Early-onset Facial and Scalp Vitiligo With Leukotrichia in a Toddler Complicated by Cultureconfirmed Trichophyton tonsurans Tinea Capitis: A Case Report

Abstract

Scalp vitiligo in early childhood can be difficult to distinguish from other pediatric scalp disorders when leukotrichia and subsequent alopecia are present. We report a toddler presenting with sharply demarcated depigmented patches with leukotrichia on the face and scalp, initially diagnosed as facial and scalp vitiligo. Months later, the child developed progressive scalp alopecia; a fungal culture from a scalp specimen yielded Trichophyton tonsurans, supporting a diagnosis of superimposed tinea capitis. The clinical course illustrates a diagnostic pitfall: leukotrichia supports follicular involvement in vitiligo, but new or progressive alopecia should not be attributed to vitiligo without reassessment. In children with scalp vitiligo, new-onset pruritus, scaling, inflammation, or enlarging alopecic patches should prompt targeted evaluation for tinea capitis or another cause of hair loss. This case emphasizes the value of chronological examination, clinical photography, and mycologic testing when pigmentary and infectious scalp diseases overlap.