International Journal of Trichology International Journal of Trichology
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Year : 2019  |  Volume : 11  |  Issue : 4  |  Page : 181-183  

Telephone handle hair: A novel trichoscopic finding in black dot tinea capitis

Department of Dermatology, Venereology and Leprosy, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Date of Web Publication19-Aug-2019

Correspondence Address:
Dr Vishu Michelle
Department of Dermatology, Venereology and Leprosy, Victoria Hospital, No. 52, First Floor, B Block, Bengaluru - 560 002, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijt.ijt_25_19

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How to cite this article:
Michelle V, Shilpa K, Leelavathy B, Asha GS. Telephone handle hair: A novel trichoscopic finding in black dot tinea capitis. Int J Trichol 2019;11:181-3

How to cite this URL:
Michelle V, Shilpa K, Leelavathy B, Asha GS. Telephone handle hair: A novel trichoscopic finding in black dot tinea capitis. Int J Trichol [serial online] 2019 [cited 2022 May 28];11:181-3. Available from: https://www.ijtrichology.com/text.asp?2019/11/4/181/264715


Tinea capitis (TC) is a superficial fungal infection, involving the hair follicles of the scalp. The incidence in India varies between 0.5% and 10%.[1] It predominantly affects children in the age group between 5 and 15 years.[1] The most frequent causes of patchy hair loss in children include TC, alopecia areata, tractional alopecia, and trichotillomania. Histopathology is an invasive technique and difficult to perform in most children, while fungal culture takes a long duration to provide results. Trichoscopy is a rapid and noninvasive tool that can be used to diagnose patchy hair loss, particularly TC without the need of an arduous biopsy.[2]

Trichoscopy is the evaluation of hair and scalp disorders using a dermoscope. It provides a magnified image which can help make morphological attributes not normally visible to the naked eye, clear.[3]

On trichoscopic examination of ten patients with black dot TC [Figure 1], we found that six children showed a new trichoscopic finding, which we would like to call the “Telephone Handle Hair.” We noticed this finding in addition to the characteristic findings of comma hairs, corkscrew hairs, black dots, and broken hairs of TC. The diagnoses of these cases were confirmed with 10%–20% Potassium hydroxide mount and fungal culture.
Figure 1: Black dot Tinea Capitis (a) diffusely over the scalp of a 5-year-old girl; (b) over the vertex of a 7-year-old girl

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The “Telephone Handle Hair” refers to a hair shaft which is bent over horizontally and appears slightly bulbous at either end, giving it the appearance of a telephone handle [Figure 2]. The cause of this appearance can only remain a speculation as damage to the hair shaft by fungal invasion, making it more easily deformable and prone to disintegration and cracking similar to comma hairs.[3]
Figure 2: (a-c) Trichoscopic images at × 20 magnification showing telephone handle hairs; (d) Artistic rendering of a telephone handle

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Slowinska et al. claimed that comma hair is a distinguishing marker for TC, followed by broken hairs and black dots.[4] Black dots and broken hairs, however, can be features of alopecia areata and trichotillomania, making them nonspecific.[2] Comma hair, corkscrew hair, and pigtail hairs were considered specific markers for TC, as they were found only in patients with TC.[4]

Other trichoscopic features that have been described include zigzag-shaped hairs, scales, peripilar casts, pustules, and meliceric crusts.[2],[5] Recently, a new finding has been described called the Morse code-like hairs, which are subtle horizontal interrupted white bands along the hair shaft.[3]

Further studies are required to determine the significance of this newly described feature so as to conclude as to whether the “Telephone Handle Hair” can be added to the armamentarium of trichoscopic signs that can help diagnose cases of TC without the need of a biopsy or culture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Pai VV, Hanumanthayya K, Tophakhane RS, Nandihal NW, Kikkeri NS. Clinical study of tinea capitis in Northern Karnataka: A three-year experience at a single institute. Indian Dermatol Online J 2013;4:22-6.  Back to cited text no. 1
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El-Taweel AE, El-Esawy F, Abdel-Salam O. Different trichoscopic features of tinea capitis and alopecia areata in pediatric patients. Dermatol Res Pract 2014;2014:848763.  Back to cited text no. 2
Elghblawi E. Idiosyncratic findings in trichoscopy of tinea capitis: Comma, zigzag hairs, corkscrew, and morse code-like hair. Int J Trichology 2016;8:180-3.  Back to cited text no. 3
Slowinska M, Rudnicka L, Schwartz RA, Kowalska-Oledzka E, Rakowska A, Sicinska J, et al. Comma hairs: A dermatoscopic marker for tinea capitis: A rapid diagnostic method. J Am Acad Dermatol 2008;59:S77-9.  Back to cited text no. 4
Arrazola-Guerrero J, Isa-Isa R, Torres-Guerrero E, Arenas R. Tinea capitis. Dermoscopic findings in 37 patients. Rev Iberoam Micol 2015;32:242-6.  Back to cited text no. 5


  [Figure 1], [Figure 2]

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