pityriasis amiantacea ( pa ) is a scalp disorder presenting with thick , silvery / yellowish , asbestos - like scales wrapping around and binding down tufts of hair .
it is typically considered to be a reactive condition to several inflammatory diseases , which may affect the scalp , mainly including psoriasis , atopic dermatitis and seborrheic dermatitis . however , although rarely , pa may be the presenting clinical pattern of dermatophyte infection ( pa - like tinea capitis ) , thus emphasizing the importance of ruling out / confirming the possibility of tinea capitis when dealing with a case of pa   we here describe for the first time the usefulness of dermoscopy as a supportive diagnostic tool in an instance of pa - like tinea capitis .
a 9-year - old girl presented with a five - week history of a progressively worsening , asymptomatic , scaling patch on the scalp .
her past medical history was unremarkable and there was no personal or family history of atopic diathesis and skin diseases .
physical examination showed thick , adherent , whitish , asbestos - like scales on the right parietal region of the scalp , surrounding and binding the hair ( figure 1a ) ; no other significant skin , nail or mucosal finding was evident .
dermoscopic examination ( performed with dermlite dl3 x10 ; 3gen , san juan capistrano , ca , usa ) revealed diffuse white scales and compact white keratotic material adhering to tufts of hair ( asbestos - like scaling ) without erythema ( figure 1b ) ; interestingly , several hairs displayed a  question mark  or 
( hair shaft bent at more than one point ) appearance ( figure 1b ) . as such dermoscopic findings may be found in tinea capitis [ 37 ] , we decided to carry out a direct microscopic examination of 10% koh preparation of the scales scraped from the scalp , which showed septate branching hyphae .
specimens were also cultured on conventional sabouraud s dextrose agar medium , with evidence of microsporum canis growth after three weeks , thus confirming the diagnosis of tinea capitis .
the patient was treated with oral griseofulvin ( 15 mg / kg once daily ) with complete resolution of the clinical picture after eight weeks of therapy .
clinical distinction between pa due to inflammatory noninfectious diseases and pa - like tinea capitis is a challenging task , with a significant likelihood of diagnostic errors / delays and prescription of inappropriate therapies . over the last few years
, dermoscopy has been showed to be a useful auxiliary instrument for the recognition of several hair disorders [ 89 ] , particularly dermatophyte infections [ 37 ] . indeed , beside nonspecific findings ( broken and dystrophic hairs , black dots , scaling , erythema , etc .
) , tinea capitis may display peculiar dermoscopic features such as  comma  hairs ,  corkscrew  hairs ,  zigzag  hairs , interrupted ( morse code - like ) hairs ,  elbow - shaped 
hairs and  question mark  hairs [ 37 ] . regarding the present instance , even though we observed dermoscopic findings that may be commonly seen in pa , i.e. , diffuse white scaling and the characteristic compact white keratotic material adhering to a tuft of hair ( asbestos - like scales ) , dermoscopy turned out to be very helpful in suspecting tinea infection by showing the aforementioned  zigzag  and  question mark  hairs .
in fact , although such features ( or similar findings ) may be rarely found in other hair disorders ( e.g. ,  zigzag  hairs in trichorrhexis nodosa , alopecia areata and monilethrix , and  question mark  hairs in alopecia areata ) [ 37 ] , they are typically not visible in classic pa . in conclusion , even though the final diagnosis relies on mycological testing , dermoscopy might come in very handy for raising the suspicion of tinea capitis presenting with a pa - like appearance by showing peculiar dermoscopic findings ( e.g. , as shown in this case ,  zigzag  and  question mark  hairs ) , which are typically not detectable in instances of pa due to inflammatory diseases . obviously , further studies on larger groups of patients are needed to confirm our observations .
 clinical distinction between pityriasis amiantacea - like tinea capitis and pityriasis amiantacea due to noninfectious inflammatory diseases is a troublesome task , with a significant likelihood of diagnostic errors / delays and prescription of inappropriate therapies . 
 we report a case of pityriasis amiantacea - like tinea capitis with its dermoscopic findings in order to highlight the usefulness of dermoscopy in improving the recognition of such a condition . 
Introduction
Case report
Discussion