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Introduction to Hair Disorder


  • Fractures(Trichoptilosis).
  • Nodes (Trichorrhexis Nodosa) .
  • Narrowings (Moniletrix).

Trichoptiloschoptilosis (Split Hair)

Mechanical and chemical trauma can lead to a longitudinal fracture of the hair shaft towards the tip (split ends).


  • Trim the hair at regular intervals
  • Avoid harsh chemicals on hair.

Trichorrhexis Nodosa

This is an acquired effect. It appears as minute grayish nodes along the shaft where the cuticle is lost and frayed cortical fibres project out giving the appearance of two paint brushes thrust into one another.

Mechanical and Chemical trauma damage the cuticle and initiate the process.

Mechanical Causes:

  • Vigorous brushing.
  • Back combing.
  • Scratching, pulling of hair.

Chemical Causes:

  • Salt water bathing.
  • Shampooing, dyeing.
  • Setting , Perming.

The hairs break or kink at the nodes thereby exposing the cortical fibres at the terminal end. T.N usually affects the distal part of the shaft of scalp hair. Uncommonly it affects the proximal shafts and is inherited.


Monilethrix:  Monilethrix (monile= necklace and thrix = hair) is an autosomal dominantly transmitted trait with variable expressivity

The affected hairs are beaded and brittle. Defective cortical cell keratinisation is cause of hair constrictions and breakage. It is due to mutation in hair keratin type 1 controlling genes on chromosome. There is mild to severe hair loss due to hair fragility. Broken hair stubs project from keratotic follicular papules. The hair shaft shows beaded appearance due to alternate zones of spindle- like thickening and thinning. A break occurs at the internodal junction where cortex is defective and medulla is absent.

Avoid mechanical and chemical trauma.

Oral etretinate is used with limited success


Pigmentary Hair Disorders

The colour of black or brown hair is due to Eumelanin, whereas Pheomelanin is responsible for blonde, auburn or reddish shades. The white colour of unpigmented hair is due to optical effects of reflection and refraction of incident light.



– refers to circumscribed whitening of hair affecting a group of neighbouring follicles. It is accompanied by depigmentation of the underlying skin and the other areas.

Causes: It is present in 60% cases of Epiloia.

  • Early regrowth in alopecia areata is often without pigment and this may lead to poliosis.
  • Severe and recurrent inflammations can damage the hair bulb melanocytes and lead to poliosis. X-rays in subepilating doses. Herpes Zoster.


Greying of hair ( Canities)

The hair bulb tyrosinase activity gradually peaks at middle age. However, with progressing age there is reduced melanocyte activity resulting in graying of hair.

Under Electron microscope grey hair shows normal number of melanocytes but with incompletely melanized melanosomes whereas white hair show reduced or absent melanocytes.

Causes ( premature canities): 

  • Hereditary premature graying.                                   
  • Nutritional deficiency (Cysteine & Methionine).
  • Vit B12 Deficiency.
  • Anemia.
  • Autoimmunity ( eg.in patients with pernicious anemia, Addison’s disease).
  • Hypo, Hyperthyroidism Infective( HIV).



  • Oral Calcium Pantothenate.
  • PUVASOL therapy.

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