Circular hairs: nomenclature and meanings

Abstract

Abstract:Trichoscopy has become an essential tool for the diagnosis of various diseases that affect the hair and scalp. Through dermatoscopy we identified a set of findings that share a circular shape of hair shafts. The objective of this study is to distinguish among the various forms of circular hairs in order to identify their peculiarities and to describe in which skin disorders they can be found.

Trichoscopy findings in dissecting cellulitis

“…Empty follicular units replaced by fibrosis represented by white dots and amorphous white areas can also be visualized in advanced forms of the disease, where the fibrotic component prevails 5, 6, 8. Additional findings already described include blue-gray dots with histopathological correspondence to pigmentary incontinence and nonspecific vascular signs, such as punctate vessels and red dots 6, 7, 10. The presence of short regrowing hairs is indicative of periods of remission, often found in early phases of the disease, while the scarring areas denote late stages with a recurrent poor response to clinical therapy 4, 5…”

“…In this stage, broken hair shafts of variable length can be found, as well as black dots, corresponding to lumps of keratin resulting from the breaking of shafts at the emergence of the follicular ostium 5 . Although controversial, the presence of exclamation mark hairs 4 and circle hairs in the initial stages of DC has also been described 6, 7…”

Keratosis pilaris caused by dupilumab for the treatment of bronchial asthma

“…6 In addition, CH is also observed in patients with alopecia areata (AA). 10,11 Very interestingly, it has been recognized that dupilumab is therapeutic not only for eczematous dermatitis but also for hair regrowth in pre-existing AA in patients with AD, 12,13 suggesting that there may be an interaction between immunological modulation by dupilumab and hair follicle growth. 3 The association between AA and AD is likely due to shared immune pathways involving Th2 over-activation.…”

Circle Hairs in a Patient with Multiple Myeloma

“… 1 , 4 Many conditions are reportedly associated with rolled hairs, including palmoplantar keratoderma, keratosis pilaris, xerosis, and other dermatitis associated with chronic itching skin, as well as with the use of medications such as corticosteroids and cyclosporine. 1 , 7–10 Other hair disorders that resemble circle hairs, which may be included in the differential diagnosis, include pigtail hairs, 11–14 coiled hairs, 12 , 14 , 15 and corkscrew hairs. 12 , 16 , 17 Table 1 summarizes the clinical, dermoscopic, and histopathologic features of circle hair and its mimickers.…”

“… 1 , 7–10 Other hair disorders that resemble circle hairs, which may be included in the differential diagnosis, include pigtail hairs, 11–14 coiled hairs, 12 , 14 , 15 and corkscrew hairs. 12 , 16 , 17 Table 1 summarizes the clinical, dermoscopic, and histopathologic features of circle hair and its mimickers. The dermoscopic characteristics for our patient were compatible with circle hairs because of the hairs’ perfectly coiled nature, despite the absence of the characteristic river-bed appearance upon histopathology.…”