frm f073 - tosti - 12963 10431 f073 - tosti... · tinea capitis in black children arch dermatol....
TRANSCRIPT
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Hair disorders
Antonella TostiFredric Brandt Endowed Professor of
Dermatology&Cutaneous Surgery Miller School of Medicine, University of Miami
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Antonella Tosti, MDF073 Hair Disorders
DISCLOSURES
Fotofinder :Consultant. CRC Press /Trichoscopyonline :Author-Royalties , Karger : Editor in chief
DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY
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Diagnosis :Monilethrix
Notice regular beading of the hair shaft at dermoscopy
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.
Monilethrix
Autosomal dominant
Mutations in the human basic hair keratins hHb6 and hHb1
Hair shaft breakage with alopecia more severe in areas of friction
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Monilethrix
Hair beading : elliptical nodes and intermittent constrictions at regular distance
Medulla absent at internode level
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Monilethrix
Hair breakage occurs at internode level
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Monilethrix
Affected hair bend in different directions
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Monilethrix
Thickness and length of the internodes can vary
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MonilethrixSeverity varies even among members of same family
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Monilethrix
Eyebrows and eyelashes can be affected
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MonilethrixMild forms can be misdiagnosed
de Lencastre A, Tosti A. Monilethrix. J Pediatr. 2012 Dec;161(6):1176.
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13 year old boy
Progressive alopecia and loss of the eyelashes since the age of 9
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Diagnosis: Scarring alopecia
Absence of follicularopenings
Peripilar casts
Hair tufting
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Keratosis follicularis spinulosa decalvans
Rare genetic disorder with X-linked or autosomal dominant pattern of inheritance
Scarring alopecia of scalp and eyebrows.
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8 year old girl
History of hairthinning and unruly hair
Deafness
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Diagnosis :Pili torti
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Pili torti Pili torti are flattened and present irregulartwisting and flattening of the hair shaft
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Pili torti Thinning and trichorrexis with hair breakage are common
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Pili torti Hair appears curly, brittle, thin and opaque because of the light reflectionloss in the twistedhair surface
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Pili torti Genetic syndromes
Bazex Dupré syndromeBeare syndromeBjörnstad syndromeCitrullinemiaConradi-HünnermannsyndromeCrandall’s syndromeFamilial acnes conglobataHypohidrotic ectodermaldysplasiaMenkes syndromeRapp-Hodgkin syndromeSalti-Salem syndromeTrichothiodystrophy
May be an isolated findingor could represent an hallmark of severalcongenital multisystemic disorders involving skin, cutaneous annexes, skeletal and neurologicalsystems
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Björnstad syndrome
Pili torti and neurosensorialdeafness
Autosomalrecessive
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Bazex -Duprè Syndrome
Pili torti
Congenital hypotrichosis
Follicular atrophoderma
Trichorrexis nodosa
Hypohidrosis
Multiple milia
Basal cell carcinomas of early onset
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15 year old girl
Hair that does not growlong and is frizzy
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Loose anagen hair syndrome
Rectangular black granular structures
Rakowska et al Trichoscopy findings in loose anagen hair syndrome:rectangular granular structures and solitary yellow dots. J Dermatol Case Rep.2015 Mar 31;9(1):1-5.
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Loose anagen hair syndromeCan use the dermatoscope to look at the roots
Anagen hairs devoid of sheaths
Ruffled cuticle
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16 year old girl
Severe hairbreakage
She can only weara shaved hairstyle
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Severe hairbreakage with trichorrhexis nodosa
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Pili annulati
The hair shaft presentsalternating light and dark bands
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Pili annulati
White bands correspond to air filled cavities
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Pili annulati
They appear dark under the microscope
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Pili annulatiHair shaft more seusceptible to weathering
Usually not associated with breakage
Donati A, Andriolo AC, Barletta M, Valente N, RomitiR. Pili Annulati and Trichorrhexis Nodosa in the Same Patient: Cause or Coincidence? Skin Appendage Disord. 2015 Mar;1(1):25-7.
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9 year old boy
Patchy alopecia
Just recentlynoticed by hairdresser
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Congenital triangular alopecia
Carpet of vellus hair
Lacarrubba F, Micali G. Congenital triangular alopecia. BMJ Case Rep. 2014 Jan 8;2014.
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.
Congenital triangular alopecia
Usually noticed in childhood
The patch contains vellus hairs
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7 year old boy
Erythematousplaque with alopecia
Present since a few years butrecently enlarged
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Sebaceous nevus
Bright yellow dots not associated to the hair follicles
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.
Sebaceous nevusCommonly present at birth
Well demarcated yellowishplaque of alopecia
Becomes verrucoid atpuberty
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Presence of bright yellowdots at dermoscopy ischaracteristic and distinguish sebaceousnevus from other causesof patchy alopecia in children
Neri et al . Usefulness of dermatoscopy for the early diagnosis of sebaceousnaevus and differentiation from aplasia cutis congenita. Clin Exp Dermatol. 2009 Jul;34(5):e50-2.
Sebaceous nevus
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15 year old boy
Patchy alopecia since a few days
Recent history of complicated surgerybecause of multiple gun shots with liverand stomaclacerations
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Black dots
Broken hairs
Pressure alopecia
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Prolongedpressure can cause ulcerationand permanentalopecia
Pressure alopecia
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2 year old girl
1 month history of
increased hair shedding
no evident patches
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Tinea capitis
Slowinska M, Rudnicka L, Schwartz RA, et al Comma hairs: a dermatoscopic marker for tinea capitis: a rapiddiagnostic method. J Am Acad Dermatol. 2008 Nov;59(5 Suppl):S77-9Hughes R, Chiaverini C, Bahadoran P, Lacour JP. Corkscrew hair: a new dermoscopic sign for diagnosis oftinea capitis in black children Arch Dermatol. 2011 Mar;147(3):355-6.
Comma and corkscrew hairs
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Tinea Capitis
Comma hair
Short broken hair that bends like a comma
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Tinea Capitis
Comma hairSeen both in ectothrix and endothrix infection
More numerous in recent infections
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Tinea Capitis
Corckscrewhair
Short broken coiled hair
Usually seen together with comma hair
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Tinea Capitis
Broken hair with casts
Short broken hair surrounded by a peripilar cast
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Tinea Capitis
Black dots
Hair broken at scalp emergency(endothrix infections)
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Tinea Capitis
Zigzag hair
Morse hair
Broken hair with horizontal white bands
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Tinea CapitisTranlucenthair
Empty bands due to massive fungal invasion
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Tinea Capitis
Corckscrew hair
Seen in patients of African descent
Depends on shape of African hair
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16 year old girl
Severe dandruffand itching
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Pediculosis
Nits
Ovoidal shapeattached to the shaft
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Pediculosis
Allows to distinguish viable from empty nits
![Page 55: FRM F073 - Tosti - 12963 10431 F073 - Tosti... · tinea capitis in black children Arch Dermatol. 2011 Mar;147(3):355-6. Comma and corkscrewhairs. Tinea Capitis Comma hair Short broken](https://reader031.vdocument.in/reader031/viewer/2022022808/5d58d3eb88c993a1608bc466/html5/thumbnails/55.jpg)
Pediculosis
Nits
Viable nit : distal estremity rounded brown in color
![Page 56: FRM F073 - Tosti - 12963 10431 F073 - Tosti... · tinea capitis in black children Arch Dermatol. 2011 Mar;147(3):355-6. Comma and corkscrewhairs. Tinea Capitis Comma hair Short broken](https://reader031.vdocument.in/reader031/viewer/2022022808/5d58d3eb88c993a1608bc466/html5/thumbnails/56.jpg)
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