A 10-year-old boy presented with multiple circumscribed patches of abnormal hair on scalp []. The first patch was noticed on vertex at the age of 7 years. This was followed by the development of three new patches during the last 1 year; two on both temporal areas and one on the occipital area. The hairs in the affected area were thicker, curlier, with random hair shaft orientation, and normal underlying scalp. Trichoscopy revealed abnormal kinking of hair shafts []. Varying diameters of a single hair shaft [], trichorrhexis nodosa-like features [], kinking, and damaged cuticle [], with normal pigmentation were observed on hair microscopy. Color of the affected hair shafts was dark and uniform. These characteristic features were absent on microscopy of normal surrounding hair shafts []. Histopathology showed abnormal bending of the hair follicle above the hair bulb [], and irregularities of inner root sheath near the bulb at the bending []. A detailed cutaneous and systemic examination along with cardiac, ophthalmic, dental, skeletal, and nervous systems evaluation did not reveal any gross abnormality.
We report the case of a 27-year-old healthy male who presented with an area of curlier and thinner hair than the rest of his scalp localized on the right parietal area. He referred that just at that location, his hair had been different since childhood, curlier than the rest. Physical examination revealed a plaque with shorter and curlier hair on an area of 10 cm in diameter on the right parietal area of the scalp. A decreased density of hair was observed. The skin on the patch was apparently healthy. There were not exclamation mark hairs or miniaturization of hair follicles. A hair pull test was negative []. A skin biopsy showed a mild perifollicular lymphocytic infiltrate, telangiectatic capillaries in the superficial dermis and several terminal hair follicles emerged in the same dilated follicular infundibulum. Interestingly, an excessive amount of normal apocrine glands were found in the deep reticular dermis. Counting of hair follicles was normal [Figure –]. Based on clinical appearance and histopathologic studies, a diagnosis of WHN was established.