Hair Tourniquet Syndrome
The mother of a 3-month-old girl brought her to the emergency department for evaluation after noticing redness and swelling of the infant’s right third toe. The girl had been born at term, with no complications related to the pregnancy or the delivery. Her birth weight was 3.97 kg. The girl had otherwise been well, with no history of previous illness or trauma. The mother denied a history of fever in the girl, and no other lesions or rash were present. Her immunizations were up to date. Review of systems was unrevealing, and the girl’s vital signs were completely stable. She was comfortable and not in any obvious distress.
Physical examination confirmed a hair tourniquet of the right third toe, which was removed using gentle manipulation with a pair of iris scissors. Complete removal of the hair led to a restoration of normal peripheral circulation.
Hair tourniquet syndrome is commonly described in infants. It occurs when a hair or thread wraps around a body part—particularly a finger or a toe, but the genitals, ankles, and wrists also can be affected—leading to occlusion of blood supply. This in turn leads to significant redness and swelling of the affected area. Most children with hair tourniquet syndrome develop unexplained irritability and often are inconsolable.
Prompt recognition of hair tourniquet syndrome is paramount and requires a high index of suspicion. Autoamputation of a digit is an unfortunate possible complication.
While documented cases of an 80-year-old man1 and an 84-year-old woman2 with involved extremities have been reported, the younger age group, especially infants younger than 4 months of age, is at higher risk for hair tourniquet syndrome, because this age corresponds with the period during which 90% of mothers experience telogen effluvium, or excessive postpartum hair loss.3
Most cases of hair tourniquet syndrome are deemed accidental, but intentional cases consistent with child abuse have been reported in the literature.4
1. Srinivasaiah N, Yalamuri RR, Vetrivel S, Irwin L. Limb tourniquet syndrome—a cautionary tale. Inj Extra. 2008;39(4):e140-e142.
2. Miller RR, Baker WE, Brandeis GH. Hair-thread tourniquet syndrome in a cognitively impaired nursing home resident. Adv Skin Wound Care. 2004;17(7):351-352.
3. Strahlman RS. Toe tourniquet syndrome in association with maternal hair loss. Pediatrics. 2003;111(3):685-6877.
4. Johnson CF. Constricting bands. Manifestations of possible child abuse. Case reports and a review. Clin Pediatr (Phila). 1988;27(9):439-444.