What’s trichorrhexis nodosa?

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Trichorrhexis nodosa is a hair condition caused by knots or growths on individual hairs, often due to damage or malnutrition. It can be diagnosed by evaluating the hair shaft and treated by addressing underlying causes and minimizing stress to the hair. In congenital cases, the disorder is often linked to other inherited disorders that weaken the hair. Diagnosis is simple and treatment involves behavioral changes and supplements. Recovery can take up to four years and some underlying congenital conditions may make it difficult to fully cure the disorder.

Trichorrhexis nodosa is a condition that results in hair breakage and difficulty growing, due to the development of small growths or knots on individual hairs. This disorder occasionally has a congenital cause, but is more often acquired due to extensive damage to the hair or sometimes to malnutrition or diseases such as hyperthyroidism. The condition can be diagnosed by evaluating the hair shaft. The treatment can then address any underlying causes and also work to minimize stress to the hair to avoid additional knots developing.

In almost all cases where this condition is due to congenital causes, the link is indirect. Trichorrhexis nodosa develops because another inherited disorder weakens the hair. This fragility seems to predispose him to the development of knots.

For example, argininosuccinic aciduria deprives the hair of arginine, making it susceptible to breakage and more prone to developing growths. Another condition, Menke’s disease, causes the body to metabolize copper poorly, which in turn affects the ability to create keratin. Fundamental to hair health, keratin must be present in sufficient quantities; otherwise the hair will be weak, which could favor the development of trichorrhexis nodosa.

Similarly, the presence of significant malnutrition or medical disorders such as hypothyroidism can deprive the hair of nutrients and create scenarios where trichorrhexis nodosa is more likely to occur. In most cases, there is no initial weakness of the hair and the condition develops through constant damage to the shafts. For example, forcefully brushing, dyeing, and setting your hair can cause knots to develop. Disorders such as trichotillomania or compulsive hair pulling and behaviors such as head banging can also damage the hair shaft.

Significantly, trichorrhexis nodosa is more likely to develop in middle-aged women. Conversely, most congenital forms of the disease develop much earlier in life. This suggests that long-term repeated damage to hair through things like brushing or perming makes people more at risk for this disorder.

Diagnosing trichorrhexis nodosa is quite simple. Under a microscope, a small sample of hair is likely to show white knots or patches. Once diagnosed, doctors must determine the cause. As mentioned, harsh hair treatment is almost always at least partially responsible. Doctors may want to look into other problems such as malnutrition, hypothyroidism, or poor synthesis of certain proteins and body chemicals.

Addressing any underlying causative factors when possible partially treats the disease. Supplements are also sometimes prescribed to boost hair health. Patients must also respect behavioral changes so that the hair is not subjected to stress. This can mean using very soft brushes on the hair; give up the use of curling irons and hair dryers; and avoiding hair dye, straightening procedures, or perms. Recovery can be challenging, taking two to four years, and some underlying congenital conditions may make it very difficult to fully cure this disorder.

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