Hair Casts or Pseudonits Acquired subsequent Psychological Trauma - overall health - Hair reduction

This is really a report presenting the abnormal situation of hair casts taking place just after psychological trauma. These pseudonits should be effectively differentiated from pediculosis capitis.

Hair casts (peripilar keratin casts), or pseudonits, are two to seven mm very long, discrete, firm, shiny, white, freely movable tubular accretions that encircle the hair shafts with the scalp. Cursory examination with the affected person with these pseudonits may perhaps consequence inside the erroneous diagnosis of pediculosis capitis.

Since their authentic description by Kligman in 1957, extra than thirty situations of hair casts happen to be noted inside the English language health care literature. Hair casts happen to be categorized into parakeratotic ("secondary") or nonparakeratotic ("idiopathic") varieties. The previous is extra frequent and is also associated to a coexistent abnormality involving the scalp, these as psoriasis. The "idiopathic" hair cast, on the other hand, is just not identified in association with any condition with the scalp or every other hair shaft abnormality.

Light microscopic and ultra structural reports with the nonparakeratotic hair casts show equally interior and outer root sheath elements and recommended an infrainfundibular origin. The specific mechanism of hair cast shedding hasn't, on the other hand, been elucidated.

We current an abnormal situation of hair casts that occurred subsequent significant emotional trauma affiliated together with the unforeseen death of the affected person's mother or father. This observation suggests a attainable causative foundation equivalent to that of Beau's lines with the nail plate.

Case Report

A 9-year-old white woman was referred by her college nurse for suspected pediculosis capitis. preliminary observation uncovered a healthy-appearing woman with shoulder-length hair made up of little white specks all found about three mm in the scalp. The scalp appeared standard. Pulling the hair didn't lead to improved hair shedding. Alopecia was not current and regional hairs have been all of equivalent duration. Microscopic examination of plucked hair showed tubular accretions or pseudonits but real nits have been not viewed.

The affected person denied any latest sickness, but had been distraught more than the untimely death of her father thirty days previously. She was not taking any medicine. relatives members have been unaffected. The hair casts have been eliminated by acetic acid soaks followed by combing; they didn't recur.

Comments

Hair casts may perhaps happen in association with parakeratotic scalp condition or as an idiopathic problem apparently unrelated to other scalp and hair shaft abnormalities. Our affected person had no proof of other dermatologic condition and was not taking any medicine. The onset of her hair casts seems temporally associated for the significant psychological strain brought on by her father's untimely death.
Nail plate and hair abnormalities are well-known to happen just after significant systemic insults, such as psychological disturbances. just after these insult, matrix mitotic exercise may perhaps slow, leading to transverse depressions with the nail plate (Beau's lines) or focal narrowing with the hair shaft (Pohl-Pincus marks). The total expansion charge and pattern stay standard.

It appears affordable that a equivalent method, impacting the method of keratinization at or simply beneath the pilar infundibulum, could consequence inside the formation of hair casts. The hair casts would then move forward distally, with standard hair expansion, at a fairly uniform tempo.

As is usually the situation, hair casts may perhaps at first be misdiagnosed since the nits of pediculosis capitis. Reassurance and basic mechanical elimination often suffice as treatment method. when the specific mechanism of hair cast formation stays for being decided, their obvious temporal relation to significant emotional trauma suggests a causative mechanism analogous to that accountable for Beau's lines and Pohl-Pincus marks.

REFERENCES

1. Kohn SR; Hair casts or psuedonits. JAMA 238: 2058-2059, 1977.

2. Kligman AM: Hair situation: Parakeratotic comedones with the scalp. Arch Dermatol seventy five: 509-511, 1957.

3. Taieb A, Surleve-Brazeilie JE, Maleville J: Hair casts. Arch Dermatol 121: 1009-1013, 1985.

4. Keipert JA: Hair Casts: critique and suggestion with regards to nomenclature. Arch Dermatol 122: 927-930, 1986.

5. Herman PS: Peripilar casts. Arch DennatolForsch 248: 321-327, 1974.

6. Beau JHS: notice sur certains caractères de sémeiologie retrospective preserves par les ongles. Arch Gen Med eleven: 447, 1846: cited by Weis-mann K: JHS Beau and his description of transverse depressions on nails. BrJ Dermatol VI: 571-572, 1977.

7. Sims RT: "Beau's lines" in hair. Br J Dermatol 79: 43, 1967.

8. Stroud JD: Hair shaft defects. Cutis: 1375-1382, 1969.
9. Colver GB, Dawber RPR: several Beau's lines because of to dysmenorrhoea. Br J Dermatol 111-113, 1984.