Trichorrhexis Nodosa Differential Diagnoses

Updated: May 28, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Diagnostic Considerations

Also consider the following:

  • Pediculosis

  • Peripilar casts

  • Dermatophytosis

  • Trichothiodystrophy

  • Argininosuccinic aciduria

  • Deposits of extraneous material

  • Hypothyroidism

Patients with syndromic diarrhea, also known as phenotypic diarrhea or tricho-hepato-enteric syndrome, have a congenital enteropathy with a distinct hair abnormality characterized by woolly hair that is easily removed and poorly pigmented. Hair-shaft microscopic analysis may show twisted hair (pili torti), anisotrichosis and poilkilotrichosis, trichorrhexis nodosa and longitudinal breaks, and trichothiodystrophy. [26]

A feature of normal healthy black African hair is an apparent increased fragility, with certain similarities to that reported for trichorrhexis nodosa (weathering secondary to physical damage). [27] This excessive structural damage is probably due to physical trauma (resulting from grooming) rather than an inherent weakness due to any structural abnormality.

Differential Diagnoses