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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Clinical features of the condition are highly variable and may depend on the causative organism, type of hair invasion and degree of host inflammatory response. The clinical signs may be subtle and diagnosis can be challenging in some patients. Common features include:

  • scalp shows scaling, and areas of irregular hair loss (as single or multiple patches), with broken hairs (seen either above or at scalp level).
  • scaling may occur irrespective of the hair loss
  • additional symptoms such as itching and rarely pain
  • signs of inflammation such as erythema or pustule formation may be seen occasionally
  • an overlying crust may appear in inflamed lesions (1).

Clinical infection pattern of the condition are as follows:

  • non inflammatory
    • grey patch
      • typically produces characteristic fine scaling with patchy circular alopecia
      • dull grey in colour due to arthrospores coating the affected hairs
    • black dot
      • produces relatively noninflammatory patches of alopecia with fine scale
      • classically studded with broken-off, swollen hair stubs, resulting in a ‘black dot’ appearance
      • patches may be multiple
    • diffuse scale
      • alopecia is minimal or absent
      • infection presents as generalized, diffuse scaling of the scalp, resembling dandruff.
  • inflammatory
    • diffuse pustular
      • a diffuse, patchy alopecia
      • may coexist with scattered pustules or low-grade folliculitis
      • may be associated with painful regional lymphadenopathy
    • kerion
      • also known as ‘kerion celsi’, this is the term given to tinea capitis presenting as a painful, boggy, inflammatory mass with associated alopecia
      • plaques may be solitary or multiple, studded with pustules and matted with thick crust
      • regional lymphadenopathy is common
    • favus
      • most commonly encountered in the Middle East and North Africa.
      • characterized by yellow, crusted, cup-shaped lesions (‘scutula’) composed of hyphae and keratin debris, which develop around follicular openings.
    • dermatophytid
      • a pruritic, papular ‘id’ eruption particularly around the outer helix of the ear
      • may accompany treatment initiation, but should not be confused with a drug reaction
      • they represent a cell-mediated host response to the dermatophyte after effective therapy has been initiated (1,2)


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