Corkscrew hairs (CHs) were first described by Hughes et al1 as trichoscopy marker for diagnosis of tinea capitis (TC) in black children. However, we recently observed the same trichoscopic picture in an adult Italian white male.
A healthy, 58-year-old white man, with skin phototype III, presented with a 2-week history of an itchy and inflammatory patch of alopecia, clinically characterized by large follicular pustules on the occipital and left retroauricular area (Figure 1). The remainder of the physical examination was negative for disease.
Erythematous patch of alopecia with large follicular pustules.
Digital trichoscopic images were collected using a videodermatoscope (FotoFinder dermoscope, FotoFinder Systems GmbH) with ×20, ×40, and ×70 magnifications showing comma hairs and a considerable number of corkscrew hairs (Figure 2). Findings from a swab were negative for bacteria, while fungal cultures of scalp scrapings identified Trichophyton tonsurans.
Comma hairs (arrows) and corkscrew hairs (circles).
While Hughes et al1 questioned whether CH is a variation of comma hair in the hair types of black patients or is specific to those with Trichophyton soudanense infection, other authors showed that CH is not specific to those with T soudanense infection2,3 and suggested that CH represents a specific trichoscopic finding of dermatophytosis of the scalp in the black race.
On the basis of the data reported in the literature, it would therefore seem likely that CH is related to endothrix trichophyton “black dots” TC in black children.1- 3 However, the same trichoscopic picture was also observed in the Italian white man described herein. Interestingly, our patient had naturally curly hair, a characteristic more evident in the black population, whose hair tends to be elliptical in cross section with a variable diameter along its shaft that resembles a twisted, oval rod.
In our opinion, the trichoscopic finding of CH seems to be a variation of the comma hair of tinea capitis,3 as described by Slowinska et al,4 suggesting that it is not a peculiar manifestation in black patients but rather a possible manifestation related to curly hair. Further investigation is needed to confirm our hypothesis.
Corresponding Author: Iria Neri, MD, Department of Specialistic, Diagnostic, and Experimental Medicine, Dermatology Unit, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy (firstname.lastname@example.org).
Published Online: June 19, 2013. doi:10.1001/jamadermatol.2013.4352.
Conflict of Interest Disclosures: None reported.
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