Summary Trichorrhexis nodosa (TN) is a hair shaft disorder characterized by fragile hair with nodes on the hair shaft. Here we report a case of aquired localised trichorrhexis nodosa and describe the importance of noninvasive tools like trichoscopy and light microscopy in the diagnosis of an isolated TN.
Hair Diseases--diagnosis

BACKGROUND: Although the diagnosis of hair disease depends on the comparison of normal and abnormal findings, data on normal hair characteristics in Koreans have not been reported. We have developed some technical improvements on phototrichogram methodology to assess hair characteristics. OBJECTIVE: This study was performed to quantify Koreans' hair characteristics at each site(eg. vertex, occipital, temporal) of the scalp according to the age and sex using the phototrichogram and to compare the differences of hair characteristics between Caucasian and Korean population. METHODS: Hairs in the precisely defined circle at each(vertex, temporal, occipital) area of the scalp in 42 healthy volunteers(16 men and 26 women) were evaluated according to sex and age groups, respectively. Each circumscribed area of the scalp, centered with a dot tattoo to ensure reproducibility, were first shaved: The shaven area was first photographed just after shaving. Two days later, grouping pattern of grouped hair unit, total and anagen hair counts were determined from low magnification image. The linear hair growth rate(micrometer/day) and hair shaft diameter were obtained from high magnification image. RESULTS: The results can be summarized as follows: 1. The range of hair density was 119+/-13/cm2~137+/-12/cm2 in male and 92+/-24/cm2~139+/-23/cm2 in female. Hair density of the occiput was significantly higher than that of temple. 2. The range of linear hair growth rate was 300+/-19micrometer/day~319+/-27micrometer/day in males and 289+/-17micrometer/day~327+/-54micrometer/day in females. Hair growth rate in each group decreased in order of vertex, occiput and temple. Most of the hairs on the vertex in older males have slower growth rate than in other groups. 3. The range of hair thickness was 70+/-6micrometer~89+/-10micrometer in males and 75+/-7micrometer~87+/-6micrometer in females. Hairs of the vertex in the older male group(age>or=45 year-old) were thinner than those of the occiput. The population of thin hair(<40micrometer) on the vertex in older males was 7.6% larger than that of other sites. 4. The range of anagen ratio was 91.0% ~ 93.7% in males and 91.9%~94.1% in females. CONCLUSIONS: Lower hair density, larger hair diameter and slower hair growth rate were remarkable in Koreans than in Caucasian. In addition, considering the hair characteristics of Koreans, the newer, improved method of phototrichogram will be a promising tool in the study of the hair disease including androgenetic alopecia, and in the quantitative analysis of the effects of agents stimulating hair growth.
Alopecia ; Diagnosis ; Female ; Hair Diseases ; Hair* ; Humans ; Male ; Scalp*

The scalp hair is composed of one hundred thousand of hairs. Each hair goes through the three phases of the hair cycle, which causes the hair to turn from an anagen hair into a catagen hair, then into a telogen hair, and finally into a new anagen hair. The number of hairs is maintained at a relatively constant level because each hair has its own hair cycle. The hair of Koreans is relatively thicker than that of Caucasians and Africans but its growth rate and density are lower. There are various factors that influence hair growth such as hormones, nutritional status, and drugs. However, androgen is most important among these factors and, particularly, androgenetic alopecia is caused by androgen and genetic factors. Because excessive dihydrotestosterone produced by 5alpha-reductase is of the greatest importance in androgenetic alopecia, finasteride or dutasteride, which inhibits the action of 5alpha-reductase, is effective in treating androgenetic alopecia. Also, minoxidil is widely used as it promotes hair growth. Furthermore, there are various types of hair diseases and specialized examination is required for differential diagnosis.
Alopecia ; Asian Continental Ancestry Group ; Azasteroids ; Diagnosis, Differential ; Dihydrotestosterone ; Dutasteride ; Finasteride ; Hair ; Hair Diseases ; Humans ; Minoxidil ; Nutritional Status ; Scalp

Trichilemmal cysts are common fluid-filled growths that arise from the isthmus of the hair follicle. They can form rapidly multiplying trichilemmal tumors-, also called proliferating trichilemmal cysts, which are typically benign. Rarely, proliferating trichilemmal cysts can become cancerous. Here we report the case of a patient who experienced this series of changes. The 27-year-old male patient had been observed to have a 1×1 cm cyst 7 years ago. Eight months prior to presentation at our institution, incision and drainage was performed at his local clinic. However, the size of the mass had gradually increased. At our clinic, he presented with a 5×4 cm hard mass that had recurred on the posterior side of his neck. The tumor was removed without safety margin, and the skin defect was covered with a split-thickness skin graft. The pathologic diagnosis was a benign proliferating trichilemmal cyst. The mass recurred after 4months, at which point, a wide excision (1.3-cm safety margin) and split-thickness skin graft were performed. The biopsy revealed a trichilemmal carcinoma arising from a proliferating trichilemmal cyst. This clinical experience suggests that clinicians should consider the possibility of malignant changes when diagnosing and treating trichilemmal cysts.
Adult ; Biopsy ; Diagnosis ; Drainage ; Epidermal Cyst ; Hair Diseases ; Hair Follicle ; Humans ; Male ; Neck* ; Skin ; Skin Neoplasms ; Transplants

Menkes disease, so called kinky-hair syndrome, is a rare fatal X-linked recessive disorder, which is caused by a mutation in the ATP7A gene encoding the copper transporting ATPase. Dysfunction of copper-dependent enzymes results in various clinical features, including skin and hair hypopigmentation, progressive neurologic degeneration, bone and connective tissue alterations with soft doughy skin and joint laxity, and vascular abnormalities, including aneurysms and bladder diverticula. Patients have the characteristic hair, which is kinky, colorless or steel-colored, and brittle with cutis laxa. Early diagnosis and treatments are perquisites for improving the clinical outcomes. Herein, we describe a rare case of Menkes disease accompanied by hair abnormality and cutis laxa in a 35-days-old boy.
Adenosine Triphosphatases ; Aneurysm ; Connective Tissue ; Copper ; Cutis Laxa ; Diverticulum ; Early Diagnosis ; Hair ; Hair Diseases ; Humans ; Hypopigmentation ; Joint Instability ; Menkes Kinky Hair Syndrome ; Skin ; Urinary Bladder

Menkes disease, so called kinky-hair syndrome, is a rare fatal X-linked recessive disorder, which is caused by a mutation in the ATP7A gene encoding the copper transporting ATPase. Dysfunction of copper-dependent enzymes results in various clinical features, including skin and hair hypopigmentation, progressive neurologic degeneration, bone and connective tissue alterations with soft doughy skin and joint laxity, and vascular abnormalities, including aneurysms and bladder diverticula. Patients have the characteristic hair, which is kinky, colorless or steel-colored, and brittle with cutis laxa. Early diagnosis and treatments are perquisites for improving the clinical outcomes. Herein, we describe a rare case of Menkes disease accompanied by hair abnormality and cutis laxa in a 35-days-old boy.
Adenosine Triphosphatases ; Aneurysm ; Connective Tissue ; Copper ; Cutis Laxa ; Diverticulum ; Early Diagnosis ; Hair ; Hair Diseases ; Humans ; Hypopigmentation ; Joint Instability ; Menkes Kinky Hair Syndrome ; Skin ; Urinary Bladder

A 39-year-old man with poliosis of his lower eyelid lashes visited our clinic. He reported that his symptoms began with a few central lashes and then spread along the adjacent lashes during the ensuing 2 weeks. A pigmented nevus, approximately 4 mm in diameter, was identified just above the white lashes without surrounding skin depigmentation. No specific findings were identified with regard to the patient's general health or serologic and radiologic testing. Excisional biopsy of the pigmented nevus was performed. On histopathologic examination, infiltration of the dermis by numerous lymphocytes and melanophages was observed. The poliosis was ultimately diagnosed as a presenting sign of the halo phenomenon in the regressive stage of a melanocytic nevus.
Adult ; Biopsy ; Diagnosis, Differential ; Eyelashes/*pathology ; Eyelid Neoplasms/*diagnosis ; Hair Diseases/*diagnosis ; Humans ; Hypopigmentation ; Male ; Nevus, Halo/*diagnosis

Alopecia areata (AA) is a disease in which the patient experiences a sudden loss of scalp hair leaving round patches. It has a lifetime risk of 1.7%. AA is known to occur on any part of the body, including the scalp, beard area, axilla, and even the pubic area. Although the pathogenesis of AA is poorly understood, the consensus is that AA is an organ-specific autoimmune disease that typically presents in the hair follicles. Susceptibility to the development of AA may be modified by environmental factors, including exposure to pro-inflammatory agents and other modulators. The differentiation of AA can sometimes be challenging as several conditions (such as trichotillomania, tinea capitis, telogen effluvium, and lupus) may resemble AA. Obtaining the patient's history, performing a hair pull test, and skin biopsy or dermoscopic findings can be helpful for confirmation. Treatment for AA is usually based on patient age and the extent of hair loss, but there are no therapeutic agents that are curative or preventive for AA. AA can progress unpredictably. Indicators of poor prognosis include atopy, co-occurring immune diseases, positive family history, young age of onset, and ophiasis.
Age of Onset ; Alopecia Areata* ; Alopecia* ; Autoimmune Diseases ; Axilla ; Biopsy ; Consensus ; Diagnosis* ; Hair ; Hair Follicle ; Humans ; Immune System Diseases ; Prognosis ; Scalp ; Skin ; Tinea Capitis ; Trichotillomania

Netherton's syndrome is an unusual disorder which consists of triad of ichtyosiform dermatosis, multiple defects of hair shaft and an atopic diathesis. The finding of bamboo hair is pathognomic in Netherton's syndrome and the ichthyosiform dermatosis may consist of either ichtyosis linearis circumflexa or congenital ichthyosiform erythroderma. Often, variability in the clinical features leads to a delay in diagnosis in many cases. We report a case of Netherton's syndrome diagnosed in the neonatal period. The patient presented with severe ichthyosis and confirmed microscopically distinctive bamboo hair.
Diagnosis ; Disease Susceptibility ; Hair ; Humans ; Ichthyosiform Erythroderma, Congenital ; Ichthyosis ; Infant, Newborn* ; Skin Diseases

While mycological examinations, potassium hydroxide preparation, and fungus culture remain the gold standard for the diagnosis of superficial dermatomycoses, mycological procedures have limitations because they are rather complex, time-consuming, and require skilled personnel and additional mycological tools. Dermoscopy is a simple, non-invasive diagnostic technique that allows better visualization of morphologic structures of the skin than the naked eye. It is easily performed with a hand-held dermoscope and allows immediate diagnosis. It has been primarily used to evaluate pigmented skin lesions, but recent advances indicate that it can also be a useful and convenient tool for diagnosing superficial dermatomycoses. The determination of specific dermoscopic patterns of fungal infection, especially in selected cases involving terminal hairs or nails, could lead to a straightforward diagnosis and facilitate their differentiation from non-fungal skin diseases. In addition, dermoscopy permits better inspection of subtle clinical features caused by fungi that are less evident to the naked eye; thus, in most cases, it can enhance clinician's diagnostic accuracy and confidence level, and allow determination of the best site for adequate mycological sampling as well as therapeutic monitoring. However, it should be a part of the evaluation in combination with other mycological tests because it does not substitute confirmatory examination for superficial dermatomycoses.
Dermatomycoses* ; Dermoscopy* ; Diagnosis ; Fungi ; Hair ; Onychomycosis ; Potassium ; Skin ; Skin Diseases ; Tinea Capitis