Interactive Quiz: Spontaneous Hair Loss
First, let’s meet the patients.
While aboard a US Navy aircraft carrier in the North Arabian Gulf, 2 active-duty sailors presented independently to the medical department with remarkably similar symptoms of hair strand breakage while brushing, along with spontaneous hair loss.
The first patient was a 33-year-old woman who presented with a 1-month history of these symptoms, along with finding a large amount of hair in her helmet at the end of each day. The patient worked primarily on the flight deck in high heat and humidity. The second patient was a 43-year-old woman who worked in a different part of the ship and presented with nearly identical symptoms 2 weeks after the first patient.
Aboard the ship, both patients lived in a tight berthing area shared by 213 women; coincidentally, they slept 1.5 m from each other. Both women denied using the other’s hairbrush, hair ties, or any hair products.
On physical examination of the first patient, numerous cream-colored nodules measuring 0.3 to 0.5 mm were seen on the hair shafts (Figure 1). The nodules were irregular, shiny, and gelatinous-appearing, with even distribution on the hair shafts proximally to distally. The hair strands would break with tension at the areas of the nodules. Examination findings of the scalp were unremarkable.
Microscopic examination of a potassium hydroxide preparation test specimen showed that the nodules were made up of a mass of small ovals that surrounded and invaded the hair shaft (Figure 2).
