II. Pathophysiology

  1. Hair breakage due to Trauma or fragile hair
  2. Primarily affects proximal Hair Shaft

III. Causes: Trauma

  1. Excessive brushing
  2. Excessive scalp scratching
  3. Excessive salt water exposure
  4. Heat application
  5. Tight hair styles (e.g. Traction Alopecia)
  6. Trichotillomania
  7. Chemical use on hair (e.g. excessive bleach, dyes, Shampoos, perms, hair relaxants)

IV. Causes: Systemic, congenital, or genetic disorders leading to fragile hair

  1. Trichorrhexis invaginata (bamboo hair)
  2. Hair shaft Intussusception (at keratinization zone)
  3. Menkes Disease
  4. Abnormal copper metabolism (results in keratinization defect)
  5. Argininosuccinic aciduria
  6. Hypothyroidism (rare cause)

V. Signs

  1. Broken hairs along proximal shaft that split into strands
    1. Hairs appear as white nodes or knots on gross exam

VI. Labs: Optional (as indicated)

  1. Complete Blood Count
  2. Serum Iron and Serum Ferritin
  3. Copper level
  4. Liver Function Tests
  5. Thyroid Stimulating Hormone (TSH)
  6. Serum and urine amino acid level

VII. Management

  1. Eliminate physical and chemical Trauma to the hairs

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