Uneven Hair Breakage in a 17-Year-Old Girl

AFFILIATIONS:
¹Medical Student, Michigan State University College of Osteopathic Medicine, East Lansing, MI
²Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI
³Assistant Professor, Department of Pediatrics, Michigan State University College of Osteopathic Medicine, East Lansing, MI

CITATION:
Teklehaimanot F, Abushukur Y, Cascardo CA, Gallagher ML. Uneven hair loss in a 17-year-old girl. Consultant. 2023;63(3):e3. doi:10.25270/con.2022.07.00004

Received January 13, 2022. Accepted January 18, 2022. Published online July 6, 2022.

DISCLOSURES:
The authors report no relevant financial relationships.

DISCLAIMER:
The authors report that informed patient consent was obtained for publication of the images used herein.

CORRESPONDENCE:
Fayven Teklehaimanot, BS, Michigan State University College of Osteopathic Medicine, 965 Wilson Road, East Lansing MI, 48824 (Teklehai@msu.edu)

A 17-year-old White girl presented for evaluation of “hair loss” that had begun approximately 1 year prior to presentation. Pertinent patient history included emotional stress and use of heating tools to straighten and blow dry her hair, with reported use of 3 times per week. She had no other significant medical history, and she took no medications.

Physical examination. The patient appeared comfortable and well-nourished, and no signs of developmental delay were apparent. Examination of the right side of the scalp revealed mild distal hair breakage with multiple small nodes on the proximal hair shaft (Figure 1). Hair in this area was also significantly shorter than the surrounding hair (Figure 2). The remainder of the scalp, head, and neck examinations were unremarkable. A focused review of systems, including immunologic, endocrine, and integumentary, disclosed no abnormal findings. The patient also denied any history of psychological disorders or inability to resist the urge to pull out hair.

Figure 1. Distal hair breakage with multiple small nodes on the proximal hair shaft.

Figure 2. Decreased hair length in area of breakage.

Based on the patient's presentation, what is the most likely diagnosis?

A. Monilethrix
B. Trichorrhexis invaginata
C. Trichorrhexis nodosa
D. Trichotillomania

Answer and discussion on next page.