The New England Journal of MedicineBlack Dot Tinea Capitis

Endothrix Infection Causes Distinctive “Black Dot” Pattern in Pediatric Tinea Capitis

A case report details the diagnosis and treatment of “black dot” tinea capitis in a 2-year-old boy. This distinctive form of scalp fungal infection, caused by Trichophyton tonsurans, presents with unique clinical features and requires specific diagnostic approaches. The case highlights the importance of recognizing this variant of tinea capitis and implementing appropriate antifungal therapy.

Key Points:

• A 2-year-old boy presented with a 4-week history of painless hair loss and black dots on his scalp
• Physical examination revealed patches of alopecia with numerous black dots on the occipital scalp
• No overlying scale was observed
• Wood’s lamp examination showed no fluorescence
• Direct microscopic examination identified fungal spores within hair shafts, indicating an endothrix infection
• Fungal culture confirmed Trichophyton tonsurans as the causative organism
• Black dot tinea capitis occurs when fungal spores weaken hair shafts, causing breakage at the scalp level
• Treatment consisted of oral terbinafine and topical naftifine
• At 8-week follow-up, hair regrowth was observed, and fungal tests were negative

HCN Medical Memo
Early recognition of “black dot” tinea capitis is crucial for prompt treatment. Physicians should be aware of this unique presentation, particularly in pediatric patients with patchy hair loss and characteristic black dots on the scalp. Microscopic examination and fungal culture are essential for accurate diagnosis and targeted therapy.

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