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.
A 5-year-old girl child presented with abnormal patch of hair since 2 years of age. Her parents noticed a single patch of curling and coiling of hair along with altered texture over the left side of scalp. Her parents felt the patch to be unruly and unsightly and hence attempted repeated tonsuring. In spite of this, the patch of hair remained the same. Birth and development history of the child was normal. Her family members did not have similar complaints. On examination, we noticed a solitary circumscribed patch of size 6×4 cm located over the left frontoparietal region of scalp. The hair over the patch had an altered texture, was lighter in color, thinner, tightly coiled, and curled giving an unkempt appearance []. The skin over the patch was apparently normal. Examination of rest of the scalp, teeth and nails were also normal. There was no evidence of palmoplantar keratoderma and evidence of any epidermal nevus elsewhere. Ophthalmic and cardiac evaluation did not reveal any abnormality. There was no evidence of precocious puberty. Based on the above findings, we arrived at a diagnosis of localized woolly hair nevus. Hair microscopic examination showed non-specific features. Scalp biopsy revealed normal hair follicles and appendages []. Routine hemogram, serum biochemistry, electrocardiogram and echocardiogram were normal.