Case Report Trichonodosis

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 M Kumaresan, MS  Deepa1
Website:
Department of Dermatology, PSGIMSR, 1Cutis Skin Clinic and Hair Transplant
www.ijtrichology.com Center, Coimbatore, Tamil Nadu, India
DOI:

10.4103/0974-7753.136760
 ABSTRACT
Quick Response Code:
Trichonodosis is characterized by knotted hair on the distal portion of the hair shaft. This
may be spontaneous or secondary to mechanical factors like vigorous scratching or
combing the hair. We report a case of spontaneous trichonodosis with abnormal scalp
and body hair.

Address for correspondence:

Dr. M Kumaresan,
Department of
Dermatology, PSGIMSR,
Coimbatore ‑ 641004,
Tamil Nadu, India.
E‑mail: dr_kumaresh@
Key words: Abnormal hair growth, kinky hair, trichonodosis
yahoo.co.in

INTRODUCTION region [Figure 3]. Eyebrow, axillary and pubic hairs were

sparse [Figure 4]. Microscopic examination of the hair

T richonodosis is characterized by knotted hair on

the distal portion of the hair shaft. This may be
spontaneous or secondary to mechanical factors like
vigorous scratching or combing the hair. Trichonodosis
may be associated with abnormal scalp and body hair
growth. The knots should be distinguished from the ova
of head louse. Although the incidence of trichonodosis is
common, it is reported less frequently.
shaft revealed knotted portions of hair; no other shaft
abnormalities were noted except for trichoschisis at the
distal portion of the shaft [Figure 5]. General and physical
examination was within the normal limits. Considering
the clinical findings and light microscopy a diagnosis of
trichonodosis was made.
DISCUSSION

CASE REPORT Trichonodosis (knotted hair) was first described by

A 19‑year‑old female patient presented with short, rough,
and unruly hair on the scalp since childhood. There was
history of breakage of hair beyond a particular length
throughout the scalp. Patient gave a history of knots
getting caught in fine‑toothed comb whenever the scalp
was combed with breakage of few hairs. There was
no family history of similar complaints. There was no
history of excessive cosmetic use or parlor activities for
hair care. On examination, the scalp hairs were dry, curly,
and short in length up to the nape of neck, transverse
split ends (trichoschisis) were seen in majority of
hairs [Figure 1]. Few hairs showed small nodules on the
distal portion [Figure 2]. Hairs were sparse in temporal
International Journal of Trichology / Jan-Mar 2014 / Vol-6 / Issue-1 31
McCarthy.[1] There are two types, one rare variety of
unknown etiology involves abnormally growing scalp
and body hair with spontaneous trichonodosis which is
predisposed to splintering and fracturing.[2] The second
commoner type, encountered in patients with normal scalp
and body hair, is considered secondary to mechanical forces
such as combing and brushing. The hairs in this type are
dry and curly, but no abnormality in structure or growth
pattern occurs.[2]
The knots are usually located on the outer third of the hair
shaft. Rarely, more than one knot is found on a single hair
and most were a simple half hitch knot.[2] Trichonodosis
is usually associated with trichoschisis. When the hair
 Kumaresan and Deepa: Trichonodosis
Figure 1: Short curly hair on the scalp
Figure 3: Sparse hair in the temporal region
Figure 5: Trichonodosis and trichoschisis in light microscopy
of subjects with trichonodosis was combed or brushed,
knots were observed to catch in fine toothed combs and
to a lesser extent, in brushes. In those with extensive
trichonodosis, one or two hairs would break off with each
stroke. Breakage usually occurred at the knot, but proximal
32 International Journal of Trichology / Jan-Mar 2014 / Vol-6 / Issue-1
Figure 2: Small nodules on the distal portion of hair shaft
Figure 4: Sparse eyebrow hair
breakage and several uprooted telogen hairs were also seen.
Microscopically, the fractured hairs tended to be flattened
on cross section.[2]
Trichonodosis is a characteristic of long, kinky scalp
hair. Kinky hair tends to be flat in cross section, whereas
curly or straight hair is oval to round. These flat or
ribbon‑shaped hairs do not lie flat on a level surface but
remain spiral.[2] When gently pulled and released, the
hairs recoil into spirals. This recoiling may lead to an
entanglement which, by chance, forms a knot that results
in trichonodosis.[2] The natural kinky hair of Negroes
consistently develops trichonodosis.
Mechanical factors such as scratching, combing, washing
or friction may produce tangling and knotting of hairs.
Repeated encounter with these factors results in tightening
of the knots.[3] The pubic and thigh regions are most
frequently involved since curliness of the hairs in those
areas predisposes them to knotting. If the knots are pulled
excessively tight, transverse splintering of the hair shaft and
 Kumaresan and Deepa: Trichonodosis

simulation of trichorrhexis nodosa may result. Not all the
hairs are involved in trichonodosis. These knots resemble
the ova of body, head and pubic lice and light microscopic
examination is necessary for differentiation. The nodules
in trichonodosis are located distally, whereas the ova are
located in the proximal shaft. The location of nodules is
of diagnostic value.
Acquired type of trichonodosis due to mechanical factors
is a common occurrence but reported less in literature.[4,5]
Spontaneous type of trichonodosis associated with abnormal
scalp and body hair is a rare occurrence. This type starts at
an early age and hair breaks away after a particular length
hair complain of hair loss or breakage, and the cause is not
apparent.
REFERENCES
1. McCarthy L. Diagnosis and Treatment of Diseases of the Hair. St. Louis:
CV Mosby Co.; 1940. p. 103‑4.
2. English DT, Jones HE. Trichonodosis. Arch Dermatol 1973;107:77‑9.
3. Weiner MA. Trichonodosis; report of a case. Arch Derm Syphilol
1948;58:238‑40.
4. Laing V, Resnick SD. Trichonodosis in a patient with straight hair. J Am
Acad Dermatol 1990;23:756‑7.
5. Trüeb RM. Trichonodosis neurotica and familial trichonodosis. J Am Acad
Dermatol 1994;31:1077‑8.

due to the fracture of hair shaft at the knot. This condition

persists indefinitely and is resistant to any form of treatment. How to cite this article: Kumaresan M, Deepa MS.
Trichonodosis. Int J Trichol 2014;6:31-3.
Treatment for the acquired type is proper hair care practices.
Source of Support: Nil, Conflict of Interest: None declared.
Trichonodosis must be considered when patients with kinky

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