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Review
. 2023 Feb 23;14(2):163-171.
doi: 10.4103/idoj.idoj_7_22. eCollection 2023 Mar-Apr.

Hair Shaft Disorders in Children - An Update

Yasmeen Jabeen Bhat  1 , Taiba Trumboo  1 , Kewal Krishan  1
Affiliations
Review

Hair Shaft Disorders in Children - An Update

Yasmeen Jabeen Bhat et al. Indian Dermatol Online J. .

Abstract

Disorders of hair shaft are a diverse group of congenital and acquired abnormalities of the hair that can pose a diagnostic and therapeutic challenge to the dermatologists. Hair shaft abnormalities can occur as an isolated phenomenon or can be associated with an underlying genetic syndrome. Any change in the texture, appearance, and growth of the hair should prompt evaluation of the patient for the presence of any hair shaft anomaly. The diagnosis can be suggested by a complete history and physical examination of the hair-bearing areas as well as other ectodermal structures (nails and teeth). A key feature in the evaluation of hair shaft defects is to determine the fragility of the hair shaft that can be elucidated by performing the "tug test." Trichoscopy and light microscopy serve as valuable tools in establishing the specific type of hair shaft disorder. An update of the approach for the diagnosis and management is included in this review.

Keywords: Children; genetic hair disorders; hair shaft disorders; trichoscopy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Graphic representation of various hair shaft disorders
Figure 2
Figure 2
A tug test to assess hair shaft fragility
Figure 3
Figure 3
Trichoscopy using videodermoscope
Figure 4
Figure 4
Algorithmic approach to diagnose hair shaft disorders
Figure 5
Figure 5
(a) Trichorrhexis nodosa. Trichoscopy showing nodular thickenings (blue arrow), and longitudinal splitting of the hair shafts leaving brush-like ends (yellow arrow; Dino-lite AF115ZT, non-polarized ×70) (b) Microscopic examination (×40) showing fracture with splaying out of hair fibers resembling two brushes or brooms pushed together
Figure 6
Figure 6
(a) Pili torti. Trichoscopy showing 180° rotated and flattened hair shafts at irregular intervals (yellow arrows; Dino-lite AF115ZT, non-polarized × 70) (b) Light microscopy (×40) shows twists at irregular intervals along the hair shaft
Figure 7
Figure 7
(a) Trichorrhexis invaginata. Icthyosis linearis circumflexa in a case of Netherton syndrome (b) Trichoscopy showing bamboo hairs with characteristic invaginations (blue arrows). The hair shafts fracture easily leaving cupped (invaginated) ends (yellow arrow; Dino-lite Edge, non-polarized ×60.5)
Figure 8
Figure 8
(a) Woolly hair. Short, sparse, and lightly pigmented hair over the scalp.(b) Trichoscopy showing “crawling snake” appearance (yellow circle; Dino-lite Edge, non-polarized ×70)
Figure 9
Figure 9
(a) Uncombable hair syndrome. Dry frizzy blond hair that stand from the scalp surface (b) Light microscopy (×10) showing lightly pigmented hair shaft with a longitudinal groove
Figure 10
Figure 10
(a) Ectodermal dysplasia. A case of 5-year-old with ectodermal dysplasia (b) Trichoscopy showing pilitorti (180°) twisting of hair shaft (blue arrow; Dino-lite Edge, non - polarized ×74.3)
Figure 11
Figure 11
Trichoptilosis: Light microscopy (×10) showing distal end of the hair shaft having longitudinal splitting
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