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      Trichoscopy of an Isolated Trichorrhexis Nodosa: A Case Report

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          Abstract

          Trichorrhexis nodosa (TN) is a well-known entity which affects hair shafts. Clinically, it presents as minute nodular concretions along the hair shaft. This is caused by the loss of cuticle and cortical fibers. On light microscopy, tiny nodules appear as “thrust paint brushes” as if two brushes are thrust into each other.[1] Trichoscopy is a noninvasive diagnostic tool. It allows the detailed visualization of hair with respect to structure and size, perifollicular areas, and scalp.[2] It provides clues for inherited and acquired causes of hair loss, and helps in the diagnosis of several hair shaft disorders.[3] Here, the authors describe the importance of trichoscopy in the diagnosis of an isolated TN. A 38-year-old male presented to the Dermatology outpatient department with a feeling that something was there at the tips of the eyebrow hairs since 1 year [Figure 1]. There was no history of trauma, itching, or topical application. Patient denied any manipulation of eyebrows. Examination revealed tiny white-to-brownish nodes on the tips of hairs of bilateral eyebrows. No similar findings were found in the eyelashes, scalp, or other hairy areas of the body. There was no scaling in the eyebrows or scalp. Systemic examination was unremarkable. Trichoscopy was performed using videodermoscopy, which showed that hair shafts were broken at multiple places with “paint brush” like ends [Figure 2; 20×]. Both proximal and distal hairs were affected resulting in hair shaft breakage giving characteristic “thrust paint brush” appearance [Figure 3; 70×]. Based on trichoscopic examination, a diagnosis of TN isolated to eyebrows was made. Figure 1 Clinical image showing tiny white-to-brownish nodes on the tips of hairs of eyebrows Figure 2 Trichoscopy using videodermoscopy shows broken hair shafts with frayed ends appearing as a paint brush. These are suggestive of tiny nodes clinically. (Nonpolarized mode, 20× magnifications; FotoFinder®, Germany) Figure 3 Trichoscopy using videodermoscopy shows “thrust paint brushes” pattern as if two brushes are thrust into each other. (Nonpolarized mode, 70× magnifications; FotoFinder®, Germany) Trichoscopically, TN, trichorrhexis invaginata, and hair casts were considered as possible differential diagnosis. Trichorrhexis invaginata is caused by brittle hairs and is characteristic of hair shaft change in Netherton syndrome. It appears as “ball-and-socket” under trichoscopy. Hair casts are remnants of inner root sheaths and appear as cylindrical transulant casings around the hair shaft in trichoscopy.[4 5] In our case, trichoscopy showed “thrust paint brush” pattern confirming the diagnosis. TN can be associated with argininosuccinic aciduria, Menkes’ kinky hair syndrome, Netherton's syndrome, hypothyroidism, or trichothiodystrophy.[6] Hence, trichoscopy is a useful diagnostic tool in TN; in this case, it diagnosed isolated TN which was confined to eyebrows. Authors suggest the usage of trichoscopy in daily practice, especially in hair disorders. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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          Most cited references 5

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          Trichoscopy in genetic hair shaft abnormalities.

          Diagnosis of hair shaft abnormalities is based on light microscopic examination of more than 50 plucked hairs. The aim of this study was to verify whether hair shaft abnormalities may be visualized by trichoscopy (hair and scalp videodermoscopy) and to analyze trichoscopic features of common genetic hair shaft dysplasias. Patients with known genetic hair shaft disorders were included into the study. Trichoscopy was performed with the use of Fotofinder II videodermoscope. Images performed at 20-fold and 70-fold magnification were analysed. In selected cases 160-fold magnification was used for better visualization of hair shafts. Our results show that characteristic light microscopy features of Netherton syndrome, monilethrix, woolly hair syndrome, pili torti, pili annulati and trichothiodystrophy may be visualized by trichoscopy. 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.
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            Trichorrhexis Nodosa with Nail Dystrophy: Diagnosis by Dermoscopy

            A 25-year-old male, born of non-consanguineous marriage presented with complaints of sparse and thin hairs over scalp and dystrophy of nails since childhood. This case highlights the association of trichorrhexis nodosa with nail dystrophy and the use of trichoscopy as a noninvasive method for diagnosis of hair disorders.
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              Patterns of scalp and hair disease revealed by videodermoscopy

               A Tosti,  EK Ross (2007)
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                Author and article information

                Journal
                Indian Dermatol Online J
                Indian Dermatol Online J
                IDOJ
                Indian Dermatology Online Journal
                Medknow Publications & Media Pvt Ltd (India )
                2229-5178
                2249-5673
                Sep-Oct 2017
                : 8
                : 5
                : 386-387
                Affiliations
                Skin and Laser Clinic, Solapur, Maharashtra, India
                [1 ] Department of Dermatology, S. Nijalingappa Medical College, Bagalkot, Karnataka, India
                Author notes
                Address for correspondence: Dr. Balachandra S. Ankad, Department of Dermatology, S. Nijalingappa Medical College, Navanagar, Bagalkot - 587 103, Karnataka, India. E-mail: drbsankad@ 123456gmail.com
                Article
                IDOJ-8-386
                10.4103/idoj.IDOJ_396_16
                5621213
                Copyright: © 2017 Indian Dermatology Online Journal

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Categories
                Through the Dermatoscope

                Dermatology

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