EC Neurology

Background: Tinea capitis is classically a disease of school-aged children and is uncommon in older adults, in whom it is frequently misdiagnosed as a non-infectious scalp dermatosis. Trichophyton violaceum var. glabrum is a rarely reported morphological variant of an anthropophilic dermatophyte that remains endemic in the Mediterranean basin and North Africa.

Case Presentation: An 81-year-old immunocompetent Moroccan woman was referred for a diffuse, insidiously progressive skin and appendage disorder of five years' duration. Examination disclosed a non-inflammatory (dry) tinea capitis with diffuse hair thinning and hairs broken flush with the scalp, violaceous erythematosquamous annular plaques with a raised border and central clearing on the abdomen and forearms, and dystrophic onychomycosis of the fingernails and toenails. Direct microscopy of plucked hairs showed endothrix parasitism. Culture on Sabouraud dextrose agar with chloramphenicol and cycloheximide yielded, concurrently from hair, glabrous skin and nails, slow-growing (10 days), waxy, glabrous colonies devoid of aerial mycelium. Microscopy showed thick, irregular, torulose hyphae bearing intercalary and terminal chlamydospores without conidia, consistent with Trichophyton violaceum variety glabrum. Oral griseofulvin combined with 2% ketoconazole shampoo led to complete clearing of the cutaneous and nail lesions and normal hair regrowth.

Discussion: Immunosenescence and the post-menopausal decline in fungistatic sebum production create a permissive niche for anthropophilic dermatophytes on the ageing scalp. The chronic, paucisymptomatic course of the glabrum variant, together with its slow and atypical growth in culture, favours prolonged diagnostic delay and multisite colonisation of keratinised tissues.

Conclusion: Dermatophytes should be included in the differential diagnosis of chronic scalp scaling and alopecia in older women. Rigorous mycological expertise — direct examination combined with culture — remains essential to identify uncommon morphological variants and to initiate appropriate antifungal therapy.

Keywords: Tinea Capitis; Trichophyton violaceum var. glabrum; Older Adults; Dermatophytosis; Endothrix; Morocco

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