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Trichorrhexis nodosa

Trichorrhexis nodosa is a common hair problem in which thickened or weak points (nodes) along the hair shaft cause your hair to break off easily.

Causes

Trichorrhexis nodosa can be an inherited condition.

The condition may be triggered by things such as blow-drying, ironing the hair, over-brushing, perming, or excessive chemical use.

In some cases, trichorrhexis nodosa is caused by an underlying disorder, including very rare ones, such as:

  • Thyroid not making enough thyroid hormone (hypothyroidism)
  • Buildup of ammonia in the body (argininosuccinic aciduria)
  • Iron deficiency
  • Menkes syndrome (Menkes kinky hair syndrome)
  • Group of conditions in which there is abnormal development of the skin, hair, nails, teeth, or sweat glands (ectodermal dysplasia)
  • Trichothiodystrophy (inherited disorder that causes brittle hair, skin problems, and intellectual disability)
  • Biotin deficiency (inherited disorder in which the body is not able to use biotin, a substance needed for hair growth)

Symptoms

Your hair may break easily or it may appear like it is not growing.

In African Americans, looking at the scalp area using a microscope shows that the hair breaks off at the scalp area before it grows long.

In other people, the problem often appears at the end of a hair shaft in the form of split ends, thinning hair, and hair tips that look white.

Exams and Tests

The health care provider will examine your hair and scalp. Some of your hairs will be checked under a microscope or with a special magnifier used by skin doctors.

Blood tests may be ordered to check for anemia, thyroid disease, and other conditions.

Treatment

If you have a disorder that is causing trichorrhexis nodosa, it will be treated if possible.

Your provider may recommend measures to reduce damage to your hair such as:

  • Gentle brushing with a soft brush instead of aggressive brushing or ratting
  • Avoiding harsh chemicals such as those used in straightening compounds and perms
  • Not using a very hot hair dryer for long periods and not ironing the hair
  • Using a gentle shampoo and a hair conditioner

Outlook (Prognosis)

Improving grooming techniques and avoiding products that damage hair will help correct the problem.

This condition is not dangerous, but may affect a person's self-esteem.

When to Contact a Medical Professional

Call your provider if symptoms do not improve with changes in grooming and other home-care measures.

Alternative Names

Hair shaft fracture; Brittle hair; Fragile hair; Hair breakage

References

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Diseases of the skin appendages. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 33.

Restrepo R, Calonje E. Diseases of the hair. In: Calonje E, Brenn T, Lazar AJ, Billings SD, eds. McKee's Pathology of the Skin. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 22.

Review Date 4/16/2019

Updated by: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.