What Is Tinea Amiantacea?
Tinea amiantacea is a distinct scalp condition. It is usually described as an eczematous (scaly, crusted, or hardened) condition in which the skin on the head (scalp) contains thick, adherent, and yellow or silver scales. These scales can extend onto the hair’s shaft and bind together to form a heavy bunch-like structure. These tight scales can appear on the scalp, defeating an individual's confidence due to the patchy appearance anywhere across the scalp. This condition is usually seen as localized, but in rare instances, cases have been reported affecting the entire scalp.
Pityriasis amiantacea is the other name for tinea amiantacea. It commonly affects people between 25 to 50 years of age. Females are less likely to be affected by this condition than males. Tinea amiantacea belongs to psoriasis and seborrheic dermatitis group. It commonly occurs as an exaggerated inflammatory response to the disease of the scalp. Few reports have suggested that it could also manifest due to lichen planus, lichen simplex chronicus, pyogenic infection, or superficial fungal infection. However, it is not caused by fungus and is an inflammatory disease. Therefore, treating tinea amiantacea is important. This scalp disorder can have serious consequences, like temporary alopecia, scarring alopecia, and permanent hair loss due to repeated hair removal from the scalp.
What Is the Cause of Tinea Amiantacea?
Tinea amiantacea often happens as a reactive condition rather than a diagnosis. It’s normally associated with conditions such as:
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Seborrhoeic dermatitis (eczema skin condition affecting the scalp).
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Scalp psoriasis (excessive flaking of the scalp with constant irritation).
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Atopic dermatitis (a skin condition causing dryness, itchiness, and scalp inflammation).
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Tinea capitis (fungal infection of the scalp).
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Lichen simplex (skin condition causing single or multiple plaques on the scalp leading to chronic itching and scratching).
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Contact dermatitis (an allergic reaction of the scalp occurring due to response to a foreign substance).
What Are the Symptoms of Tinea Amiantacea?
Tinea amiantacea is generally seen in children and young adults. Females are less likely to be affected by this condition than males. The main characteristic feature of tinea amiantacea is thick scales binding down the tufts and wrapping around the hair. Depending on the duration and underlying condition, the scales can appear localized or generalized. Secondary infections like staphylococcal infections can complicate this infection due to sticky, oozy, and crusty scalp conditions. The most common symptoms of tinea amiantacea are:
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Yellow or silvery-white scales. The scales are found to be arranged like shingles on a roof and appear as asbestos flakes. The scales are more pronounced at the hair ends where the follicles are found.
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Redness of the scalp.
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Bumpiness on the scalp due to the presence of scales.
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Inflammation of the scalp.
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Burning sensation of the scalp.
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Dandruff-like flaking.
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Dryness of the scalp.
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Hair loss.
The scalp under the scales commonly appears normal, but in some cases, it also appears reddish and scaly. Hair loss may be noted in the areas affected by tinea amiantacea. However, hair will regrow after extensive and continuous treatment. Individuals affected with tinea amiantacea can face difficulty combining and separating the hair strands from each other as they are clumped together with the scales.
How Is Tinea Amiantacea Diagnosed?
Tinea amiantacea is diagnosed based on the physical examination and medical history. Dermoscopy (examining skin lesions with a dermatoscope) will help diagnose tinea amiantacea. The dermoscopic features will include comma hairs, elbow-shaped hairs, interrupted (morse code-like) hairs, zigzag hairs, corkscrew hairs, and question mark hairs with diffuse white or yellowish scaling. The compact scales are thick, silver, and attached to tufts of hair.
To rule out tinea capitis, mycological cultures done on conventional Sabouraud’s dextrose agar medium are required. Scraping from the scalp and small hair follicles extracts are sent to a laboratory for further clinical investigation. Histopathology is not necessary.
In scalp biopsy, nonspecific features are seen, like diffuse parakeratosis, hyperkeratosis, and follicular keratosis. A distinguishing feature of tinea amiantacea is a sheath of horns surrounding the hair shaft, distinguishing it from other inflammatory hair disorders like seborrheic dermatitis, psoriasis, lichen simplex, etc.
What Is the Treatment for Tinea Amiantacea?
Tinea amiantacea is a troublesome and irritating condition. Therefore, immediate treatment is needed. However, the treatment is short-term and does not include any difficult procedure. While treating tinea amiantacea, the trichologist removes the scales on the scalp with the help of medicines (anti-inflammatory and keratolytic agents). The dosage and application time of medicine depends on the degree of the infection. In severe cases, medicine needs to stay on the scalp for an extended period, which helps in better penetration of the medicine into the skin of the scalp.
In cases of fungal infection, antifungal medications are used over the affected area. The bacteria Staphylococcus is present in most cases. When these bacteria are found, treatment with systemic antibiotics and coal tar shampoo will help to cure the condition completely. Vegetable and mineral oils are also used in some instances under the supervision of specialists. Steroids and lotions may help to get rid of inflammation and itching. These scales on the scalp are very stubborn and, thus, difficult to remove. On removal of these scales, a yellow sticky discharge oozes out. So utmost care and caution are needed during the procedure. Peeling such scales is not advisable without specialist supervision as it could cause permanent scarring and alopecia. Some preventive measures should be taken for patients with tinea amiantacea to avoid worsening the condition.
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Avoid strenuous physical activities, which can affect body temperature and worsen itching.
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Avoid hot showers or baths, as they can also worsen itching. Oatmeal baths help in soothing the itching.
Conclusion
Tinea amiantacea is an eczematous scalp with thick, adherent, and yellow or silver scale deposits on the scalp. It is an irritating and troublesome condition, causing mental stress to the affected individuals. This can be caused due to aggravation or reaction to presenting illness. Treatment can cure the condition, but long-term treatment is required. Consult a trichology as early as possible for effective and beneficial treatment.
