The American Society of Dermatopathology

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Interactive Case Study - April 2022

Hair breakage in a 38-year-old patient

Kathleen E. Kramer, MD; Willis H. Lyford, MD; Nicholas F. Logemann, DO

Question 1:

38-year-old woman presented with a several-year history of diffuse hair breakage occurring diffusely on the scalp and most prominently affecting the vertex of her scalp. She denied any pain, pruritus, or previous history of hair loss. She denied hair loss or hair thinning at any other body sites. She denied a history of similar hair loss in family members. Physical exam revealed mid-shaft hair breakage, primarily at the vertex of the scalp, with retained hair shaft density at the skin of the scalp and no evidence of miniaturization. No scale, crust or pustules were noted at the scalp. Light microscopy of the hair shaft demonstrated findings shown in figures 1-3 and the clinical appearance is shown in figures 4-7. 
Figure 1 
Figure 2 
Figure 3 
Figure 4 
Figure 5 
Figure 6 
Figure 7 

What is the most likely diagnosis?