Hair & Nails

The National Institute of Arthritis and Musculoskeletal and Skin Diseases is offering "Easy-to-Read Health Information on Bones, Muscles, Joints, and Skin" for consumers. The CD-ROM contains print-friendly copies of NIAMS publications in English, Spanish, and Chinese, as well as links to NIAMS and NIH resources and to nonprofit organizations. To order a copy of the CD-ROM, call 877-226-4267.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases is offering "Easy-to-Read Health Information on Bones, Muscles, Joints, and Skin" for consumers. The CD-ROM contains print-friendly copies of NIAMS publications in English, Spanish, and Chinese, as well as links to NIAMS and NIH resources and to nonprofit organizations. To order a copy of the CD-ROM, call 877-226-4267.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases is offering "Easy-to-Read Health Information on Bones, Muscles, Joints, and Skin" for consumers. The CD-ROM contains print-friendly copies of NIAMS publications in English, Spanish, and Chinese, as well as links to NIAMS and NIH resources and to nonprofit organizations. To order a copy of the CD-ROM, call 877-226-4267.

SAN FRANCISCO — Few patients will admit that they compulsively pull out their hair, but a hair biopsy can help make the diagnosis of trichotillomania, Dr. Pearl C. Kwong said at a meeting sponsored by Skin Disease Education Foundation.

Clinically, the missing hair may be barely noticeable or may show signs of regrowth, such as uneven hair lengths. In contrast, hairs lost from alopecia areata will be approximately the same length if they regrow. If a patient picks hair from a favored area of the scalp, a "Friar Tuck" sign can be a clue to trichotillomania, she said. Patients usually have no skin abnormalities elsewhere.

Both children and adults with this impulse control disorder typically deny hair-pulling, and parents may be unwilling to accept a possible diagnosis of trichotillomania, said Dr. Kwong, a dermatologist in Jacksonville, Fla.

She recalled one girl who tried to hide her hair-pulling habit by eating the pulled hairs, which caused a bowel obstruction that required surgery. "To the end, the patient was denying that she ate her hair. The evidence was there in the bowel," Dr. Kwong said.

A hair biopsy can help with diagnosis. On histology, a high frequency of telogen hairs and a high frequency of noninflamed catagen hairs are typical of trichotillomania.

Accurate data on the prevalence of trichotillomania are hard to get because people hide the disorder, but it is estimated to affect 8 million people in the United States. The mean age of onset seems to be 8 years in boys and 12 years in girls, and 1%–2% of college students have experienced or currently have symptoms. Adults with trichotillomania often report that the disorder started at a young age, even as young as 1 year old, and it is more likely to be diagnosed in women than in men.

In infants or young children, pulling or twisting the hair usually is self-limited and is a benign form of trichotillomania. It may be a sign of psychosocial stress or an underlying psychological problem, however, and can become a chronic condition.

Adolescents and adults diagnosed with trichotillomania tend to have a poorer prognosis, with chronic remissions and exacerbations. Patients may avoid social situations or have GI complaints. "There's usually underlying psychopathology in that family," Dr. Kwong said.

Although scalp hair is the most common target, hair-pulling may focus on any hairy parts of the body, including eyelashes, eyebrows, or hair in pubic, perirectal, or armpit areas. "I see a lot of kids who pull their eyelashes. Eyebrows, not as much," she said.

In young children, treat trichotillomania as a short-term habit disorder by cutting the hair very short (like a crew cut in boys) and applying Vaseline to the hair. "They stop their habit right away because it's so slippery they can't pull," Dr. Kwong said.

Referral to psychiatry, psychology, or developmental and behavioral pediatrics should be considered, especially in patients older than young children. Trichotillomania has been associated with obsessive control disorder, personality disorders, body dysmorphic disorder, schizophrenia, and mental retardation.

Occasionally, people with trichotillomania compulsively pull hair from other people or pets, she added.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SAN FRANCISCO — Few patients will admit that they compulsively pull out their hair, but a hair biopsy can help make the diagnosis of trichotillomania, Dr. Pearl C. Kwong said at a meeting sponsored by Skin Disease Education Foundation.

Clinically, the missing hair may be barely noticeable or may show signs of regrowth, such as uneven hair lengths. In contrast, hairs lost from alopecia areata will be approximately the same length if they regrow. If a patient picks hair from a favored area of the scalp, a "Friar Tuck" sign can be a clue to trichotillomania, she said. Patients usually have no skin abnormalities elsewhere.

Both children and adults with this impulse control disorder typically deny hair-pulling, and parents may be unwilling to accept a possible diagnosis of trichotillomania, said Dr. Kwong, a dermatologist in Jacksonville, Fla.

She recalled one girl who tried to hide her hair-pulling habit by eating the pulled hairs, which caused a bowel obstruction that required surgery. "To the end, the patient was denying that she ate her hair. The evidence was there in the bowel," Dr. Kwong said.

A hair biopsy can help with diagnosis. On histology, a high frequency of telogen hairs and a high frequency of noninflamed catagen hairs are typical of trichotillomania.

Accurate data on the prevalence of trichotillomania are hard to get because people hide the disorder, but it is estimated to affect 8 million people in the United States. The mean age of onset seems to be 8 years in boys and 12 years in girls, and 1%–2% of college students have experienced or currently have symptoms. Adults with trichotillomania often report that the disorder started at a young age, even as young as 1 year old, and it is more likely to be diagnosed in women than in men.

In infants or young children, pulling or twisting the hair usually is self-limited and is a benign form of trichotillomania. It may be a sign of psychosocial stress or an underlying psychological problem, however, and can become a chronic condition.

Adolescents and adults diagnosed with trichotillomania tend to have a poorer prognosis, with chronic remissions and exacerbations. Patients may avoid social situations or have GI complaints. "There's usually underlying psychopathology in that family," Dr. Kwong said.

Although scalp hair is the most common target, hair-pulling may focus on any hairy parts of the body, including eyelashes, eyebrows, or hair in pubic, perirectal, or armpit areas. "I see a lot of kids who pull their eyelashes. Eyebrows, not as much," she said.

In young children, treat trichotillomania as a short-term habit disorder by cutting the hair very short (like a crew cut in boys) and applying Vaseline to the hair. "They stop their habit right away because it's so slippery they can't pull," Dr. Kwong said.

Referral to psychiatry, psychology, or developmental and behavioral pediatrics should be considered, especially in patients older than young children. Trichotillomania has been associated with obsessive control disorder, personality disorders, body dysmorphic disorder, schizophrenia, and mental retardation.

Occasionally, people with trichotillomania compulsively pull hair from other people or pets, she added.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SAN FRANCISCO — Few patients will admit that they compulsively pull out their hair, but a hair biopsy can help make the diagnosis of trichotillomania, Dr. Pearl C. Kwong said at a meeting sponsored by Skin Disease Education Foundation.

Clinically, the missing hair may be barely noticeable or may show signs of regrowth, such as uneven hair lengths. In contrast, hairs lost from alopecia areata will be approximately the same length if they regrow. If a patient picks hair from a favored area of the scalp, a "Friar Tuck" sign can be a clue to trichotillomania, she said. Patients usually have no skin abnormalities elsewhere.

Both children and adults with this impulse control disorder typically deny hair-pulling, and parents may be unwilling to accept a possible diagnosis of trichotillomania, said Dr. Kwong, a dermatologist in Jacksonville, Fla.

She recalled one girl who tried to hide her hair-pulling habit by eating the pulled hairs, which caused a bowel obstruction that required surgery. "To the end, the patient was denying that she ate her hair. The evidence was there in the bowel," Dr. Kwong said.

A hair biopsy can help with diagnosis. On histology, a high frequency of telogen hairs and a high frequency of noninflamed catagen hairs are typical of trichotillomania.

Accurate data on the prevalence of trichotillomania are hard to get because people hide the disorder, but it is estimated to affect 8 million people in the United States. The mean age of onset seems to be 8 years in boys and 12 years in girls, and 1%–2% of college students have experienced or currently have symptoms. Adults with trichotillomania often report that the disorder started at a young age, even as young as 1 year old, and it is more likely to be diagnosed in women than in men.

In infants or young children, pulling or twisting the hair usually is self-limited and is a benign form of trichotillomania. It may be a sign of psychosocial stress or an underlying psychological problem, however, and can become a chronic condition.

Adolescents and adults diagnosed with trichotillomania tend to have a poorer prognosis, with chronic remissions and exacerbations. Patients may avoid social situations or have GI complaints. "There's usually underlying psychopathology in that family," Dr. Kwong said.

Although scalp hair is the most common target, hair-pulling may focus on any hairy parts of the body, including eyelashes, eyebrows, or hair in pubic, perirectal, or armpit areas. "I see a lot of kids who pull their eyelashes. Eyebrows, not as much," she said.

In young children, treat trichotillomania as a short-term habit disorder by cutting the hair very short (like a crew cut in boys) and applying Vaseline to the hair. "They stop their habit right away because it's so slippery they can't pull," Dr. Kwong said.

Referral to psychiatry, psychology, or developmental and behavioral pediatrics should be considered, especially in patients older than young children. Trichotillomania has been associated with obsessive control disorder, personality disorders, body dysmorphic disorder, schizophrenia, and mental retardation.

Occasionally, people with trichotillomania compulsively pull hair from other people or pets, she added.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Cigarette smoking was significantly associated with androgenetic alopecia after investigators controlled for age and family history in a community-based survey conducted in Taiwan.

Androgenetic alopecia, the most common type of hair loss in men, is known to be a hereditary disorder, but environmental factors are presumed to play a role in pathogenesis as well. Three earlier studies addressed a possible link with cigarette smoking, but their results were inconsistent, the Taiwanese investigators wrote (Arch. Dermatol. 2007;143:1401–6).

Dr. Lin-Hui Su of Far Eastern Memorial Hospital and Tony Hsiu-Hsi Chen, Ph.D., D.D.S., of National Taiwan University, both in Taipei, surveyed 740 men from the general population aged 40–91 years who were found to have cosmetically significant male-pattern baldness.

After controlling for the effects of age and family history, they found that current and former smokers were significantly more likely to have moderate or severe androgenetic alopecia than were men who had never smoked (odds ratio 1.8). Men who currently smoked at least 20 cigarettes per day had more than double the risk of those who had never smoked (odds ratio 2.3).

Smoking intensity—defined as duration of smoking in years multiplied by the number of cigarettes smoked per day—was positively correlated with the degree of baldness.

Although this study did not assess the mechanisms by which smoking may promote hair loss, the investigators proposed four possibilities.

"First, smoking might be deleterious to the microvasculature of the dermal hair papilla. Second, smoke genotoxicants may do damage to DNA of the hair follicle," they said.

Third, smoking may cause an imbalance in the follicular protease or antiprotease systems. "Smoking-induced oxidative stress may lead to the release of proinflammatory cytokines that, in turn, results in follicular microinflammation and fibrosis."

Fourth, smoking may induce a hypo-estrogenic state by increasing the hydroxylation of estradiol and the inhibition of aromatase.

Cigarette smoking was significantly associated with androgenetic alopecia after investigators controlled for age and family history in a community-based survey conducted in Taiwan.

Androgenetic alopecia, the most common type of hair loss in men, is known to be a hereditary disorder, but environmental factors are presumed to play a role in pathogenesis as well. Three earlier studies addressed a possible link with cigarette smoking, but their results were inconsistent, the Taiwanese investigators wrote (Arch. Dermatol. 2007;143:1401–6).

Dr. Lin-Hui Su of Far Eastern Memorial Hospital and Tony Hsiu-Hsi Chen, Ph.D., D.D.S., of National Taiwan University, both in Taipei, surveyed 740 men from the general population aged 40–91 years who were found to have cosmetically significant male-pattern baldness.

After controlling for the effects of age and family history, they found that current and former smokers were significantly more likely to have moderate or severe androgenetic alopecia than were men who had never smoked (odds ratio 1.8). Men who currently smoked at least 20 cigarettes per day had more than double the risk of those who had never smoked (odds ratio 2.3).

Smoking intensity—defined as duration of smoking in years multiplied by the number of cigarettes smoked per day—was positively correlated with the degree of baldness.

Although this study did not assess the mechanisms by which smoking may promote hair loss, the investigators proposed four possibilities.

"First, smoking might be deleterious to the microvasculature of the dermal hair papilla. Second, smoke genotoxicants may do damage to DNA of the hair follicle," they said.

Third, smoking may cause an imbalance in the follicular protease or antiprotease systems. "Smoking-induced oxidative stress may lead to the release of proinflammatory cytokines that, in turn, results in follicular microinflammation and fibrosis."

Fourth, smoking may induce a hypo-estrogenic state by increasing the hydroxylation of estradiol and the inhibition of aromatase.

Cigarette smoking was significantly associated with androgenetic alopecia after investigators controlled for age and family history in a community-based survey conducted in Taiwan.

Androgenetic alopecia, the most common type of hair loss in men, is known to be a hereditary disorder, but environmental factors are presumed to play a role in pathogenesis as well. Three earlier studies addressed a possible link with cigarette smoking, but their results were inconsistent, the Taiwanese investigators wrote (Arch. Dermatol. 2007;143:1401–6).

Dr. Lin-Hui Su of Far Eastern Memorial Hospital and Tony Hsiu-Hsi Chen, Ph.D., D.D.S., of National Taiwan University, both in Taipei, surveyed 740 men from the general population aged 40–91 years who were found to have cosmetically significant male-pattern baldness.

After controlling for the effects of age and family history, they found that current and former smokers were significantly more likely to have moderate or severe androgenetic alopecia than were men who had never smoked (odds ratio 1.8). Men who currently smoked at least 20 cigarettes per day had more than double the risk of those who had never smoked (odds ratio 2.3).

Smoking intensity—defined as duration of smoking in years multiplied by the number of cigarettes smoked per day—was positively correlated with the degree of baldness.

Although this study did not assess the mechanisms by which smoking may promote hair loss, the investigators proposed four possibilities.

"First, smoking might be deleterious to the microvasculature of the dermal hair papilla. Second, smoke genotoxicants may do damage to DNA of the hair follicle," they said.

Third, smoking may cause an imbalance in the follicular protease or antiprotease systems. "Smoking-induced oxidative stress may lead to the release of proinflammatory cytokines that, in turn, results in follicular microinflammation and fibrosis."

Fourth, smoking may induce a hypo-estrogenic state by increasing the hydroxylation of estradiol and the inhibition of aromatase.

BALTIMORE — Nail dystrophy and a history of trauma should raise suspicion of subungual epidermoid inclusions, Dr. Beth S. Ruben said at the annual meeting of the American Society of Dermatopathology.

Dr. Ruben and her colleagues have encountered 17 such cases. Common clinical impressions included pachyonychia, hemorrhage, onychomycosis, or carcinoma.

"The fingers and thumb were involved more than the toes," she said. Fingers and thumbs were affected in nine cases, toes were affected in seven cases, and location was not specified in one case. "In some cases [12], there was nail dystrophy either clinically or histologically," said Dr. Ruben of the University of California, San Francisco.

In five cases, there was evidence of trauma. Calcification was noted in four cases.

Histologically, look for small, pale clusters of keratinocytes forming small cysts that resemble the follicular isthmus, or even ductal epithelium, and small, solid aggregates. Sometimes there might be an underlying bony abnormality, and there might be associated hyperkeratosis of the nail bed, she said.

Subungual cysts can be classified using a system developed by Italian investigators (Dermatologica 1989;178:209–12).

Type I inclusions are quite superficial. Nails might appear normal or exhibit clubbing. Less cystic variants can be mistaken for neoplasms.

Type II inclusions are more extensive. The nail bed might be hyperkeratotic. Cysts can be superficial or deep. The nail plate might be thickened. Most of the cases in the series reported by Dr Ruben were of the superficial type (type I).

The differential diagnosis should include subungual keratoacanthoma and ony-cholemmal carcinoma, Dr. Ruben said.

BALTIMORE — Nail dystrophy and a history of trauma should raise suspicion of subungual epidermoid inclusions, Dr. Beth S. Ruben said at the annual meeting of the American Society of Dermatopathology.

Dr. Ruben and her colleagues have encountered 17 such cases. Common clinical impressions included pachyonychia, hemorrhage, onychomycosis, or carcinoma.

"The fingers and thumb were involved more than the toes," she said. Fingers and thumbs were affected in nine cases, toes were affected in seven cases, and location was not specified in one case. "In some cases [12], there was nail dystrophy either clinically or histologically," said Dr. Ruben of the University of California, San Francisco.

In five cases, there was evidence of trauma. Calcification was noted in four cases.

Histologically, look for small, pale clusters of keratinocytes forming small cysts that resemble the follicular isthmus, or even ductal epithelium, and small, solid aggregates. Sometimes there might be an underlying bony abnormality, and there might be associated hyperkeratosis of the nail bed, she said.

Subungual cysts can be classified using a system developed by Italian investigators (Dermatologica 1989;178:209–12).

Type I inclusions are quite superficial. Nails might appear normal or exhibit clubbing. Less cystic variants can be mistaken for neoplasms.

Type II inclusions are more extensive. The nail bed might be hyperkeratotic. Cysts can be superficial or deep. The nail plate might be thickened. Most of the cases in the series reported by Dr Ruben were of the superficial type (type I).

The differential diagnosis should include subungual keratoacanthoma and ony-cholemmal carcinoma, Dr. Ruben said.

BALTIMORE — Nail dystrophy and a history of trauma should raise suspicion of subungual epidermoid inclusions, Dr. Beth S. Ruben said at the annual meeting of the American Society of Dermatopathology.

Dr. Ruben and her colleagues have encountered 17 such cases. Common clinical impressions included pachyonychia, hemorrhage, onychomycosis, or carcinoma.

"The fingers and thumb were involved more than the toes," she said. Fingers and thumbs were affected in nine cases, toes were affected in seven cases, and location was not specified in one case. "In some cases [12], there was nail dystrophy either clinically or histologically," said Dr. Ruben of the University of California, San Francisco.

In five cases, there was evidence of trauma. Calcification was noted in four cases.

Histologically, look for small, pale clusters of keratinocytes forming small cysts that resemble the follicular isthmus, or even ductal epithelium, and small, solid aggregates. Sometimes there might be an underlying bony abnormality, and there might be associated hyperkeratosis of the nail bed, she said.

Subungual cysts can be classified using a system developed by Italian investigators (Dermatologica 1989;178:209–12).

Type I inclusions are quite superficial. Nails might appear normal or exhibit clubbing. Less cystic variants can be mistaken for neoplasms.

Type II inclusions are more extensive. The nail bed might be hyperkeratotic. Cysts can be superficial or deep. The nail plate might be thickened. Most of the cases in the series reported by Dr Ruben were of the superficial type (type I).

The differential diagnosis should include subungual keratoacanthoma and ony-cholemmal carcinoma, Dr. Ruben said.