Tinea and fungal skin infection — structured clinical encounter

Station 1 — recognition and confirmation

Asked for my first impression, I would recognise this as tinea capitis. The broken hair stubs and the black dots flush with the scalp are hair broken off at the surface, the endothrix pattern typical of Trichophyton tonsurans, and the enlarged occipital node favours a fungal scalp infection over a non-infectious dermatosis such as alopecia areata, which is smooth and non-scaly with exclamation-mark hairs and no nodes. I would confirm with potassium hydroxide microscopy of a plucked hair looking for branching septate hyphae and arthroconidia, and send fungal culture to identify the species. ^[1]