Hair disorders

Antonella TostiFredric Brandt Endowed Professor of

Dermatology&Cutaneous Surgery Miller School of Medicine, University of Miami

Antonella Tosti, MDF073 Hair Disorders

DISCLOSURES

Fotofinder :Consultant. CRC Press /Trichoscopyonline :Author-Royalties , Karger : Editor in chief

DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY

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

Monilethrix

Hair beading : elliptical nodes and intermittent constrictions at regular distance

Medulla absent at internode level

Monilethrix

Hair breakage occurs at internode level

Monilethrix

Affected hair bend in different directions

Monilethrix

Thickness and length of the internodes can vary

MonilethrixSeverity varies even among members of same family

Monilethrix

Eyebrows and eyelashes can be affected

MonilethrixMild forms can be misdiagnosed

de Lencastre A, Tosti A. Monilethrix. J Pediatr. 2012 Dec;161(6):1176.

13 year old boy

Progressive alopecia and loss of the eyelashes since the age of 9

Diagnosis: Scarring alopecia

Absence of follicularopenings

Peripilar casts

Hair tufting

Keratosis follicularis spinulosa decalvans

Rare genetic disorder with X-linked or autosomal dominant pattern of inheritance

Scarring alopecia of scalp and eyebrows.

8 year old girl

History of hairthinning and unruly hair

Deafness

Diagnosis :Pili torti

Pili torti Pili torti are flattened and present irregulartwisting and flattening of the hair shaft

Pili torti Thinning and trichorrexis with hair breakage are common

Pili torti Hair appears curly, brittle, thin and opaque because of the light reflectionloss in the twistedhair surface

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

Björnstad syndrome

Pili torti and neurosensorialdeafness

Autosomalrecessive

Bazex -Duprè Syndrome

Pili torti

Congenital hypotrichosis

Follicular atrophoderma

Trichorrexis nodosa

Hypohidrosis

Multiple milia

Basal cell carcinomas of early onset

15 year old girl

Hair that does not growlong and is frizzy

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.

Loose anagen hair syndromeCan use the dermatoscope to look at the roots

Anagen hairs devoid of sheaths

Ruffled cuticle

16 year old girl

Severe hairbreakage

She can only weara shaved hairstyle

Severe hairbreakage with trichorrhexis nodosa

Pili annulati

The hair shaft presentsalternating light and dark bands

Pili annulati

White bands correspond to air filled cavities

Pili annulati

They appear dark under the microscope

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.

9 year old boy

Patchy alopecia

Just recentlynoticed by hairdresser

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

7 year old boy

Erythematousplaque with alopecia

Present since a few years butrecently enlarged

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

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

15 year old boy

Patchy alopecia since a few days

Recent history of complicated surgerybecause of multiple gun shots with liverand stomaclacerations

Black dots

Broken hairs

Pressure alopecia

Prolongedpressure can cause ulcerationand permanentalopecia

Pressure alopecia

2 year old girl

1 month history of

increased hair shedding

no evident patches

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

Tinea Capitis

Comma hair

Short broken hair that bends like a comma

Tinea Capitis

Comma hairSeen both in ectothrix and endothrix infection

More numerous in recent infections

Tinea Capitis

Corckscrewhair

Short broken coiled hair

Usually seen together with comma hair

Tinea Capitis

Broken hair with casts

Short broken hair surrounded by a peripilar cast

Tinea Capitis

Black dots

Hair broken at scalp emergency(endothrix infections)

Tinea Capitis

Zigzag hair

Morse hair

Broken hair with horizontal white bands

Tinea CapitisTranlucenthair

Empty bands due to massive fungal invasion

Tinea Capitis

Corckscrew hair

Seen in patients of African descent

Depends on shape of African hair

16 year old girl

Severe dandruffand itching

Pediculosis

Nits

Ovoidal shapeattached to the shaft

Pediculosis

Allows to distinguish viable from empty nits

Pediculosis

Nits

Viable nit : distal estremity rounded brown in color

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