalp infection in children&#46; It is caused by different dermatophyte species of the genera <span class="elsevierStyleItalic">Trichophyton</span> and <span class="elsevierStyleItalic">Microsporum</span> and has a prevalence of approximately 1&#37; in developed countries&#46; The condition should be suspected in patients with a single or several small plaques of alopecia accompanied by broken hairs&#44; desquamation&#44; and itching&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The differential diagnosis of hair loss in children should include tinea capitis&#44; alopecia areata&#44; traction alopecia&#44; trichotillomania&#44; and loose anagen syndrome&#44; although in this last case&#44; there is generally diffuse hair loss due to traction and an absence of itching and desquamation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Trichoscopy is also a very useful tool in many of these conditions and offers better diagnostic performance than simple clinical inspection as it can reveal distinctive features<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Characteristic findings in trichotillomania are hairs with a similar diameter&#44; black dots&#44; broken hairs of differing lengths&#44; and coiled hairs &#40;due to traction&#41;&#46; In alopecia areata&#44; dermoscopy shows smaller hair follicles&#44; yellow dots&#44; and exclamation mark hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the 15 cases of tinea capitis evaluated by dermoscopy in the literature&#44; the distinctive features were broken hairs and comma hairs&#46; Comma hairs correspond to hair shafts that have ruptured because of the presence of multiple hyphae&#59; they have a uniform thickness and color and marked distal angulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;8</span></a> Corkscrew hairs were recently proposed as a new dermoscopic marker of tinea capitis in black children&#44; in whom clinical features can occasionally be more difficult to see&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Of the 15 cases published to date of tinea capitis with comma hairs as a distinctive feature&#44; 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        "identificador" => "xack35266"
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        "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">We thank Dr Javier Pem&#225;n&#44; from the Department of Microbiology at Hospital Universitari i Polit&#232;cnic La Fe de Valencia&#44; Spain for his contribution to the first case&#46;</p>"
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ISSN: 15782190
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