Segmented heterochromia in scalp hair

Segmented heterochromia of scalp hair is characterized by the irregularly alternating segmentation of hair into dark and light bands and is known to be associated with iron deficiency anemia. The authors report the case of an 11-year-old boy with segmented heterochromia associated with iron deficiency anemia. After 11 months of iron replacement, the boy's segmented heterochromic hair recovered completely.     

Segmented heterochromia in black scalp hair associated with iron-deficiency anemia. Canities segmentata sideropaenica

A newly recognized disorder of black scalp hair is characterized by the irregularly alternating segmentation of hair into dark and light bands. A 15-year-old girl had segmented heterochromic scalp hair in association with iron-deficiency anemia. The clinical and laboratory investigations support the view that low serum iron levels play a critical role in reducing eumelanogenesis and in the possible failure of melanin transfer. The segmented heterochromic hair recovered completely after iron supplementation, which coincided with increased eumelanogenesis in the recovered hair. This clinical experience indicated participation of iron in the kinetics of melanogenesis within the follicular melanocytes.     

Heterochromia of the scalp hair following Blaschko lines

Heterochromia of the scalp hair is characterized by the presence of tufts of hair of a color that differs from the general hair color. It is considered a disorder of pigmentation when the tufts are asymmetrically distributed. We report four patients with isolated congenital tufts of heterochromia in the scalp hair following the Blaschko lines of the head.     

Heterochromia of the Hair and Eyelashes with Blaschkoid Dyspigmentation

Heterochromia of the hair involves the presence of two distinctive colors of scalp hair in one individual. We report the case of a 4‐year‐old girl with reddish streaks of scalp hair, heterochromia of the eyelashes, and cutaneous hypopigmentation following the lines of Blaschko.     

Lipedematous alopecia: an uncommon clinicopathologic variant of nonscarring but permanent alopecia

A 52-year-old black woman presented with a 5-year history of gradual swelling and slowed hair growth involving the vertex and both parietal regions of the scalp. Gradually, the swelling progressed to involve the entire scalp, only sparing a peripheral crown. She reported no history of trauma or medications. Slight pruritus of the involved area was the only accompanying symptom. There was no family history of a similar condition. Her past medical history included surgery for ovarian cysts, 10 years previously, and cholelithiasis. Physical examination revealed diffuse hair thinning and alopecia, more prominent along the vertex and parietal regions (Fig. 1a). There was no evidence of scalp inflammation, scaling, or increased hair fragility. The scalp was mildly tender on palpation and had a boggy, spongy consistency. The hairs which still remained in the involved areas were thin, short, and soft (Fig. 1b). The involved area was slightly hypopigmented when compared with adjacent noninvolved scalp. The rest of the physical examination was within normal limits. No abnormalities of the hair shaft were observed on microscopic examination of several plucked hairs. Laboratory investigations, including a complete blood cell count, blood chemistry, urinalysis, sedimentation rate, antinuclear antibodies, and serologic tests for syphilis, hepatitis B and C virus, and human immunodeficiency virus, were negative. A computed tomography scan of the skull demonstrated diffuse and regular thickening of subcutaneous fatty tissue of the scalp, disclosing a maximum scalp thickness of 15 mm at the vertex (Fig. 2). The biopsy from the vertex revealed a normal epidermis and dermis, with diffuse loss of hair follicles. The most striking feature consisted of a large increase in thickness of the subcutaneous fatty tissue (Fig. 3a). Pre-existing hair follicles were replaced by vertical fibrous tracts of lamellar fibroplasia with no inflammatory infiltrate (Fig. 3b). Adipocytes showed a normal size and shape, but the connective tissue septa, which are normally present separating the subcutaneous tissue into fat lobules, were lacking, and subcutaneous fatty tissue consisted of a continuous and diffuse sheet of mature adipocytes (Fig. 3c). Orcein stain revealed normal contents of elastic fibers with foci of condensation at the sites of disappeared pre-existing hair follicles (Fig. 3d). Colloidal iron and Alcian blue (pH 2.5) stains revealed no mucin deposits.     

PLICA NEUROPATHICA AFTER USING HERBAL SOAP

A 22-year-old woman was referred to dermatology from oncology for an opinion regarding the sudden matting of scalp hair of 10 days duration. A case of primary infertility for 7 years, this patient was undergoing chemotherapy with doxorubicin, cyclophosphamide, and cisplatin after operative removal of a papillary cystadenoma (clear ceil type) from her left ovary 40 days previously.
She had noticed a sudden matting of her hair 3 to 4 hours after using a soap containing Acacia concinna for washing her hair. All efforts to disentangle the matted hairs were futile. She was feeling very uncomfortable because of the heavy solid mass of tangled hair. She told of rubbing her wet hair and using a wet towel to cover her hair after use of the soap. She denied earlier use of the soap, shampoo, setting lotions, bleaches, or hair dye. She had not cut her hair since early childhood.
Examination showed a huge, firm almost stony mass of severely tangled hair on her scalp, which was more marked over the vertex and occipital areas (Figs. 1 and 2). The hairs in the frontal area were free, thin, and straight. The skin over the entire scalp was normal. On light microscopy, a few hairs showed features of trichorrhexis nodosa. Routine hematology was normal. The patient was unable to tolerate the pain and discomfort because of the stony hard mass. She shaved her head and offered her hair in a temple, as is a common custom in parts of South India.     

脂水肿性脱发1例

 报告1例脂水肿性头皮伴脂水肿性脱发。患者女,44岁,因头皮肿胀、增厚伴脱发5年余就诊。皮肤专科检查：患者头顶部可见一面积约9 cm×18 cm的梭形毛发稀疏区域,残留断发＜2 cm,脱发区头皮呈黄褐色,稍隆起,明显增厚,触之柔软,似海绵状;拉发试验阴性。头部MRI示头皮下脂肪层不均匀增厚。皮损组织病理示：毛囊数量减少,毛囊由增生的纤维组织替代,少许淋巴细胞浸润。诊断为脂水肿性头皮伴脂水肿性脱发。患者及家属拒绝治疗,随访半年余,病情未进展。     

Tinea capitis in adults over fifty years of age

An 89-year-old black woman was examined for generalized folliculitis of the scalp that proved to be tinea capitis caused by Trichophyton tonsurans. To our knowledge, she is the oldest known patient with this condition to be reported to date. Although it is uncommon in adults, this condition must be considered when clinicians are evaluating patients with hair loss and nonspecific scalp dermatitis.     

A case of black dot ringworm attributable to Trichophyton violaceum: a simple method for identifying macroconidia and microconidia formation by Fungi-Tape and MycoPerm-Blue

An 85-year-old Japanese woman sought a dermatologic consultation for evaluation of a walnut-sized alopecia with pityroid desquamation in the parietal region of her scalp. She had been admitted to a nursing home about three months earlier, and, at that time, a thumb-tip-sized, scaly alopecia was noted. Several hairs at the site were eroded in a black dot. Direct KOH microscopy of affected hair showed large spore endothrix infection. To isolate macro- and microconidia for fungal identification, we incubated the affected hair and scales and obtained giant colonies in a special enriched medium. Using Fungi-tape and MycoPerm-Blue, we were able to collect and identify Trichophyton violaceum macro- and microconidia from the white, powdery, fluffy colony that slowly developed after about six weeks of growth on enriched medium. Over the past 20 years, only about 20 cases of tinea capitis caused by T. violaceum have been reported in Japan, and macroconidia have been identified in only 4 cases, including this one.     

Receptor site dominance after hair transplantation in alopecia areata

A 32-year-old woman presented with a patchy and ophiasis type of alopecia areata. She reported that at the age of 25 she had undergone plastic surgery for the same hair problem. In the occipital region, partial excision of bald areas and transplantation of punched grafts from unaffected areas of her scalp had been performed, but these grafts completely lost their hair shortly after transplantation. At the age of 30 she had developed, in addition, patchy alopecia areata in other areas of the scalp. The present observation of receptor site dominance of the area affected by alopecia areata suggests that the primary abnormality is situated in the affected tissue, and that the disease is caused by local spreading of a hitherto unknown factor.     

Circumscribed alopecia: an unusual manifestation of pediculosis capitis

A healthy 10-year-old girl was referred for evaluation of patchy hair loss on the scalp of longer than 6 months duration. She had been diagnosed and treated for head lice approximately 1 month before onset of the hair loss. Examination of the scalp showed discrete ovoid patches of hair loss at the vertex scalp. A scrape of the area of hair loss was performed, and a nit was visible on microscopic examination. Focal hair loss may represent an atypical manifestation of ongoing pediculosis capitis.     

Monilethrix in pedigree

A 30-year-old female patient presented with tiny papular scalp lesions with sparse, very short, curly hair of only 8 to 12 mm. Microscopic examination of hair revealed typical beaded or moniliform appearance. She also had typical lesions of psoriasis for past 2 months. Her father, 2 sisters and her 6-year-old daughter had similar types of beaded scalp hair.     

全身毛发受累的念珠形发1例

报告1例21岁男性患者，自幼头发稀少，头部营养不良性秃发，全身毛发程度不一的串珠状改变或黑点状断发，伴毛囊角化性丘疹。光镜见典型串珠状改变。扫描电镜观察胸毛，一根毛小皮消失，一根存在，狭窄部见明显的纵嵴，纵沟。病理见毛囊稀少、萎缩。     

Cutaneous angiosarcoma of the face and scalp presenting as alopecia

An 83-year-old woman presented with a 6-month history of hair loss and painless bruising involving her forehead and scalp. She was otherwise well. Skin biopsy of her scalp confirmed angiosarcoma with a significant increase in miniaturized and telogen hair follicles and some tumour-associated scarring hair loss. She was commenced on the chemotherapeutic agent paclitaxel and then subsequently the semi-synthetic taxane docetaxol. Treatment was terminated because of lack of response and adverse effects. Alopecia is an uncommon presentation in angiosarcoma and in this case there was a mixed pattern of focal scarring and follicular miniaturization. The latter was present only in areas of tumour involvement and not in a typical pattern distribution for androgenetic alopecia. The direct role of tumour in follicular miniaturization and alopecia is speculated and the implications of this for novel future treatment strategies is discussed.     

Heterochromia of the scalp hair: a result of pigmentary mosaicism?

Five patients who presented stable bands of hair of a different color with respect to the surrounding hair are reported. In 4 patients this was an isolated finding. One patient also had diffuse linear skin hypopigmentation and other abnormalities. We hypothesize that these 5 cases represent a distinct type of hair heterochromia, possibly because of somatic mosaicism for genes affecting pigmentation.     

Bubble hair – a possible explanation for its distribution

A 23-year-old white woman presented with a circumscribed area of shortened hairs along the anterior hairline. Approximately 1 month previously, the involved hairs had broken abruptly following shampooing. She used a hot air blow dryer for hair styling, but did not use electric rollers or a curling iron. Nor did she bleach, dye, or permanently wave her hair. The patient's hair styling technique involved wrapping hairs of the frontal hairline over a round brush whilst blow drying. There was no personal or family history of alopecia or scalp infections.
On physical examination, an oval-shaped area of shortened hairs (5–6 cm in length) was noted along the anterior hairline (Fig. 1). The area of involvement measured 5×4 cm and was to the left of the midline. The texture of the affected hairs was coarser than that of the unaffected hairs, and these broken hairs were somewhat crinkled in appearance. There was no erythema, scale, or discrete areas of alopecia on the scalp. By light microscopy, the broken hairs demonstrated multiple bubbles within the hair shafts (Fig. 2). Some of the bubbles led to the distension of the hair shaft. There was no evidence of trichorrhexis nodosa.     

Never too old to regenerate? Wound induced hair follicle neogenesis after secondary intention healing in a geriatric patient

Wound healing is a natural process to restore the structure and function of injured or diseased tissues. Repair of a skin wound usually leads to a scar while regeneration implies fully recovery of function and structure of the damaged tissue. Adult skin wound usually heals with scar while fetal skin heals scarless. Hair regeneration in elderly scalp wound has never been observed. We reported an 80-year-old patient with a large wound on the scalp after excision of a basal cell carcinoma healed by secondary intention wound healing. The patient's wound healed very well aesthetically. Interestingly, on approximate post wound day 180, a hair was observed to be growing towards the surface and eventually erupted in the center of the wound. The hair remained black at 42-month follow-up. This case demonstrated that neogenesis of hair is possible even in geriatric patient. To the best of our knowledge, this is the first report of hair regrow in human skin after wound healing.     

'Black dots' seen under trichoscopy are not specific for alopecia areata

Background. ‘Black dots’ are macrocomedo‐like round structures localized to the follicular ostium, and are considered a specific trichoscopic feature of alopecia areata (AA). Aim. To characterize specific features of ‘black dots’, and assess their possible presence in common hair and scalp disorders. Methods. In total, 107 patients with hair loss [30 with alopecia areata (AA), 37 with androgenetic alopecia (AGA), 17 with chronic telogen effluvium (TE), 23 with other hair and scalp diseases] and 93 healthy controls were examined, using a videodermoscope with 20–70 times magnification. Results. There was a correlation between the black dots and the early acute phase of the various alopecia types with the presence of the black dots. Black dots were found in 11% (22/107) of patients with hair loss, including 53.3% (16/30) with AA; in 40% (2/5) of patients with severe chemotherapy‐induced alopecia, and in 100% of patients with dissecting cellulitis of the scalp (n = 2), hypotrichosis simplex (n = 1), and congenital aplasia cutis (n = 1). No black dots were seen in patients with AGA or TE. Conclusions. Black dots are not specific for AA, and may be present in other hair and scalp diseases.