Diagnostic accuracy of dermoscopy in pediatric patients with tinea capitis

Abstract

Background: Tinea capitis is a common superficial fungal infection in children. Diagnosis relies on clinical assessment combined with laboratory investigations, which may be limited by delayed results and poor cooperation in pediatric patients. Dermoscopy is a rapid, non-invasive technique with potential diagnostic value.

Objectives: To evaluate the diagnostic accuracy of dermoscopy as an index test for tinea capitis in pediatric patients using laboratory-based methods as the reference standard, and to identify disease-associated dermoscopic features.

Methods: A cross-sectional diagnostic accuracy study was conducted in 112 children aged 0–18 years presenting with scalp disorders. The reference standard diagnosis was defined as compatible clinical features plus at least one positive laboratory test, including potassium hydroxide (KOH) examination, Wood’s lamp examination, or fungal culture. Dermoscopy was performed as the index test by evaluators blinded to laboratory results. Laboratory investigations were interpreted independently by personnel blinded to dermoscopic findings. Sensitivity, specificity, and overall diagnostic accuracy were calculated, and interobserver agreement for dermoscopic features was assessed.

Results: According to the reference standard, 84 patients (75.0%) were diagnosed with tinea capitis. Dermoscopy showed high diagnostic performance, with a sensitivity of 95.2% and high overall accuracy. Highly specific dermoscopic features included perifollicular scale, comma hair, corkscrew hair, bent hair, and barcode-like hair. Interobserver agreement ranged from good to excellent.

Conclusions: Dermoscopy is a highly accurate and sensitive index test for tinea capitis in pediatric patients and may serve as a useful adjunctive tool in clinical practice when performed by experienced users.