Fungus Invasion into Human Hair Tissue in Black Dot Ringworm: Light and Electron Microscopic Study

In order to investigate the morphology of fungi invading into the human hair tissue, three cases of black dot ringworm caused by Trichophyton violaceum and Trichophyton glabrum were studied by light and electron microscopy. Fungal elements were mainly present in the hair cortex and showed a constant morphologic change during the differentiation of hair layers. The fungal elements, located deep in the keratogenous zone of the cortex, showed less electron dense non-septate hyphae. Distally, the hyphae showed septation and contained several scattered dense bodies in the cytoplasm. At the level where the Huxley’s layer was keratinized, the fungal elements were transformed into arthrospores, which occupied the large volume of the cortex; each spore was surrounded by a fiber- and melanosome-free, electron lucent halo. Fungal elements occasionally invaded the keratinized hair cuticle and keratinized inner root sheath in a few hair follicles. Fungi do not invade the hair germinative cells. There seems to be a distinct relationship between the morphology of the invading fungi and the cortical cell differentiation in black dot ringworm; a balance between the fungus proliferation and the cortical cell development may be present.