Hair casts and nits - differentiating using dermoscopy
2 Department of Dermatology, KIMS Al Shifa Hospital and Research Center, Perinthalmanna, Kerala, India
Department of Dermatology, College of Medicine, King Faisal University, Al-Hasa Campus, Al Hasa
Kingdom of Saudi Arabia
|How to cite this article:
Kaliyadan F, Ashique KT. Hair casts and nits - differentiating using dermoscopy. Indian J Dermatol Venereol Leprol 2019;85:434-435
A 10-year-old female patient presented to us with complaints of itching of the scalp. Her mother had noticed lice on the scalp. A clinical diagnosis of pediculosis capitis was made. Dermoscopy showed nits attached to the hair shaft [Figure - 1].
|Figure 1: Viable ovoid nit containing the embryo attached to the hair shaft with a tubular cast – Polarized dermoscopy, 10X, Dermlite foto II pro attached to Canon 650D single-lens reflex camera|
Another 12-year-old female patient presented with complaints of itching and scaling over the scalp. A clinical diagnosis of seborrheic dermatitis was made. Dermoscopy of the hair shaft revealed multiple hair casts [Figure - 2].
|Figure 2: Multiple peripilar casts appearing as irregular, amorphous white structures. Polarized dermoscopy 10X, Dermlite foto II pro attached to Canon 650D single-lens reflex camera|
Dermoscopy can be a useful tool to differentiate nits from hair casts. Nits appear as ovoid structures attached to the hair shaft with a tubular cast. Viable nits show the embryo within, whereas hatched nits appear translucent and empty. Peripilar keratin casts or hair casts, sometimes called “pseudo-nits,” on dermoscopy show bizarre, irregular-shaped and amorphous white structures [Figure - 2].
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