Trichorrhexis Nodosa: Causes, Symptoms, Diagnosis and Treatment
Trichorrhexis nodosa is a commonly occurring abnormality of the hair shaft. It is characterised by the presence of nodules in the hair strand that cause hair breakage and alopecia. This disorder is primarily classified into two types, congenital and acquired forms. It mainly affects the scalp hair, but eyelashes, eyebrows and pubic hair can be affected too. When examined under the microscope, Trichorrhexis nodosa features little cracks on the hair shaft from which several fibres emerge that resemble two brushes pushed against each other in the opposite direction.

What is Trichorrhexis Nodosa?

Trichorrhexis nodosa is a very common occurrence that affects the hair shafts of the scalp hair. The hair shafts show presence of tiny nodules which are brittle regions on the shaft that cause easy breakage of the hair. These whitish- yellow nodes are randomly distributed along the hair shaft, they make the hair frail and prone to break easily. This defect can be hereditary and the condition manifests within the first year of the affected infants being born. It is inherited in an autosomal dominant fashion. The other but most common cause is the acquired type, where a certain physical and chemical stress to the hair causes Trichorrhexis nodosa. Some of the physical factors responsible for the damage to the hair shaft are excessive combing of hair, hair straightening and perming, blow-drying, use of high temperatures and long time exposure to ultraviolet radiation. Also, chemical trauma like too much of salt water contact, excessive use of shampoo, bleaching and use of sprays on the hair make the hair shafts susceptible to developing this disorder. Trichorrhexis nodosa is also observed along with many other syndromes and conditions like Netherton’s syndrome, Menke’s kinky hair syndrome, iron deficiency, ectodermal dysplasia (aberrant growth and development of hair, skin and nails) and also hyperthyroidism has been associated to this condition.

Background Of Trichorrhexis Nodosa

Trichorrhexis nodosa was first described by Samuel Wilks in 1852. This disorder is a commonly occurring one and is more prevalent in people of African heritage due to their peculiar hair styling methods. Trichorrhexis nodosa features nodules on the hair shaft that vary in number and are randomly placed. They are the weak points from which the breakage of the hair occurs. Persistent trauma to the hair strands results in this hair shaft defect. Trichorrhexis nodosa is primarily observed on scalp hair that has been exposed to trauma, but sometimes hair on other regions of the body gets affected too due to a structural anomaly that makes the hair fragile.

Causes of Trichorrhexis Nodosa

The causes of Trichorrhexis nodosa can be hereditary or acquired. Mutations in certain specific genes cause structural deformity in the hair shaft, rendering it weak and brittle. These regions of weakness further develop into the characteristic nodules which make the hair shaft prone to breaking easily. The most common cause of this disorder is acquired, wherein external trauma and stress to the hair strands can make the hair liable to breakage. This physical stress includes excessive heat treatment, blow-drying or chemical treatment of hair. Also, Trichorrhexis nodosa can be triggered along with other conditions like iron deficiency, hypothyroidism, argininosuccinate aciduria (excessive build up of ammonia in the blood stream) and Menke’s kinky hair syndrome.

Symptoms of Trichorrhexis Nodosa

The most distinct symptom of Trichorrhexis nodosa is brittle hair that breaks easily. Also, white flecks and nodules are observed on the hair shafts that vary in number. Another symptom of this anomaly is dull hair and also the inability to grow hair long. Many a time split ends to the hair shaft are also observed. Trichorrhexis nodosa is often noted with other syndromes like Menke’s kinky hair syndrome, ammonia build up in the blood, iron deficiency, hyperthyroidism and ectodermal dysplasia.

Common Symptoms of Trichorrhexis Nodosa include,

  • Brittle hair that breaks easily
  • Presence of white nodules on the hair
  • Dullness in hair
  • Reduction in hair growth
  • Spilt ends on hair shaft

Diagnosis of Trichorrhexis Nodosa

The diagnosis of Trichorrhexis nodosa is done with the help of a microscopic examination. A hair strand is taken and investigated under a microscope for the characteristic whitish nodules. Sometimes, a skin biopsy is done to check for genetic mutations. A recent diagnostic approach to investigate Trichorrhexis nodosa has been Trichoscopy. Trichoscopy employs a videodermascope which then examines the hair as well as the scalp. The preliminary feature of two brushes pushed against each other in opposite direction can be observed by this method. This is a non-invasive method and does not involve any plucking or cutting of hair strands. It is a very reliable and an easy method to diagnose Trichorrhexis nodosa and other types of hair shaft defects.

Treatment of Trichorrhexis Nodosa

The treatment of Trichorrhexis nodosa depends upon its type. In acquired cases, reducing or altogether avoiding the physical trauma helps and brings improvement. If there are any underlying diseases accompanying Trichorrhexis nodosa, they are given the due course of treatment. In order to prevent breakage, it is recommended to keep the hair hydrated and well conditioned. The affected individual is advised to follow gentle hair care and avoid harsh handling. In the case of hereditary form of this disease there can be no such treatment given as there is a defect at the gene level. Sometimes however, there is improvement and reversal with age and hair shows normal growth.

What is the Outlook (Prognosis) for People With Trichorrhexis Nodosa?

The prognosis for people with acquired Trichorrhexis nodosa is actually very good. If the trauma to the hair is reduced and avoided, acquired Trichorrhexis nodosa is very much reversible. Depending upon the rate of growth of the new hair from the follicle, Trichorrhexis nodosa can be easily controlled.

How do you cure Trichorrhexis Nodosa?

Trichorrhexis nodosa can be cured by taking proper and gentle care of the hair. Most of the cases are acquired due to external environment factors like perming, high heat treatments, exposure to ultraviolet light and chemical treatment of the hair. If these causative factors are avoided, the hair can be restored back to it normal health with proper hydration and conditioning. In case of alopecia due to Trichorrhexis nodosa, mild natural therapies can help and prove effective.


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