A case of widespread non-pigmented hair regrowth in diffuse alopecia areata

A 62-year-old woman presented with diffuse alopecia areata affecting more than 50% of her scalp hairs with sparing of non-pigmented hairs. She was treated with a 2-month course of oral prednisolone and extensive hair regrowth occurred. The new hairs were completely non-pigmented. As a result, the patient's hair colour is now strikingly and completely white, with a normal hair density. This response has been sustained for 6 months after cessation of treatment.     

The case of the felted wig

A sudden matting of hair after shampooing of a hairpiece is reported, which led the patient to a lawsuit. Chemical analyses showed that hairs were weathered and led to a possible explanation of the curious phenomenon.     

Trichoteiromania

We describe a 61-year-old patient who compulsively rubbed her hair and her scalp because of a psychiatric disorder. Permanent rubbing resulted in fracturing of the hair shafts, leaving 2 cm long hairs and areas with stubs of 1mm length, giving the impression of bald spots. The distal ends of affected hair shafts were split, giving the impression of white tips. Light microscopy of the hair shafts showed split, brush-like ends of otherwise normal hair. We suggest the name trichoteiromania, which means "compulsive rubbing of hair", as a new term to describe hair loss in such cases.     

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.     

Nonsynchronized segmented heterochromia in black scalp hair

Nonsynchronized segmented heterochromia in black scalp hair is a rarely reported entity, the only previous report being described in association with iron deficiency anaemia. A 14-year-old girl presented with a 2-year history of nonsynchronized segmented heterochromia. She was otherwise well and her serum iron, copper, zinc and protein levels were all within the normal range. She had no clinical evidence of vitiligo or alopecia areata. This patient is believed to represent the first reported case of nonsynchronized segmented heterochromia in black scalp hair as a presentation of premature greying of the hair.     

Dry dermoscopy in clinical treatment of alopecia areata

Although dermoscopy is conventionally utilized with immersion gel for diagnosis of pigmented tumor, we utilized dry dermoscopy, which is dermoscopy without immersion gel, for clinical treatment of alopecia areata (AA). The scalp skin and hair of a 38-year-old Japanese male, and 23-, 22- and 47-year-old Japanese females with AA, whose normal hair color was black, were examined by dry dermoscopy. Exclamation mark hairs, short hairs, fractured hairs and black dots, all characteristic of AA, were detected by dry dermoscopy of the scalp of the 23-year-old female with ophiasis type AA. In the case of the 47-year-old female with round hair loss on the occipital scalp and diffuse hair loss over the fronto-vertical region, dry dermoscopy was useful for diagnosis of AA based on hair characteristic of AA. After she received corticosteroid pulse therapy with 500 mg of i.v. methylprednisolone on 3 successive days, her hair showed apparent regrowth and disappearance of the abnormal hairs characteristic of AA, evidenced by dry dermoscopy 1 month later. In a case of long-lasting AA in the 23-year-old female, we found a follicular plaque-like appearance at the opened hair follicle pores by dry dermoscopy. Histopathologically, the incompletely differentiated remnant hair shaft was packed in the follicular infundibulum. In addition, regrowing vellus hairs, which were difficult to clinically recognize, were detected by dry dermoscopy. Dry dermoscopy is therefore useful for both diagnosis and follow up of AA.     

Matting of hair following use of a new herbal shampoo

An Indian woman had irreversible entanglement (matting) of scalp hair following the use of a new shampoo. Previous shampoos used were well tolerated. Unaccustomed shampoo is the most likely cause, but the piling of long hair on the top of the head while shampooing and the repeated friction of combing of wet hair might both have facilitated the process of matting.     

Matting of scalp hair during shampooing—a new look

We present a new case of irreversible hair matting, a rare, but important and alarming, acquired hair disorder. This case was investigated to test the causal hypothesis proposed in 1984. At the same time four other specimens of matted hair from patients and tangles from normal individuals were also examined. Light and electron microscopy showed dramatic permanent twisting and bending of the hairs through 180 degrees. There was marked variation in the fibre width of hairs from matted samples, with some longitudinally split along a considerable length. This bending and entanglement of hairs of varying widths (felting) seemed to be the main reason for the hairs becoming so dramatically knotted together in four of the cases. In only one case was there any evidence of a viscous fluid binding the hair together. This finding suggests that there may be two different mechanisms involved in hair matting.     

Familial primary localized amyloidosis L

Netherton's syndrome is a rare autosomal recessive condition with variable expression. It comprises an ichthyosiform dermatitis and erythroderma of variable intensity and manifestations, associated with hair abnormalities. The pathognomonic finding (required for diagnosis) is that of trichorrhexis invaginata identified by light and scanning electron microscopic examination of hair shafts. This may be difficult to establish because the hair is sparse and not all hairs exhibit abnormalities. In one patient, cutaneous and hair problems had existed since infancy, and despite repeated examination of scalp hairs, the definitive diagnosis was made only by examining eyebrow hairs at the age of 30 years. We subsequently compared the number of diagnostic lesions found on scalp and eyebrow hairs from two other patients with previously diagnosed Netherton's syndrome. The density of lesions was greater in eyebrow than scalp hair, and furthermore, all eyebrow hairs had at least one lesion. It is proposed that microscopic examination, if possible, of both scalp and eyebrow hair from patients in whom Netherton's syndrome is suspected would increase the chance of a positive diagnosis.     

MULTIRIATE NORMAL FREQUENCY DISTRIBUTIONS FOR THE ANALYSIS OF SCALP HAIR MEASUREMENTS

SUMMARY.— Observations were made on samples of 10 scalp hairs from each of 20 male undergraduates who were all 20 years of age. The greatest diameters of the hairs were measured proximally just above the hair root and distally 40 mm. away from the root when the hair was dry and wet.
It was found that the paired dry proximal and distal measurements could have been a random sample from a bivariate normal distribution. The dry proximal and wet proximal measurements did not fit a bivariate normal distribution until a square root transformation was made on the wet measurements.
Analysis of variance of the proximal dry measurements showed that the observations on each subject were not random samples from a homogeneous population. The mean and variance of the observations differed for each subject.
In a subsidiary experiment the diameter of the hair shaft was found to be constant for distances up to 40 mm. from the hair root.
It was concluded that measurements of hair shaft diameters can be described by a multivariate normal distribution for an uncountably infinite number of variables.     

瘢痕性女性型脱发1例

报道1例瘢痕性女性型脱发。患者女,36岁,因脱发加重十余年就诊。皮肤科检查：弥漫性头发稀疏,发质细软,可见多数铅笔橡皮擦样大小的灶性秃发区。TrichoScan检查提示额部毛发密度明显降低,毛发直径变异度大于20%,毳毛比例明显增加。毛发镜检查：毳毛增加,可见大量直径3 ~ 5 mm的灶性秃发区域,部分毛囊开口消失,可...     

Circumscribed scalp hair loss following multiple hair-cutter ant invasion

A 32-year-old woman presented with an abrupt, localized loss of scalp hair that occurred on the previous day. Her nails, skin, and mucosae were normal. On the vertex of the scalp, there was a circular patch of alopecia; the hairs were broken at approximately equal lengths above the skin surface. Several erythematous macules were seen in the affected area, but scale, twisted hair, and exclamation-mark hairs were not present. Further examination revealed the presence of ants on the scalp. This patient is one of several referred to our department presenting with hair loss associated with hair-cutter ant invasion.     

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.     

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.     

Facial hirsutism following danazol therapy

We describe a 32-year-old woman who presented with excessive facial hair growth of sudden onset that disturbed her psychologically. She had been treated for fibrocystic breast disease with danazol for 6 months. Two months after discontinuation of the drug, the patient had complete reversal of the hair abnormality.     

鸟巢状发一例

鸟巢状发是不可逆的毛发异常，通常与使用离子/草药肥皂、洗发液、寄生虫感染、精神疾病的改变有关，本文报道1例女性患者，53岁，全部头发缠结4周。皮肤科检查见头顶有0.27m长、0.15m宽的头发缠结块。诊断鸟巢状发，建议患者剪除患发。     

Trichotemnomania: obsessive-compulsive habit of cutting or shaving the hair

A 28-year-old woman presented with a completely hairless scalp. The disorder had started 1 year ago, and at the same time she had developed dysphonia. During the past year, her hair disease had been diagnosed as alopecia areata totalis by many specialists, including several dermatologists. A close inspection of her scalp, however, revealed that no alopecia was present, because all infundibula were filled with a hair shaft that, on microscopic examination, showed cleanly cut surfaces. A scalp biopsy specimen showed completely normal structures. The pubic area was found to be covered with hair stubs of the same length. Therefore, a diagnosis of trichotemnomania was made. This term is derived from Greek thrix (hair), temnein (to cut), and mania (madness). After a stressful life event, the patient had developed both psychogenic dysphonia and the compulsive habit to remove the hair of her scalp, eyebrows, and axillary and pubic areas by shaving. Trichotemnomania is a distinct obsessive-compulsive disorder that should not be confused with trichotillomania. The condition should be taken into account when a supposed alopecia areata looks somewhat unusual.     

Morphological and biochemical characteristics of trichothiodystrophy-variant hair are maintained after grafting of scalp specimens on to nude mice

Trichothiodystrophy (TTD) is a hair defect associated with abnormal composition of the high-sulphur proteins (HSP). HSP can be modified quantitatively (reduced amount of qualitatively normal HSP: TTD-variant) and qualitatively (TTD). In this study we show that the amino acid composition of hairs collected from the scalp of a patient with TTD-variant (donor) was preserved in hairs produced by donor scalp follicles maintained up to 6 months as grafts on to nude mice. It is the first time that an exceptionally rare, clinically and biochemically well-characterized hair dysplasia has been maintained under laboratory conditions for a long period of time. The linear growth rate of TTD-variant hairs was similar to that of control hairs grown under comparable conditions. The persistence of disease-specific abnormalities in the hair shaft indicates that the TTD-variant mutation is expressed without significant quantitative modifications, and appears independent of systemic host-related factors. This model may serve as a clinically relevant working platform for evaluating regulation of abnormal gene expression in the hair follicle under well-controlled experimental conditions.     

Expression of the L-fucose moiety on infrainfundibular follicular keratinocytes of terminal follicles, its decreased expression on vellus and indeterminate follicles of androgenetic alopecia, and re-expression in drug-induced hair regrowth.

The distribution of various glycoprotein molecules on the surface of follicular keratinocytes was studied with a panel of lectins with specificity for various sugar moieties on biopsy specimens from both bald/balding scalp and normal occipital scalp, of 23 patients with androgenetic alopecia as well as on biopsies of normal forearm skin of four patients. The most significant differences between bald and normal scalp biopsy were noted with Ulex europaeus agglutinin I (UEA I). We noted an increased (91.8% +/- 3.1; mean +/- SE) expression of UEA I binding sites on the infra-infundibular follicular keratinocytes in anagen terminal scalp hairs, compared to 28.5% +/- 5.2 in the indeterminate (anagen) hairs of balding scalps, and 23.2% +/- 6.3 in the anagen follicles of vellus fore-arm hairs. By contrast, the telogen hairs demonstrated minimal UEA I staining: 4.0% +/- 0.8, mean +/- SE in telogen scalp hairs, 1.8% +/- 0.5 in telogen hairs of balding scalps (0% in completely bald scalps, in which all the hairs were in the telogen phase), and 1.9% +/- 0.2 in telogen forearm hairs. The percentage of UEA I staining correlated with the length of the infra-infundibular follicles in all cases studied. In three cases of hair regrowth after hair growth promotors, the UEA I staining increased to 80.6% +/- 6.1 in anagen hairs and correlated with increased length of infra-infundibular follicles. Our data indicate that there are 1) marked differences between anagen and telogen follicles in UEA I binding to infra-infundibular follicular keratinocytes; 2) the percentage of UEA I staining reflects the size (length) of the infra-infundibular hair follicle; and 3) the anagen follicles of balding scalps (indeterminate hairs) show UEA I staining resembling that exhibited by anagen follicles of vellus hairs.     

A girl with loose anagen hair syndrome and uncombable, spun-glass hair

A 4-year-old girl presented with a 2-year history of scalp hair that had an odd texture, was difficult to manage, tended to "stick out" from the scalp, and was irregular in length. A hair pull test revealed that hairs could be easily and painlessly extracted. Light microscopic examination of the hair demonstrated anagen hairs with a ruffled cuticle and distorted bulb as well as an unusual undulation and grooving of the shafts. These findings are consistent with both loose anagen and uncombable hair syndromes. The occurrence of both syndromes in the same patient seems unlikely, and we propose that our patient has loose anagen hair syndrome with features resembling uncombable hair syndrome.