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case_images: Clinical and dermoscopic pictures of skin lesions. Images taken at the patient's first visit (A and C) and three weeks later (B and D). Trichoscopy of tinea capitis (B) with morse code-like hair (red arrow), corkscrew hair (purple arrows), comma hair (green arrows), and perifollicular scaling (yellow arrow).
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case_images: On trichoscopy at the first visit, the scalp showed abnormalities with fine scales and the hair roots were encased in a distinctive white sheath, as shown in the accompanying pictures (Figures 1A and B). The patient was then examined in the darkroom under a Wood's lamb, bright blue-green fluorescence was seen emanating from the hairs, as shown in Figures 1C and D.
case_images: Images of fungi eroding hair under the scanning electron microscope. Appearance of normal hair (A) appearance of a hair that has just been eroded by fungus (B); two severely eroded hair features obtained at the centre of the lesion (C and D).
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case_images: SEM revealed that the area near the hair root was occupied by a large number of spores, without complete hair cortex or keratin fibre bundles, which were observed in the nearby normal area (Figure 2A). The trichoderms in this region were protruding, splitting and then peeling off (Figures 2B-D). A large number of spores were present along the entire length of the hair shaft, with no empty bands and absence of early breakage (Figure 2C). Dense clusters of spores erode the cuticle and form huge defects with corresponding locations of early hair breakage (Figure 2D).
case_images: Images of diseased hair and fungal culture. Obvious spores (A) and hyphae (B) in the affected hair. The same mycelium as in the previous hair (C). Pathogenic fungi inoculated in Salmonella agar (D) and on YPD medium (E and F) give rise to woolly colonies.
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case_images: Microscopic examination of the hair sample after potassium hydroxide treatment revealed the presence of hyphae and spores on the outer surface of the hair shaft as shown in Figure 3A and B, suggesting a possible ectomycorrhizal infection. Dense woolly colonies with golden to brownish yellow surface grew on the medium after 7 days (Figure 3C-E). These colonies showed septate hyphae and a few spores under a Calcofluor White (CFW) fluorescence microscope (Figure 3F), but unfortunately the typical large conidia of Microsporum canis were not observed.