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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
.
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.
.
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
.
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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