Trichorrhexis Nodosa

What is Trichorrhexis Nodosa?

Trichorrhexis Nodosa (TN) is a hair condition which leads to breakage of hair due to nodes or clumps formed on the shafts owing to varied reasons. The condition was first described by Samuel Wilks in 1856 and it was named by M. Kaposi in 1876.

Trichorrhexis Nodosa ICD 9 Code

The ICD 9 code of this condition is 704.2.

Trichorrhexis Nodosa Incidence

This condition is prevalent in certain races like the Africans, who are found to acquire it. Distal form of acquired TN can be noticed more in Asians and whites. There might be a gender-based link, as it is more common with particularly due to an inherited disorder named Argininosuccinic aciduria. Congenital TN can show up at or a few months after birth.

What does Trichorrhexis Nodosa look like?

When these tiny white nodes are studied under the microscope, they appear like paintbrushes opposed against each other. These white nodes are disheveled cortical fibers that are prone to fractures, a common feature of Trichorrhexis Nodosa. They occur on the hair of the scalp as well as the pubic region.

Trichorrhexis Nodosa Causes

Due to the loss of cuticle, lumps may appear on the shafts of hair. Two of the primary causes include trauma caused by chemicals from hairstyling products and mechanical damage due to blow dry. Often due to excessive hairstyles like ponytails and weaving, back-brushing techniques or exposure to UV rays, it can be aggravated. In its acquired form, it can be found in African population who frequently use hot irons or hair-styling products.

Picture of Trichorrhexis Nodosa

Picture 1 – Trichorrhexis Nodosa

Apart from external causes, it can also be congenital in nature. It can become highly pronounced if there is an underlying problem which weakens the shaft even more.  Hair can become weak due to problems like alopecia areata, influencing in the further development of this condition. Some disorders that weaken and damage hair shafts include:

  • Hypothyroidism
  • Trichothiodystrophy
  • Argininosuccinicaciduria
  • Ectodermal dysplasia
  • Menkes’ kinky hair syndrome
  • Netherton syndrome

Trichorrhexis Nodosa Symptoms

Distal Trichorrhexis Nodosa is an acquired TN condition in which the nodes develop towards the end of the hair strands. This condition is prevalent with specific populations belonging to Asia and Caucasia. It causes hair to split and break subsequently.

On the other hand, proximal TN occurs close to the scalp, making hair dull and rough. Localized TN can be seen to occur as a patch and occur due to physical injury.  Other common signs may comprise:

  • Development of small white nodes
  • No visible hair growth
  • Breakage from the tips of hair
  • Split ends or thinned ends
  • Breakage around the scalp
  • Hair thickened as specific regions
  • Change of color towards the tips, getting whitish

Trichorrhexis Nodosa Diagnosis

Diagnosis can be done by placing the hair shaft under the microscope. TN becomes apparent if the sample shows white spots on it. It is often diagnosed while investigating other diseases as it is a common symptom of some other ailment.

High power Dermoscopy is capable of depicting damages to the fibers to perfection. Tests to diagnose hypothyroidism and malnutrition can be done to assess the underlying cause. CT scan of the brain or EEG can be applied for checking the occurrence of mental retardation.

Treatment for Trichorrhexis Nodosa

If there is an underlying condition which is provoking TN, a doctor should be consulted for further treatment. By treating deficiency of nutrients and the root cause of the congenital disorder, the symptoms can be eliminated.

Image of Trichorrhexis Nodosa

Picture 2 – Trichorrhexis Nodosa Image

Acquired TN can be cured by adopting proper measures while managing hair. Prime lookout should be to minimize trauma to the hair and bettering environmental conditions which influence good health of the hair. By using these tips, you can get rid of TN in a couple of years.

  • Avoid using shampoos laced with chemicals as they will adversely affect your hair. Do not forget to condition your hair with protein conditioners and rinses to keep them supple.
  • Use a gentle brush and right brushing techniques to avoid hair damage.
  • Stop using hairstyling products like straightening agents which have massive chemicals in them.
  • Avoid using hot dryers and straightening irons very frequently to minimize damage.

Trichorrhexis Nodosa Prognosis

This non-contagious hair problem can be successfully cured within 4 years, if mechanical and chemical damages do not occur again. This is not an infectious condition and most often not looked upon as a serious problem as several ways of cure are available. It can also be prevented by following a good regimen for hair. Although hair loss is common, resorting to natural therapies can make it grow back again.


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