Dermoscopic Features of Tinea Capitis in Korean Patients: Correlation With Clinical Subtypes, Age Groups and Causative Dermatophytes.

BACKGROUND

Tinea capitis (TC) presents with diverse clinical manifestations that may complicate diagnosis. Dermoscopy is a useful adjunctive tool, but data correlating dermoscopic findings with clinical and mycological characteristics in Korean patients remain limited.

OBJECTIVE

To characterize dermoscopic features of TC in Korean patients and evaluate their associations with clinical subtypes, age distributions and causative dermatophytes.

METHODS

We retrospectively analysed 71 patients with mycologically confirmed TC diagnosed between 2011 and 2025. Dermoscopic patterns were compared across clinical subtypes, fungal species and age groups. Representative dystrophic hairs were further examined using super-resolution confocal laser scanning microscopy.

RESULTS

The cohort demonstrated a bimodal age distribution, with peaks in children (≤ 10 years) and elderly adults (≥ 61 years). Microsporum canis was the predominant pathogen (71.8%). The most frequent dermoscopic findings were scaling (83.1%), black dots (78.9%), follicular hyperkeratosis (78.9%) and broken hairs (78.9%). Empty follicles were significantly associated with Trichophyton infections (p = 0.001), whereas zigzag hairs, Morse code-like hairs, bent hairs and scaling were significantly more frequent in Microsporum infections (p < 0.05). Comma hairs were commonly observed in diffuse pustular and black dot subtypes. Children more often exhibited Morse code-like hairs, whereas elderly patients showed higher rates of empty follicles and perifollicular erythema. Confocal microscopy confirmed distinct structural shaft damage corresponding to characteristic dermoscopic patterns.

CONCLUSION

Dermoscopy provides valuable diagnostic and aetiological clues in TC, enabling differentiation between clinical subtypes and prediction of causative fungal species. These findings are especially relevant in adult-predominant, Microsporum-endemic settings and support dermoscopy as an important adjunct to routine clinical evaluation.