Hair associations

alopecia areata

acrodermatitis enteropathica, Addison’s d., adrenal d., Alezzandrini’s s., asthma, atopic dermatitis, connective tissue d., diabetes mellitus, Candida endocrinopathy s., Down s., Hashimoto’s thyroiditis, LP, LE, myasthenia gravis, pernicious anemia, polymyalgia rheumatica, RA, stress, thyroid d. (8-12%), ulcerative colitis, vitiligo, Vogt-Koyanagi s.

alopecia universalis

loss of all body hair; alopecia areata, exfoliative erythroderma

alopecia, cicatricial

acne keloidalis, CTCL, dissecting cellulitis of the scalp, DLE, dystrophic epidermolysis bullosa (Hallopeau-Siemens), folliculitis decalvans, Graham-Little s., Gunther’s d., hemochromatosis, ichthyosis (congenital erythrodermic), lichen planopilaris, lupus pernio, metastatic disease, mixed inflammatory scarring alopecia, Parry-Romberg s., PCAS, PCT, pseudopelade, PSS, pustular psoriasis, scleroderma, traction alopecia, ulcerative lichen planus, Vohwinkel’s s.

alopecia, moth-eaten

secondary syphilis

alopecia, noncicatricial

acrodermatitis enteropathica, AIDS, alopecia areata, biotin deficiency, Clouston’s s., Cronkhite-Canada s., dermatomyositis, erythroderma, follicular eczema, follicular mucinosis, Hodgkin’s d., IFAP s., KID s., lipoid proteinosis, lupus erythematosus, multiple carboxylase deficiency, Olmsted’s s., PRP, psoriasis, Rothmund-Thomson s., Satoyoshi’s s., Sezary’s s., sprue, Vogt-Koyanagi-Harada s., zinc deficiency

alopecia, patchy

lipoid proteinosis

alopecia, primary scarring; lymphocyte associated

alopecia mucinosa, discoid lupus, lichen planopilaris, pseudopelade of Brocq

alopecia, primary scarring; pustulofollicular

acne keloidalis nuchae, dissecting cellulitis of scalp, erosive pustular dermatosis of the scalp, favus, folliculitis decalvans, kerion, tinea capitis

alopecia, primary scarring; vesiculobullous

cicatricial pemphigoid, epidermolysis bullosa

anagen effluvium

boric acid intoxication, colchicine, mercury intoxication, protein malnutrition, radiation therapy, systemic chemotherapy, thallium poisoning

anagen/telogen ratio, decreased

alopecia areata

atrichia

AD, alopecia areata, alopecia-onychodysplasia-hypotrichosis s., AR, atrichia with papular lesions, Baraitser’s s., CL, demotrichic s., ectodermal dysplasia with severe MR, Hayden’s s., Jeanselme and Rime hypotrichosis, Marie-Unna hypotrichosis, Mendes da Costa s., Moynahan’s s., odonto-onychodysplais with alopecia, Perniola’s s., Shokeir’s s., Silvestrini-Corda s., Steijlen’s s., Tricho-onychodysplaia with xeroderma, Wilson’s s.

balance beam alopecia

pressure alopecia in gymnasts

bamboo hair

ball & socket deformity-trichorrhexis invaginata; Netherton s.

bayonet hair

acquired pigmented nodal swelling of hair shaft

beaded hair

monilethrix 

black dot hair

appearance with fungal infection; Trichophyton tonsurans, Trichophyton violaceum

brittle hair

arginosuccinase lyase deficiency, autoimmune thyroid d., Basan s., BIDS s., Cote-Katsantoni s., craniolenticulosutural dysplasia, ectodermal dysplasia, focal dermal hypoplasia, Graves d., hypohidrotic ectodermal dysplasia, IBIDS s., Pollitt s., Sabinas s., selenium poisoning, Shapira’s s., thyroid d.

broomstick eyelashes

unruly fine eyelashes; kwashiorkor

bubble hair

acquired open areas of hair shaft; hair dryer induced

coarse hair

de Lange s., Rapp-Hodgkin s.,

corkscrew hairs

wound hairs of lower extremities; scurvy, vitamin C deficiency

doll’s hair

follicular convergence; lichen planopilaris

ectothrix

fungal arthrospores surrounding hair shaft; Microsporum andouinii, M. canis, M. ferrugineum, M. gypsum, M. phanum, Trichophyton verrucosum, T. mentagrophytes

endothrix

fungal spores growing within hair shaft; Trichophyton tonsurans, T. violaceum

exclamation point hairs

shortened hair from fracture at weak points, distal broader than proximal; alopecia areata

exclamatory hair

tapering proximal hair shaft; anagen effluvium

eyebrow aplasia

anhidrotic ectodermal dysplasia, atrichia congenita, isolated familial characteristic, keratosis pilaris atrophicans, KID s., monilethrix, oculomandibular dysostosis, oculovertebral dysplasia, pili torti, polydysplastic epidermolysis bullosa, progeria, Rothmund-Thomson s., Tietze’s s.

eyebrow confluence

Cornelia de Lange s., hypertrichosis lanuginosa, isolated familial characteristic, Kwashiorkor, Waardenburg s.

eyebrow hair loss

alopecia areata, atopic dermatitis, follicular mucinosis, Graham-Little-Feldman s., hypothyroidism, leprosy, myxedema, Netherton’s s., progeria, Rapp-Hodgkin s., retinoids, secondary syphilis, Tietze’s s., trichotillomania, ulerythema oophyrogenes

eyebrow hypertrophy

Cornelia de Lange’s s., Hurler s., hypertrichosis lanuginosa, idiopathic gingival fibromatosis and hypertrichosis, isolated familial characteristic, trichomegaly

eyelash hypertrophy

AIDS, trichomegaly

flag sign

bands of light & dark dyspigmented hair; kwashiorkor

forelock, white

piebaldism, poliosis with multiple malformations, Waardenburg’s s., Woolf’s s.

gray hair, premature

ataxia telangiectasia, B12 deficiency, Book’s s., coup de sabre, Chediak-Higashi s., Fisch’s s., prolidase deficiency, Rothmund-Thomson s., Seckel’s s., vitiligo, Waardenburg s., Werner s.

gray patch

discrete, gray, lusterless hair; tinea capitis

Hertogh’s sign

lateral thinning of eyebrow hair; atopic dermatitis, hypothyroidism

hirsutism

anorexia, cancer (ovary, testicular), congenital, Cushing s., dermatomyositis, Donohue s., hypothyroidism, malnutrition, medications, Sanfilippo s., severe head injury, Stein-Leventhal s. (polycystic ovaries)

hyperthyroidism

alopecia areata, hair shedding, thyroid disease

hypertrichosis, generalized

acquired: acrodynia, acromegaly, anorexia nervosa, Cushing d., dermatomyositis (juvenile), diabetes mellitus, drugs, head injury, hyperostosis interna, hypothyroidism, idiopathic gingival fibromatosis and hypertrichosis, malabsorption s., multiple sclerosis, PCT, POEMS s., post encephalitis, schizophrenia

congenital: Ambras s., Coffin-Siris s., congenital generalized hypertrichosis, congenital hypertrichosis lanuginosa, congenital macrogingiva & giant fibroadenomas, Cornelia de Lange’s s., DEB-Cockayne Touraine, erythropoietic protoporphyria, faun tail, fetal alcohol s., generalized smooth muscle hamartoma, Gorlin’s s., Gunther’s d., hepatoerythropoietic porphyria, hereditary gingival fibromatosis/hypertrichosis, Hurler’s s., hyperkinetic circulatory disorder, Lawrence-Seip s., leprechaunism (Donohoe’s s.), LSA in female children, melorheostosis, neurofibromatosis, osteochondrodysplasia with hypertrichosis, PCT, POEMS s., PSS, Schinzel-Giedion s., stiff skin s., total lipodystrophy, variegate porphyria

hypertrichosis, localized

acquired: Becker’s nevus, bites, burns (periphery), chickenpox, chromic osteomyelitis, congenital AV fistula, denervated areas, HIV (eyelashes), immunization sites (smallpox, diphtheria-tetanus), insect bites, irritants, lichen simplex, lymphedema, melorheostotic scleroderma, osteosclerotic myeloma, post morphea, pressure, stasis, sympathetic dystrophy, trauma, under casts

congenital: congenital smooth muscle hamartoma, diastematomyelia, hairy elbows, hairy pinna, pigmented nevus, spina bifida, spina bifida occulta, trichomegaly, traction, Winchester s.

hypomelanosis

Book s, Down s., Fanconi’s s., Hallermann-Streiff s., myotonic dystrophy, Pierre-Robin s., progeria, Rothmund-Thomson s., Seckel’s s., Treacher-Collins s., tyrosinuria, Werner’s s.

hypopigmentation

phenylketonuria

hypotrichosis (see pili torti & trichoschisis)

argininosuccinicaciduria, cartilage hair hypoplasia, ectodermal dysplasia, Hallermann-Streiff s., Jeanselme & Rime hypotrichosis, Kalin’s s., lipoid proteinosis, Marie-Unna hypotrichosis, regional choridal atrophy & alopecia, Rombo s., Schopf-Schulz-Passarge s.

nutritional deficiency: biotin, calorie malnutrition, essential fatty acid, Hartnup d., homocytinuria, protein, zinc

IBIDS s.

birefringence of hair, pili torti, sparse hair, trichorrhexis nodosa, trichoschisis

loose anagen s.

hair sheding; absent root sheath, normal anagen bulb, ruffled cuticle

lupus hairs

short, fractured hairs from increased hair fragility; LE

Maria-Unna hereditary hypotrichosis

AD; sparse, absent at birth, wiry hair in childhood, variable loss at puberty; twisting, longitudinal ridging, cuticle peeling

melanin casts

amorphous intrafollicular deposits of melanin pigment

monilethrix

AD, AR; mutation in hair keratin hHb6, type II keratin genes, hHb1, chromosome 12q13 keratin cluster; elliptical nodes on hair shaft

moth-eaten hair

patchy alopecia; syphilis

ophiasis pattern

periphery of scalp with hair loss; alopecia areata

pili annulati

AD, sporadic; alternating bright & dark bands of hair shaft

pili bifurcati

division of hair into two hair shafts; congenital, damaged hair, pseudopelade, pili torti, trichotillomania

pili canaliculi

grooved hair; trichothiodystrophy AKA spun glass hair, uncombable hair, triangle hair

pili multigemini

multiple buds within hair follicle

pili spinulosis

dilated pore containing multiple tufted white hairs; eruptive hair cysts, keratosis pilaris, seborrheic keratosis

pili torti

twisted, tort hair; arginosuccinicaciduria, arthrogryposis & ectodermal dysplasia, Bazex’s s., Björnstad’s s., citrullinemia, Conradi-Hunermann chondrodysplasia punctata, Crandall’s s., ectodermal dysplasia with syndactyly, etretinate, hypohidrotic ectodermal dysplasia, isotretinoin, Menkes’ kinky hair s., monilethrix, Netherton’s s., PIBIDS s., pili canaliculis, pili torti & enamel hypoplasia, pseudomonilethrix, Salamon’s s., Salti-Salem s., striate keratoderma, Tay’s s., tricho-odontonychial dysplasia with pili torti, trichorrhexis nodosa, trichothiodystrophy

pili torti; AD

AD; flattened, twisted hair shaft; citrullinemia, dental & ocular abnormalities, ichthyosis, keratosis pilaris, sensorineural deafness, trichothiodystrophy

Pohl-Pinkus marks

hair shaft constrictions; acquired trichodystrophy; antimitotic drugs, emotional stress, systemic d.

premature graying

antimalarial ingestion, ataxia telangiectasia, B12 deficiency, chloroquine ingestion, Cockayne’s s., dystropia myotonia, prolidase deficiency, pernicious anemia, pangeria, progeria, poikiloderma congenitale

pseudo pili annulati

non-hereditary, no hair shaft cortex abnormality, alternately flattened hair shaft

pseudomonilethrix

irregular flattened & expanded hair shaft; compressed overlapping hairs, trauma

pull test

gentle traction at base of 25-50 terminal hairs; loss of 2-3 hairs per pull is pathologic

silver color hair

Chediak-Higashi s., Elejalde s., Griscelli s., Hermansky-Pudlak s., infantile sialic acid storage d., Menkes kinky hair s., Riyadh chromosome breakage s., Robert’s phocomelia s., selenium deficiency

sparse eyebrow/eyelash

Pallister-Killian s.

sparse hair

Dubokowitz’s s., Langer-Giedion s., Marinesco-SjØgren s., Nicolaides-Baraitser s., Pallister-Killian s., progeria, Schopf-Schulz-Passarge s., Shapira’s s.

swarm of bees

peribulbar lymphocytic infiltrate; alopecia areata

telogen effluvium

endocrine: hyperthyroidism, hypothyroidism, perimenopause, post-menopause, postpartum

medications: anticoagulants, ACE inhibitors, antimitotic agents, b-blockers, lithium, OCPs, retinoids, valproic acid, vitamin A toxicity

nutritional: caloric deprivation, deficiency (biotin, essential fatty acid, iron, zinc), protein deprivation

other: physical stress, psychological stress

trichoclasis

transverse fractures through cortex; chemical or physical trauma, trichothiodystrophy

trichodystrophy, acquired

structural abnormality of hair shaft; bleaching, drying, frequent combing & brushing, intense sunlight exposure, permanent waving, systemic d.

trichomalacia

alopecia areata, traction alopecia, trichotillomania

trichomegaly

long eyelashes; a interferon, cyclosporine A, erythrocytic porphyria, HIV, kala-azar,

trichonodosis

AD; knotted hair

trichoptilosis

split ends; congenital hypotrichosis (Marie-Unna), normal, uncombable hair s.

trichorrhexis invaginata

ball & socket intussusception of distal hair into proximal shaft; congenital ichthyosiform erythroderma, ichthyosis linearis circumflexa, lamellar ichthyosis, Netherton’s s.

trichorrhexis nodosa

intrashaft node (paint brush node); Apert’s s., arginosuccinic aciduria, biotin deficiency, citrullinemia, KID s., lamellar ichthyosis, Menkes’ kinky hair s., Netherton’s s., PIBIDS s., sulfur-deficient hair, trauma

trichoschisis

transverse fractures through hair; chemical trauma, physical trauma, PIBIDS s., trichothiodystrophy

trichothiodystrophy

brittle hair from decreased sulfur content; pili torti, trichoschisis

alternating bands under polarization; BIDS s., hyperammonemia, IBIDS s., Marinesco-SjØgren s., PIBIDS s.

woolly hair

axially twisted hair shaft; normal (blacks)   1) AR; striated palmoplantar keratoderma, cardiac abnormalities  2) AD; palmoplantar keratoderma (Unna-Thost), right ventricular dysfunction

Jackson-Sertoli s.