Report Trichoscopic features of tinea capitis among primary school children in north central Nigeria Gboyega M. Olarinoye 1 , MBBS, FMCP, Oludolapo S. Katibi 2 , MBBS, FMCPaed, MMedSC Derm, Omotoyosi N. Ilesanmi 1 , MBBS, FWACP, Samuel A. Fayemiwo 3 , MBBS, MSc, FMCPath, Adebola O. Ogunbiyi 4 , MBBS, FMCP, FWACP, FRCP and Adekunle O. George 4 , MBBS, FMCP, FRCP 1 Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria, 2 Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria, 3 Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Oyo State, Nigeria, and 4 Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria Correspondence Gboyega M. Olarinoye, MBBS, FMCP Department of Medicine University of Ilorin Teaching Hospital Ilorin, Kwara State Nigeria E-mail: gboye9@yahoo.com Conflict of interest: None. Funding source: None. doi: 10.1111/ijd.15130 Abstract Background The myriad of coexisting risk factors for tinea capitis (TC) in parts of Africa makes it common among schoolchildren from this region. Diagnosis ideally involves microscopy and culture of scalp scrapings, which is not always feasible in resource-poor settings. Small-scale reports have identified trichoscopy (dermoscopy of hair and surrounding skin) as a cheap, quick, and simple tool for evaluating TC. We sought to describe the trichoscopic features of TC among Nigerian children. Methods A total of 204 children with clinically diagnosed TC had trichoscopy of their scalp lesions and culture of scalp scrapings. Trichoscopic features and culture results were noted. Results Perifollicular scaling (78.4%), interfollicular scaling (69.1%), and black dots (44.1%) were the commonest trichoscopic features. Others include regrowing hairs (18.6%), comma hairs (14.7%), broken hairs (13.2%), corkscrew hairs (3.4%), zigzag hairs (2.5%), and peripilar casts (2.0%). All children with comma, corkscrew, and zigzag hairs, as well as most with black dots (88.9%), broken hairs (88.9%), and regrowing hairs (77.5%) had positive cultures, irrespective of the isolated dermatophyte. Comma hairs were specific for Tinea infection with positive culture of dermatophytes. The presence of black dots in combination with individual features like broken hairs, regrowing hairs, perifollicular scaling, or interfollicular scaling also had a high specificity for positive cultures. Conclusion In the management of children with TC, trichoscopy is useful as a diagnostic tool, especially where access to laboratory evaluation is either not instant or unavailable. Introduction Tinea capitis (TC) is a dermatophyte infection of the scalp and associated hair follicles. It is usually caused by different species of Trichophyton and Microsporum. 1–3 It is the most frequent superficial fungal infection encountered among prepubertal chil- dren. Although distributed worldwide, the infection is quite com- mon among children in West Africa and parts of Asia, where factors, such as humid climate, poor hygiene, poor living stan- dards, and certain social habits, favor its proliferation and spread. 1,3–5 The reported prevalence of TC infection among schoolchildren in studies from Nigeria range between 14 and 50%. 3,5–11 Implicated dermatophyte species have varied with time and geographic location within the country. 1,5,7,12 Associated scalp pruritus, painful lymphadenopathy, dermato- phytid reactions, mental stress, fear of stigmatization, and undue self-awareness have all been identified as sources of physical and psychosocial morbidity among affected children. 13 These may result in a reduction in their quality of life. 13 There is therefore a need for prompt diagnosis and adequate treatment of this condition in our environment. Diagnosis and subsequent follow-up of TC with laboratory methods are recommended for the holistic management of the infection. 14 However, these may not be always feasible in areas with limited human and material resources. Additionally, potas- sium hydroxide (KOH) microscopy cannot determine the invading dermatophyte, while fungal culture may take up to 4 weeks to yield definite results. A rapid, easy to use, relatively cheap, and on-the-spot method of evaluating children with clinical features suggestive of TC may significantly aid its management, particu- larly in low-income settings within our environment, where several identified risk factors for TC infection coexist. Trichoscopy entails a magnified view of the hair and surrounding skin under illumina- tion, in order to reveal features that are not apparent to the naked ª 2020 the International Society of Dermatology International Journal of Dermatology 2020 1