Hair shaft dysplasias

Epidermolytic palmoplantar keratoderma with woolly hair and dilated cardiomyopathy

BACKGROUND

A new cardiocutaneous syndrome has been noted, characterized by an epidermolytic palmoplantar keratoderma and woolly hair, and associated with dilated cardiomyopathy.

OBJECTIVE

This describes the clinical and histopathologic characteristics of this new syndrome.

METHODS

Eighteen patients were examined clinically and histologically from 1970 to 1997. Cardiologic examinations were performed in 12 patients. The cutaneous lesions were classified according to the presence of obligatory and facultative elements of the syndrome.

RESULTS

Patients were born with woolly hair. Around the first year palmoplantar keratoderma and the other keratotic elements appeared. The first cardiac abnormalities are exclusively electrocardiographic and occur in asymptomatic patients. In these patients, dilation of the left ventricle together with alterations in muscle contractility are observed. The dilated cardiomyopathy can lead to congestive heart failure and death.

CONCLUSION

The association of woolly hair and palmoplantar keratoderma with a histopathologic pattern of epidermolytic hyperkeratosis has not been previously described. Their frequent association with dilated cardiomyopathy defines a cardiocutaneous syndrome. Whenever woolly hair is associated with any kind of palmoplantar keratoderma, a search for possible cardiac abnormalities is recommended.

A new clinical disorder of twisted and rolled body hairs with multiple, large knots

BACKGROUND

We present a new hair disorder characterized by an unusual twisting and matting of body hairs. This disorder may occur as an acquired or, possibly, an inherited trait.

OBJECTIVE

Our purpose was to analyze the clinical features of three patients and report the changes revealed by light microscopy and scanning electron microscopy.

METHODS

We examined two unrelated adults with acquired multiple large knots of body hairs and a newborn infant with a familial history of the same entity.

RESULTS

In the two adults the hairs were rolled and knotted together, and twisting of body hairs occurred in areas where rubbing was frequent. In the familial type, which was suggestive of an autosomal dominant inheritance pattern, no mechanical explanation could be found. Light microscopy confirmed the clinical impression of twisted and felted hairs, and scanning electron microscopy revealed sticking of at least 20 hairs. No underlying skin disease or deeper process was found.

CONCLUSION

Multiple twisted and rolled body hairs that may develop into multiple, large knots may appear as a minor variant of hair matting or felting. Scanning electron microscopy shows multiple hairs that originate from different hair follicles and roll and stick together centrally.

Rapp-Hodgkin syndrome with pili canaliculi

A 20-year-old woman and her 12-year-old brother had hypohidrotic ectodermal dysplasia, cleft lip and palate, midfacial hypoplasia with narrow nose from the nasal bridge to the tip, narrow dysplastic nails, and conical teeth and hypodontia, and hypospadias and hypoplastic uvula in the boy. The woman had major underdevelopment of intellectual capacity. The most important hair anomalies in both siblings were sparse eyebrows, pili torti, and pili canaliculi. Some of the pili canaliculi had two canals (pili bicanaliculi), and the cross section for scanning electron microscopy had a quadrangular aspect. This is the seventh family reported with Rapp-Hodgkin ectodermal dysplasia.

Structural hair abnormalities in ectodermal dysplasia

The hair of patients with three ectodermal dysplasias--ectrodactyly ectodermal dysplasia clefting syndrome (EEC); orofacial-digital syndrome (OFD) type I; and anhidrotic ectodermal dysplasia syndrome (AED)--were studied by scanning electron microscopy. While no pathognomonic abnormalities were noted for each condition, hair shaft structural defects were evident in all patients studied. The EEC clefting syndrome and OFD I shared the most deforming defects, while AED had fewer.