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Case Reports
. 2010 Jan;2(1):56-9.
doi: 10.4103/0974-7753.66918.

Monilethrix in pattern distribution in siblings: diagnosis by trichoscopy

Nilam Jain  1 , Uday Khopkar
Affiliations
Case Reports

Monilethrix in pattern distribution in siblings: diagnosis by trichoscopy

Nilam Jain et al. Int J Trichology. 2010 Jan.

Abstract

Monilethrix is a heritable hair shaft defect characterized by localized or diffuse alopecia resulting from hair fragility over friction areas, predominantly the temporal and occipital regions, and follicular keratosis over the occipital region. However, it lacks macroscopic features that enable easy and rapid diagnosis in medical practice. Hair shaft microscopy is the basis for diagnosing monilethrix. We present a report of two Indian male siblings aged 24 and 21, who presented with thinning and hair loss from the scalp in male pattern distribution and multiple skin-colored follicular papules over the nape of the neck and bilateral forearms since childhood. Trichoscopy of scalp hair revealed characteristic uniform elliptical nodes and intermittent constrictions along with variation in hair shaft diameter, presence of few vellus hair and yellow dots, suggesting a diagnosis of monilethrix with early-onset androgenetic alopecia. Dermoscopy of the papules revealed multiple stubs of broken hair arising from them with a similar beaded appearance, suggesting a diagnosis of monilethrix. The diagnosis of monilethrix was confirmed with light microscopy and hair clipping. This report highlights the patterned distribution of hair loss in monilethrix probably due to the early unmasking of androgenetic alopecia and the use of trichoscopy as the diagnostic modality.

Keywords: Androgenetic alopecia; hair shaft disorder; monilethrix; trichodermoscopy.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figures 1 and 2
Figures 1 and 2
Diffuse hair loss with thinning of hair resembling androgenetic alopecia in siblings
Figure 3
Figure 3
Multiple follicular keratotic papules over the nape of the neck and forearm
Figure 4
Figure 4
Beaded or moniliform appearance of the hair shaft with nodes and internodes
Figure 5
Figure 5
Hair arising from the keratotic papules shows internodal constrictions and regular bends
Figure 6
Figure 6
Light microscopy (20×) – beaded hair with constriction and fraying at internodal junctions
Figure 7
Figure 7
Abnormal hair with constriction, bulge and perifollicular fibroplasia and infiltrate in response to broken hair shaft within the follicle (scanner view)
See this image and copyright information in PMC

References

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