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Hair shaft abnormalities- clues to diagnosis treatment. Presented by Dr. Anahita Vali Dermatologist
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به نام خداوند جان و خرد
Hair shaft abnormalities-clues to diagnosis treatment.
Presented by Dr . Anahita ValiDermatologist
رودابه و زال داستانكند دستگيري تا كه را تار اين نيدم پرورا بدان
را يارمدان فسانه و دروغ را اين تو
موها عجيب استحكاممو رشته بلند يك توانائي
وزنه را گرمي 100كردنو پاره آنكه بدون داردحتي و شود گسسته
محكمي .ميتوان ريسمانبافت موها از
What is the similarities between hair & plants ?
The commonest causes of hair fragility and breakage are cosmetic.
Avoid/Avoid/Avoid
Repeated physical injury from overzealous grooming, backcombing, braiding and traction and long exposure to heat and ultraviolet light can cause weathering and damage to the hair. Chemical injury from perm lotions, straighteners and hair dyes can cause similar changes. Rare inherited conditions like monilethrix, pili torti, trichorrhexis nodosa, and trichothiodystrophy and trichorrhexis invaginata cause brittle hair and obvious hair loss from breakage.
Gentle hair care should be the prime concern. Avoid
داخل شيميائي پيوندهاي از متاثر مو ظاهري شكلاست آن
هيدروژني پيوندهاي سولفيدي دي پيوندهاي
تر ضعيفبيشتر تعداد
ها مو پذيري انعطاف مسئول
مو شدن خيس درزمانبه هيدروژني باندهاي
و ميشوند شكسته دفعاتآن شدن خشك زمان در
ميگيرند شكل دوباره
تر مستحكم ترو قويمواد ها آن تغئير راه تنها
شيميائيكمتر تعداد
Hair shaft abnormalities are characterized by changes in color, density, length and structure.
Hair dysplasias dry and looks lusterless.
easily broken, slow-growing, and seldom required cutting.
Office diagnosis of hair shaftabnormalities
1. Good clinical history emphasizes other skin appendages such as the nails, sweat and sebaceous glands.
2. Careful examination of the hair and scalp3. Evaluation of affected hair shafts under , the light
microscope . important note :To take representive hairsFrom of the scalp .
4.Trichoscopy
Different areas
Good IdeaExamine the of theaffected shaft adjacent to scalp toexclude the effects of
Proximal 1-2 cm
Weathering .
Microscopic examination With normal transmitted light or with polarized light. Hairs can be examined dry between two glass slide . Better and under higher magnification with a mounting medium The hairs placed side by side on slide without overlap under the
coverslip . The electron microscope (scanning or transmission)
Before making the diagnosis of aHair shaft abnormality , it isImportant to have a throughKnowledge of the
Variation in normal hairs .
It should be remembered thatnormal hairs differ considerably inlength , diameter , cross section , color andCuticular pattern even in the
Same patient .
Normal hair variations
1) Straight 2) Wavy3) Curly ( helical ) 4) Woolly or peppercorn ( spiral )
`ت بالس دام `ه حلق `ت دوس موي `لسله سماجراست اين از فارغ نيست حلقه اين در هركه
NO biochemical differences
Have been detected among theVarious forms of human hair . PhysicalProperties of hairs are derived fromthe central portion of the hair shaft , the
Cortex , which comprises 90% of the hair shaft .
Variations among raceswide structural variability even in normal hair
– Asiatic hair : visually straight– Caucasian hair : may be straight , wavy or curly .
– Negroid hair : woolly or peppercorn .
Hair shaft Defects
A. Inherited eg . Trichorrhexis invaginataB. Acquired eg . Trichoptilosis
Trichoscopy Dermoscopy is a method based on
epiluminescence microscopy, which is used to visualize living skin in magnification. Videodermoscopy of hair and scalp (trichoscopy) is a new method, which allows viewing hair shafts in vivo in many-fold magnification without the need of pulling hair for diagnostic purposes of examination
Trichoscopy in genetic hair shaft abnormalities
20-fold and 70-fold magnification were analysed. In selected cases 160-fold magnification was used for better visualization of hair shafts.
Several reports indicate the usefulness of trichoscopy in diagnosing hair and scalp disorders, including androgenic alopecia, alopecia areata or lipedematous alopecia.
Conclusion Genetic hair shaft
abnormalities may be diagnosed by trichoscopy in a single diagnostic session without the need of plucking or cutting them for diagnostic purposes.
Trichoscopy of hair shafts demonstrated a “crawling snake” appearance, with short wave cycles under 20× magnification We liken this appearance to the head of the mythical character Medusa, a character in Greek mythology, whose scalp hair was made of living snakes. Apart from that, the examination demonstrated broken hair shafts.
Evenly pigmented, coarse-textured, and extremely curly scalp hair
crawling snake” appearance
Hair abnormalities are extremely common in genoder-matoses. Hair changes may be a significant finding or even the initial presentation of a syndrome giving the clue to the diagnosis, in diseases such as trichothiodystrophy, Netherton syndrome, or Woolly hair syndrome.
Most hair shaft abnormalitiesCan be seen sporadically innormal hair so need to be foundConsistently in different areas of theScalp to be of
Diagnostic importance
Hair Shaft Defects in Children Children may be born with a
good head of hair, or relatively little hair, or no hair at all. At birth, any of these may be normal events, but at 12 months of age, the average child will have diffuse scalp hair growth and by 2 years should have normal scalp hair. If funny-looking hair is present, or if scalp hair is totally absent in a child aged 1 years old, then that should cause concern. Hair shaft defects in children may only involve certain areas such as the nape of the neck and the temples, or may affect much or all of the scalp hair.
The Netherton syndrome is characterized by three major clinical
features: ichthyosiform dermatosis (non-bullous ichthyosiform erythroderma or as ichthyosis linearis circumflexa), atopy and
a characteristic hair abnormality.
Clinically hair appears sparse, dull, brittle and short. The hair shaft abnormality,
called bamboo hair or trichorhexis invaginata is microscopically characterized by an invagination of the distal portion of
the hair shaft into its proximal portion forming a "ball in cup" appearance and is considered pathognomonic for Netherton
syndrome.
B. Without fragility , have no functional significance .
● Pili annulati (ringed hair )● Woolly hair● Woolly hair nevus● Uncombable hair syndrome (cheveux
incoiffables )● Straight hair nevus
Hair shaft DefectsA. With fragility causing patchy hair loss● Monilethrix● Pseudomonilethrix● Pilitorti● Bamboo hair ( nethertons syndrome )● Trichorrhexis nodosa
Weathering●Sun●Wind●Swimming●Washing●Friction●Excessive hair styling
Trichoclasis
Trichoclasis refers to the common “greenstick” fracture of the hair shaft, consisting of a transverse fracture splinted by an intact cuticle. There is no constant abnormality of the cuticle or cortex in this condition. Trichoclasis can be found in different hair shaft abnormalities or simply following excessive hair care and trauma. Usually when physical trauma accounts for trichoclasis, the affected area shows sporadic and patchy damage, which can be reversed with gentle hair care.
Pili Multigemini and Pili Bifurcati In pili multigemini, hairs are formed from
2 to 8 hair papillae and matrices. The hair shafts are surrounded by a common outer root sheath but each hair has its own inner root sheath, arising from one follicular canal. Given this tight arrangement, emerging hairs may look flattened, triangular, or ovoid with possible longitudinal grooves. In adults, pili multigemini is usually found in the beard region, sometimes in a linear distribution. In children, the scalp is typically the affected area. Pili bifurcati refers to hair shafts that emerge from a single papilla but then split into two shafts with their own distinct cuticles which can then rejoin as one shaft, even more than one time. It represents a restricted from of pili multigemini and occurs on the scalp rather than the beard.
ساله هفت خاطرات دفترچه مو ساقه اكتسابي آسيبهاي
موي كردن صاف يا فركردنسر
سر موي بري رنگ يا كردن رنگكردن شانه يا دادن پوش
برعكسمويا اتو از نامناسب استفاده
سشوارگرفتن آفتاب
استخر از زياد استفاده
ها دهنده حالت يا مو هاي كننده نرم
جديد هاي كننده نرم پانتنولبار داراي بزرگ مولكولهاي
مثبت الكتريكيدارد منفي بار اندكي خود مولبه به مولكولها چسبيدن
ديده آسيب فلسهايكوتيكول
و آراستن قابليت نتيجه درمي .براق افزايش مو بودن
يابد
ب ويتامين از مشتقيوباعث جذب مو تار داخل به
ميشود آن دهي رطوبت
نفوذ نيز سر پوست داخل بهرطوبت باعث و كند مي
ميشود نيز فوليكولها رسانيدر را مناسبي رطوبت نتيجه در
آن اختيار در مو رويش زمانگذارد مي
حدود در انسان است 6موي PH هيچ كه موئي ايزوالكتريك نقطه
نشده ايج\اد آن در است 3/67تغئيري
مو تارهاي اچ پي اين دربار انتقال به تمايلي
ندارند الكتريكي
سر موي روي بر كلر اثراتكلر كم بسيار مقادير حضور در حتي
1PPM
در پروتئين تخريب باعث كلرميشود كوتيكول اپي سطح
زمان در شامپو گيري بكاركلر حاوي آب از استفاده
دهد مي كاهش را آسيب
With light microscopy hair shaftabnormalities can be divided into fourCategories , these includes :1) Fractures of the hair shaft2) Irregularities of the hair shaft 3) Hair shaft coiling and twisting4) Exogenous matter on the hairshaft
Fractures of the hair shaft
Transverse ( Trichoschesis , Trichorrhexis nodosa ) Oblique ( Tapered fractured , eg anagen effluvium )Longitudinal (Trichoptilosis )
Acquired trichorrexis nodosa (more common )
● Trauma● Excessive weathering● Back combing● Stressed hair styles● Head rolling and banging● Habit tic● Trichotillomania● Scratching● Perming and dyeing of hairs
Congenital trichorrhexis nodosa● Rare● May occur as an isolated entity● May occurs with a metabolic abnormality such as1. Arginosuccinic aciduria2. Citrullinemia3. Menkes disease4. Trichothiodystrophy .( hair sulfur <50% normal)
Heat is a great enemy to hair .
(the dryer must always be used with great care and at a moderate setting )
حرارت از ديده آسيب موهاي براي درماني هيچندارد وجود زياد
درست و منظم،مرتب گيري بكارها دهنده حالت از
بصورت مو كامل پوششباعث ميتواند كردن بتونه
شود خوره مو بروز كاهش
Pili torti regular twists of the hair shaft along the long axis
Hair Shaft Coiling and Twisting- Pili Torti
Pili torti refers to the hair shaft that is twisted on its own axis leading to irregularly spaced beads from the twists, making the hair brittle and break easily. Twisted hairs can be seen normally on a scalp, particularly the pubic and axillary hair are normally twisted. Pili torti is usually a congenital condition but can be acquired as well. Children with neural hearing loss have been seen with pili torti which would lead the investigator to insist on early auditory testing. Bjornstad’s syndrome is a rare condition characterized by hearing loss and pili torti. Hypogonadism can be present (Crandall’s syndrome) along with mental retardation. As mentioned, Menkes’ kinky hair syndrome can have pili torti, trichorrhexis nodosa, trichoclasis, and trichoptilosis, making the hair feel like steel wool. A unique form of pili torti is known as corkscrew hair in which many hairs are twisted in a double spiral, which can occur associated with widely spaced teeth and joined fingers and toes (syndactyly).
Monilethrix autosomal dominant hair disorder periodic thinning of hair shafts /tendency to fracture
at constricted points. clinically in hair fragility and patchy
dystrophic alopecia Follicular abnormalities seen in monilethrix range from subtle perifollicular erythema and
hyperkeratosis to horny follicular papule formation.
[Mutations in hair specific keratins, especially hHb1 and hHb6, which
are primarily expressed in cortical trichocytes, cause predominantly structure
abnormalities of hair cortex.
pili annulati showed a random pattern of intermittent abnormal cavities .Light bands observed by clinical examination appeared as dark bands when imaged by light
microscopy, reflecting cortical spacers containing air in the light bands and fluid in the dark bands.
TrichothiodystrophyLight microscopy showed hair shafts with an irregular, undulating contour and transverse
fractures through the hair shaft (trichoschisis). Polarized light microscopy showed bright and dark .Hair shafts were notably flattened, folded most probably during the hair
mounting process.
Trichoscopy in trichotiodystrophy patients was non-specific. At a higher magnification hairs showed a non-homogenous structure reassembling grains of sand within the hair
shaft and a slightly wavy contour
These features are visible in patients with dark and light hairs. This has to be
distinguished from a symptom called intermittent medulla, observed in normal thick hair shafts, which may be
wrongly diagnosed as pili annulati. In these cases, the medulla visible as light-colored constitutes less than 50% of the hair shaft
width, the light bands are short and the intervals between them are usually shorter
than the bands' own length. Our study shows that this feature can be
distinguished by trichoscopy from the light bands in pili annulati, which take up more
than a half of hair shaft width. The boarders of bands are not clear-cut and the intervals between these bands are usually
longer than the bands' own length.
Oblique Fractures- Tapered Fracture
Fractures of the hair that cause a pencil point appearance are due to inhibition of nucleic acid and protein synthesis and therefore mitosis during anagen. Progresive narrowing of the emerging hair shaft may lead to a detached fractured hair with the thinner end near the scalp end. This is most commonly seen in anagen effluvium from cytotoxic chemotherapy drugs that disturb anagen hair shafts.
Trichostasis spinulosa refers to multiple
hairs that are present in one follicular canal with 5 to 50 vellus hairs that are embedded in a large comedo. Trichostasis is now regarded as a normal, age-related process that is a variant of a comedo. It principally affects the chest and back, especially the scapular area and is less common on the abdomen, face, and neck. Topical retinoic acid is the most effective treatment.
Trichostasis Spinulosa
Trichostasis spinulosa refers to multiple hairs that are present in one follicular canal with 5 to 50 vellus hairs that are embedded in a large comedo. Trichostasis is now regarded as a normal, age-related process that is a variant of a comedo. It principally affects the chest and back, especially the scapular area and is less common on the abdomen, face, and neck. Topical retinoic acid is the most effective treatment.
Prophylaxis of acquiredhair shaft Defects
●Avoid harsh shampoos ●To comb dry hair( since friction is higher in wet hairs )
●Minimize damage from hair cosmetics
Hair dryers applied on wet hair at high temperaturesmay also provoke the well – known
phenomenon of Bubble hair .
Conditioning agentshelp to protect hair .
Therapy of hair shaft disorders should focus on the cause.
In addition, minimizing traumatic influences to hair shafts, such as drying hair with an electric dryer or permanent waves and dyes, is important. A short hairstyle is more suitable for patients with hair shaft disorders.
