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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/
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.
Go to:
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
Go to:
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.
Go to:
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 1A glistening white spotty appearance in the temporal region of the scalp in case 1
Figure 2The 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 3The 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)
Go to:
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 4Discrete spotty glistening white areas involving the vertex region with broken hairs in case 2
Go to:
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 5Spotty 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.
Go to:
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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