Hair Study Shows Breakage Caused by Tangle Teezer-like brush

virtuenow

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Localised Acquired Trichorrhexis Nodosa of the Scalp Hair Induced by a Specific Comb and Combing Habit - A Report of Three Cases

Abhay Mani Martin and P Sugathan

Department of Dermatology, Baby Memorial Hospital, Calicut, Kerala, India
Address for correspondence: Dr. Abhay M. Martin, Consultant Dermatologist, Baby Memorial Hospital, Calicut - 673 004, Kerala, India E-mail: [email protected]

Author information ► Copyright and License information ►

Copyright : © International Journal of Trichology
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.



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Abstract

Trichorrhexis nodosa is a hair shaft disorder often encountered in clinical practice. Acquired trichorrhexis is commoner of the two types and is most often due to weathering from physical or chemical causes. We report three representative cases of localized acquired trichorrhexis encountered in our clinic attributable to a specific comb, used commonly in Kerala, a Southern state of India.

Keywords: Acquired trichorrhexis nodosa, comb, light microscopy, localized form

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INTRODUCTION

Trichorrhexis nodosa is a disorder of the hair shaft characterized by easy breakability of hair and microscopically by nodes on the hair shaft 1. Trichorrhexis nodosa may be congenital or acquired. The more common acquired form results from repeated trauma to the hair shaft. Physical trauma like comb and combing habits have not been subjected to detailed scrutiny in the etiopathogenesis of trichorrhexis nodosa. The following three cases are representative of the type of patients we encounter and combing habits have been found to be closely linked to the development of trichorrhexis.

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CASE 1

A 28 year old male presented with a history of “broken hairs with glistening tips” on the temporal aspects of the scalp [Figure 1]. The condition was bilaterally symmetrical and asymptomatic. The patient had no systemic medical illnesses and there was no family history of similar illness. There was no history of use of hair cosmetics, hair bleaching, hair dyes, hair perming or straightening. We enquired about his comb and combing habits. The comb was made of plastic, had a round base with a slot to slip the fingers in for gripping. The bristles were short and vertical, arranged in linear rows and equidistant from each other [Figure 2]. We asked the patient to demonstrate his combing technique [Figure 3]. The comb was run over the scalp as vigorous strokes from the frontal aspect, brushed across the vertex and temporal aspects and ended at the occipital region. He combed his hair often, which averaged about 8-10 times a day. Clinical examination showed short stubs of hair focally on the temporal aspect of the scalp and the tips of the hairs had a glistening appearance. The hairs over the rest of the scalp were normal. The damaged hair samples were collected for light microscopic examination which showed breaks of the hair shaft at irregular intervals with fraying of the cut edges.
Figure 1
A glistening white spotty appearance in the temporal region of the scalp in case 1


Figure 2
The distinctive comb attributed as the cause of trauma, with short and vertical bristles, arranged in linear rows and equidistant from each other. Also appreciate that the comb is made of plastic, has a round base with a slot to slip the fingers in for ...


Figure 3
The technique of combing adopted by these patients. (The comb was run over the scalp as vigorous strokes from the frontal aspect, brushed across the vertex and temporal aspects and ended at the occipital region, around 8-10 times a day)



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CASE 2

A 35 year old male patient presented with complaints of “broken hairs with glistening white spots” on the vertex of the scalp noticed for the past 3 months [Figure 4]. He used a similar comb and had a similar combing habit.
Figure 4
Discrete spotty glistening white areas involving the vertex region with broken hairs in case 2



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CASE 3

A 19 year old engineering graduate presented with an identical hair shaft defect on the temporal aspects of the scalp. He too reported repeated combing of his hair, often during a day and soon after he got off his motorbike to set the ruffled hairs [Figure 5].
Figure 5
Spotty white glistening areas localized strictly to the temporal aspect in case 3


The clinical examination and light microscopic findings in case 2 and case 3 were similar to case 1. There were no systemic medical illnesses or familial hair defects notable on history in all the three cases. While light microscopic examination was done in all, a trichoscopic examination and electron microscopic examination were not done.

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DISCUSSION

Trichorrhexis nodosa is a hair shaft defect that occurs due to weathering. In 1852, Samuel Wilks of Guy's Hospital first described the condition, although the term trichorrhexis nodosa was not proposed until 1876 by M. Kaposi.[1] The term trichorrhexis nodosa refers to the light microscopic appear-ance of a fracture with splaying out and release of individual cortical cells from the main body of the shaft of hair, producing an appearance suggestive of the ends of two brushes pushed together.[2] The condition may be classified into three variants - a primary congenital form, trichorrhexis nodosa as part of other syndromes and acquired trichorrhexis nodosa.[2]

ETA: Snipped of Causation and Comb Characteristics:

The hair shaft when brushed with the comb gets entangled amongst the bristles, and is pulled backwards in a forceful stroke. The repeated friction that occurs in the combing process may be a reason for cuticular disruption, breakage of the hair shaft at periodic intervals and fraying of the ends.


Read the whole article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129123/
 
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I didn't want to post the whole article, but in summary, this article shows certain brushes can cause extreme breakage. The term Trichorrhexis Nodosa is just the scientific term for breakage, don't let it confuse you! When people posted about the Tangle Teezer causing breakage about a year and a half ago, I didn't want to beleive it. In fact, I didn't beleive that a brush alone could cause the midshaft and weird splits everyone was describing. I reluctantly gave up the TT and moved on. I came across this article that reconfirms what everyone said, ladies! What do you think?

This study suggests as TREATMENT:

Treatment options in acquired trichorrhexis nodosa are aimed at avoiding the incriminated offending agent. This could be repetitive physical trauma or chemical damage or insults. The patients in the above cases were asked to avoid the comb and use straight combs with elongated bristles. The use of oils and conditioners was recommended to reduce the hair shaft cuticular damage by reducing the hair – comb friction, which is the prime cause of the weathering defect.

The treatment recommendations above also reconfirm that coating the hair in conditioner and detangling w/wide tooth comb is the best way to get the job done w/minimal exposure to damage. Awesome. I explored w/shorter combs and they were much more stressful on the hair. I found the jumbo Hercules Sageman comb and ones shaped like it w/long (and wide) teeth to be the absolute best.
 
That's really interesting, Honestly I brush my hair at least 2-3 per day I dunno if that's a lot but I hate seeing it tangled up!! I can't help it.
 
That's really interesting, Honestly I brush my hair at least 2-3 per day I dunno if that's a lot but I hate seeing it tangled up!! I can't help it.

I guess not all brushes cause extreme breakage. What kind of brush are you using-- is it similar in design/structure to this brush or the TT? It's all about maximizing length retention for me. So I generally stay away from brushes. ETA: Welcome to the board!
 
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Interesting, thanks for posting. Hmmm that looks like a shampoo brush which people have said performs very differently than a Tangle Teaser even though they look similar. Idk I haven't used either - too many horror stories!

I love finger detangling for now, but I do agree that a wide tooth comb with loads of conditioner is best if you're going to use tools. Also sounds like they were combing scalp to ends (root to tip) - huge nono.

I'll have to look into those Sageman combs if I start using them again.
 
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thanks for the interesting article ,I use Denman brushes and have zero breakage (i do have some split ends though),i think brushing vigorously has alot more to do with breakage than the brush itself.
 
That's why I don't do brushes on DD's natural hair or my relaxed hair. The both of us have fine strands and brushes rip our hair to shreds; natural boar bristles and the denman brushes are bad for us. I sometimes use the boar bristle brush to neaten our hairline but I mostly use a baby brush on my delicate hairline.
 
I've used my tangle teaser faithfully ever since I got it about 3 years ago.

I like to think that I'm very gentle when I use it. I start from the ends and work my way up. Detangling takes me about 10-15 minutes. If I use a regular comb, it takes roughly 40 minutes to an hour to detangle my hair. I haven't really seen any adverse effects from it.

Since using the tangle teaser, I feel like regular combs don't get all the tangles out.

I understand that it doesn't work for everyone, but it works for me.
 
Thanks for posting. I used to rave about the TT but now have switched to wide tooth bone combs and don't have nearly as much shed hair.
 
Very interesting article. It's just proof of what I thought when I first saw these types of brushes come out; that may work for some people's hair, but it would be the same as running the rough side of a velcro strip through my hair. No thank you! :ohwell:
 
this why i only use my denman on flat ironed hair. i tried using it on a small section and was very gentle but felt it was going to rip my hair out. my hair was wet when used it and its also made my shrinkage worse and made my hair very frizzy. the tangle teezer has always been scary looking to me.
 
Thanks for that awesome article. I tried the teezer once and was like nah uh..........that mug was ripping my good hair out. Tried the denman brush and that was a fail too. Tried the Tangle Tamer and struck gold!
 
thanks for the interesting article ,I use Denman brushes and have zero breakage (i do have some split ends though),i think brushing vigorously has alot more to do with breakage than the brush itself.

There is a very long thread somewhere on here where many women were reporting splits caused by the Tangle Teezer. I don't think everyone was brushing "vigorously". I never saw breakage from the TT but alot of women were confident they were using it as intended and nonetheless having midshaft splits.

Here are the threads:
http://www.longhaircareforum.com/showthread.php?t=514691 : original thread, best if read backwards for these purposes

http://www.longhaircareforum.com/showthread.php?t=532923

http://www.longhaircareforum.com/showthread.php?t=539749
 
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Yeah, that would be a case study :look: . I say poh-tay-toe you say poh-tah-toe.

Lol, virtuenow stop being e-sensitive. I appreciate your thread, I just came in her looking for an actual study about us. Lol, you got my hopes up and dashed them with a pic of an Indian man with a bald spot. :lachen:
 
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