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Research Article: What Percentage of Hairs Are Infected in Biopsies of Fungal Folliculitis?

Date Published: 2023-04-21

Abstract:
Fungal folliculitis (including tinea capitis and Majocchi granuloma) has a wide range of clinical presentations, and biopsy may be obtained to distinguish this from other conditions with similar presentations. The study aims to evaluate the proportion of hairs infected in biopsies of fungal folliculitis. Copath records were searched for diagnoses of fungal folliculitis, tinea capitis and Majocchi granuloma between 1 January 2000 and 31 December 2020. Confirmed cases were pulled and reviewed by a dermatopathologist to count the total number of hairs on the sample and the total infected. Of 72 included cases, the median number of hair follicles per biopsy was 3 (IQR 1,4), and the median proportion of hairs infected was 54.2% (IQR 33.3%, 100.0%). Nineteen (26.4%) had only one hair included in the biopsy which was also an infected hair (100% of hairs were infected). The percentage of total hair follicles infected differed significantly depending upon location (p = 0.0443), with a smaller percentage of infected hairs in biopsies of tinea capitis. Clinicians should be cautious when using biopsy for diagnosis of fungal folliculitis, specifically, when there are few hairs in the specimen. Failure to capture infected hairs leads to false negative diagnoses.

Introduction:
Dermatophytes are fungi that require keratin for growth. Fungal folliculitis is infection of a hair follicle caused by fungus and includes tinea capitis and Majocchi granuloma. These conditions have varying cutaneous presentations including erythematous papules, perifollicular or subcutaneous nodules, and abscesses; the presentation can vary based on the immune response of the host and the causative organism [1,2,3]. Biopsies may be obtained to distinguish fungal folliculitis from other conditions with similar…

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