Trichorrhexis nodosa, what is it?

Trichorrhexis Nodosa What Is It?

Trichorrhexis nodosa is a frequent hair disease that causes the hair to break off quickly. The condition is characterized by thicker or weak places (nodes) on the hair shaft.

What Are the Underlying Factors That Lead to Trichorrhexis Nodosa?

Trichorrhexis nodosa is sometimes a disorder that is passed down through families. The condition could be brought on by activities like blow drying, straightening the hair, excessive brushing, perming, or using excessive chemical products. Trichorrhexis nodosa can be caused by various underlying conditions, some of which are uncommon. Some of these conditions include:

  • Insufficient production of thyroid hormone by the thyroid (hypothyroidism)
  • Increased levels of ammonia in the blood (argininosuccinic aciduria)
  • Iron deficiency
  • Trichothiodystrophy (an inherited condition that produces brittle hair, skin conditions, and intellectual incapacity)
  • Biotin insufficiency

Other causes include:

Menkes syndrome: This syndrome is a collection of disorders characterized by an aberrant maturation of the skin, teeth, hair, nails, or sweat glands. Menkes disease is a type of sex-linked recessive condition defined by a deficiency in the absorption of copper, which ultimately results in low levels of serum copper. Copper is required for the activity of the enzymes that contribute to the synthesis of keratin.

Therefore, patients with this illness have an innate keratinization fault, which leads to a twisting of the hairs (known medically as pili torti), trichorrhexis nodosa, and weaker hairs. Because the hairs that result from these genetic and metabolic problems are more vulnerable to trauma, they will likely exhibit the nodes characteristic of trichorrhexis nodosa.

Some families have an autosomal dominant inheritance pattern that causes a main congenital type of trichorrhexis nodosa present at birth. This type of ectodermal dysplasia can develop on its own or in conjunction with other mild ectodermal abnormalities.

In addition, trichorrhexis nodosa has been described in a patient with hypothyroidism. It is speculated that a buildup of mucin in the external root sheath is what triggers the hair-shaft deficiency by exerting pressure on the internal root sheath. Because of this accumulation, there may be a problem with the maturation and differentiation of matrix cells, which will lead to a growth deficiency in the hair shaft.

Trichorrhexis nodosa could also be a major aspect of trichohepatoenteric syndrome (THES). The disorder is an autosomal recessive syndrome also marked by severe diarrhea in childhood, immunodeficiency, facial dysmorphism, hypopigmentation, liver disease, cardiac deformities, and possibly platelet disorders, e.g., lowered platelet alpha-granules, unusual induced alpha granule content discharge, abnormal lipid additions, abnormal platelet canalicular system, and a limited number of microtubules. Mutations in the TTC37 gene have been associated with it.

A heterozygous germline mutation known as Ala111Thr was found in the proband of another disorder with dysmorphic features, which included cleft palate, hypotrichosis with trichorrhexis nodosa, oligodontia, and ridging of nails. This mutation was found in the P63 gene in both the proband and his mother.

What Signs and Symptoms Are Associated with Trichorrhexis Nodosa?

  • Your hair can break easily, or it might give the impression that it is not growing.
  • Under a microscope, the scalp area of African Americans reveals that hair tends to break off at the scalp before growing long.
  • When it affects other people, the issue most frequently manifests at the tip of the hair shaft, which might take the shape of breakouts, thinning hair, or white hair tips.

Three primary classifications can be applied to acquired trichorrhexis nodosa: proximal, distal, and localized.

The condition known as proximal trichorrhexis nodosa is quite common in black people who style their hair with caustic chemicals (relaxers). Involved hairs acquire distinctive nodes and snap off a few millimeters from the skin’s surface in regions of the body that are prone to friction from activities such as combing the hair or sleeping on the affected area. Because of this breakage, regions of alopecia have developed. Certain individuals are more vulnerable than others, which may have a basis in genetics.

People of white or Asian descent are most likely affected by distal trichorrhexis nodosa. A few inches out from the scalp, nodes, and breakage might form, resulting in hair that is uneven and lackluster in appearance.

Breakage is typically the result of excess hair processing and is commonly related to trichoptilosis, also known as split ends. Trichoptilosis is a condition in which the hair splits in a longitudinal direction.

Trichorrhexis nodosa that is localized manifests as a patch that is often no more than a few centimeters wide. It is most likely that it was caused by constant scratching and rubbing. It is often accompanied by pruritic dermatoses, like contact dermatitis, atopic dermatitis, or circumscribed neurodermatitis. Young men in certain regions of India are known to trigger trichorrhexis nodosa excessively, combing their hair.

The presence of trichorrhexis nodosa characterizes Menkes disease. Epilepsy is among the most prominent characteristics of this condition, beginning with an early focal status, followed by infantile spasms, and finally, multifocal and myoclonic epilepsy beyond 2 years.

Evaluations And Checkups

The hair and scalp are going to be examined by a medical professional. A few of the hairs will be examined more closely with a microscope. Experts may prescribe blood tests to screen for illnesses such as anemia and thyroid disease.

What Kinds of Treatments Are Available for Patients Who Have Trichorrhexis Nodosa?

What Are the Underlying Factors That Lead to Trichorrhexis Nodosa?

Trichorrhexis nodosa can be treated if the underlying condition is addressed. Your healthcare practitioner may suggest the following steps to help limit the amount of damage done to your hair:

  • You should replace harsh brushing with gentle brushing done with a soft brush.
  • Keeping away from harsh chemicals like those found in perms and straightening treatments
  • Not using a hair dryer with a high heat setting for extended periods, and avoiding ironing the hair.
  • Making use of mild shampoo and conditioner

What Is the Prognosis for Trichorrhexis Nodosa?

Improving one’s grooming methods and avoiding using items that are harmful to hair will assist in correcting the issue. This disorder is not harmful but can harm a person’s sense of self-worth.


It is important to inquire about the patient’s usual hair care practices and exposure to their surroundings and chemicals to identify the cause of the patient’s physical or chemical injury.

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