Trichotillomania is a compulsive habit of pulling out hair, most commonly from the scalp. It affects females more than males and children more than adults. Hair is pulled from the front and sides in an irregular pattern, leaving patches of different hair lengths. Treatment involves counseling and sometimes antidepressants. Traction alopecia is hair loss caused by tight hairstyles like braids or ponytails that put constant tension on hair. It affects African Americans more and can cause scarring. Treatment involves changing hairstyles and avoiding chemicals or heat. Hair shaft disorders can be genetic defects like monilethrix that causes beaded hair, or acquired from injuries, diseases or medications. They often cause fragile hair

1. Hair breakage
disorders
Hussein Ali Ahmed

2. Trichotillomania
• Is a compulsive desire or habit to pluck hair.
• The child develop the habit of twisting hair around the finger & pulling it .
• Can be on the scalp or any other hairy region (e.g., beard).
• More common in children than adults and in females than males.
• Can be combined with neurotic excoriations.

3. Hair is pulled more frequently from fronto-parietal region more
pronounced on the side of dominant hand.
Ill-defined patch on which the hair are cut & broken at various
length from the scalp .
Scalp is normal .
Eyelashes , eyebrows , & other hairy areas could be affected .
Increasing sense of tension and relief when pulling the hair
It can be caused by anxiety, depression& emotional
deprivation.
Clinical features

7. Differential Diagnosis
2. Monilethrix1. Alopecia Areata

8. 3. Traction alopecia
4. Tinea Capitis 5. Loose Anagen Syndrome

9. Treatment
• Referral to psychiatrist .
• Wear a bandana to bed, Wet down your hair.
• Although no medications are approved by the FDA specifically for the
treatment of trichotillomania, some medications may help control certain
symptoms (antidepressant such as clomipramine (Anafranil).

10. Traction Alopecia
• Traction alopecia is a type of hair loss that happens over time.
• It's caused by putting the hair under constant strain or tension and is usually
caused by different hairstyles.
• The scalp may appear normal or may show evidence of inflammation or
scarring .

11. "Fringe sign" is commonly found in patients
with traction alopecia of the marginal hairline –
this means that some hair is retained along the
frontal and/or temporal rim of the hairline.

12. Risk Factors
• Hairstyle: braids , or pony tails , hair rollers , &
hot hair-straightening combs
• Race : African American.
• Chemicals It is caused by a combination of too
much stress (traction) on the hair and the use
of harsh relaxers and dyes.

13. • History : pain on the scalp due to hairstyle.
Increase in hair loss in certain hairstyle.
• Examination :
1) Scalp appear normal or may show evidence of
inflammation.
2) Fringe sign
Diagnosis

14. Treatment
• Change the hairstyle (cessation of the chronic traction).
• Try to avoid chemicals and heating.
• Minoxidil to regrow hair.
• Biotin supplements to strengthen the hair.
• Surgical (hair replacement) for more severe cases.

16. Hayder Qusay Fadhil
Hair shaft disorders

17. • The medulla and cortex have pigment cells responsible for
hair color.
• The cuticle is the outer and strongest part of the hair shaft. It is
made up of dead flattened cells that overlap each other.
• The cuticle is keratinized i.e., the cells are largely made of a
protein called keratin; keratin is also an important component of
skin and nails.
• The sebaceous gland produces sebum, which protects the
hair shaft and acts as a natural conditioner.

18. Whatcauseshairshaftdefects?
• Hair shaft defects may be due to external injury or genetic abnormality.
 External injury to hair shaft.
• Repeated physical injury is the commonest cause of increased hair fragility. This
may be due to:
1. Excessive grooming
2. Traction from braiding or tight pony tail
3. Heat from a hair dryer
• Chemical injury may be caused by:
1. Perming lotions
2. Straighteners
3. Dyes

19. Weathering
● Sun
● Wind
● Swimming
● Washing
● Friction
● Excessive hair styling

20. Beaded hair / monilethrix
• The name beaded hair reflects hair shafts with narrowed segments between “nodes”
normal thickness.
• It is also called monilethrix.
• The scalp is most commonly involved.
• The affected hair shafts appear beaded a few months after birth. They break off leaving
patches of scalp with abnormally short hairs.
• The scalp may also have a rough appearance because of a build up of keratin around
the hair follicle.
• There is no known treatment.

21. •Monilethrix is inherited as an autosomal dominant characteristic.
•This means an affected individual has a 50% chance of passing it on to
each of their male and female children.
•It is caused by changes in the keratin gene cluster at chromosome 12.

22. Prevention
The avoidance of trauma is the most effective method of managing this anomaly.
Because congenitally abnormal hair tends to have an increased susceptibility to
weathering and cosmetic damage, patients should avoid exposing their hair to things
that prevent hair from growing to its maximum length such as:
• Sunlight
• Dyes
• Bleaches
• Chemicals used in permanent waving
• Curling devices

23. • No effective treatment is available.
• A wig can be used.
• Some report spontaneous improvement.
• Topical minoxidil 2% (1 mL night and day for 1 y) led to an increase of normal
hair shaft without any adverse effects in one report so it may be a good
therapeutic option to treat monilethrix.
Treatment

25. Pilitorti
• Pili torti describes a flattened hair shaft with clusters of narrow twists at
irregular intervals. The hairs are abnormally fragile.
• It may be genetic in origin (inherited) or acquired.
• When inherited, pili torti may be present at birth or appear during
infancy.
• Pili torti is associated with a number of inherited syndromes.

27. Pili torti

28. • Acquired pili torti may arise in the following circumstances:
1. Associated with anorexia nervosa and malnutrition
2. Following oral retinoid treatment (isotritinoin , acitretine )
3. At the edge of inflammatory scalp conditions such as cutaneous lupus erythematous
and lichen planopilaris, due to fibrosis (scarring), which distorts the hair follicle.

29. • No treatment but it may improved during puberty
• The acquired form is after anorexia nevrosa and oral retinoid therapy

30. Syphilitic alopecia
• Observed in syphilis patients.
• Hair loss can occur as patchy “mouth eaten”
thinning occurring in small irregular areas.

32. Scarring hair loss
1. Developmental defects ( e.g. epidermal nevi, aplacia cutis )
2. Physical injuries :- mechanical trauma, burns, radio dermatitis .
3. Fungal infection :- kerion, favus .
4. Bacterial infection :- T.B., syphilis, carbuncle, furuncle, folliculitis.
5. Protozoal infection :- leshmaniasis.
6. Viral infection :- herpes zoster , varicella.
7. Tumors :- basal cell ca. , squamous cell ca., syringoma, metastatic tumor ,
lymphoma.
8. Dermatosis of uncertain etiology :- lichen planus , lupus erythematosus ,
scleroderma , dermatomyositis , etc….
9. Medicament:- high dose of busulfan