Circle Hairs in a Patient with Multiple Myeloma

Figures & data

Figure 1 Dermatological examination: (A) multiple brown scales with adherent centers and detached, outward-turning edges, with multiple, overlying, small black dots on the extensor areas of both lower extremities; (B) close-up view showing abnormal hairs on the areas of skin abnormality.

Figure 2 Dermoscopic examination: (A) multiple dark hairs with a perfectly circular arrangement, located under a thin layer of skin (original magnification x20); (B) close-up view of circle hairs (original magnification x80).

Figure 3 Histopathological examination: laminated hyperkeratosis with hypogranulosis and a dilated hair follicle.

Table 1 Clinical, Dermoscopic, and Histopathologic Features of Circle Hair and Its Mimickers

	Circle Hair	Rolled Hair	Pigtail Hair	Coiled Hair	Corkscrew Hair
Epidemiology	- Overweight - Middle-aged man	-	Not specific, may be found as a result of rapid hair regrowth in children	40% in patients with trichotillomania and very rarely (<1%) in alopecia areata and tinea capitis	-
Clinical morphology	A perfectly concentric hair under a thin skin layer dispersed among surrounding normal hairs	An irregularly coiled hair shaft with not perfectly circular configuration into a hyperkeratotic papule, signs of inflammation, and peripilar casts may be present	A short, regularly coiled hair with tapered end resembling a pig’s tail	- A circular hair with a thicker extremity comparing to pigtail hair - May occasionally have a hook-like appearance	- A hair winding many times around itself - Perifollicular hemorrhage (ascorbic acid deficiency)
Distribution	Abdomen, back, trunk, and thighs	Extensor extremities, back, shoulders, and buttocks	Scalp	Scalp	- Scalp (tinea capitis) - Trunk and/or extremities (ascorbic acid deficiency)
Dermoscopic features	A small diameter hair shaft with a perfectly circular arrangement under a translucent layer of stratum corneum	An irregularly twisted hair into a hyperkeratotic papule, peripilar cast	A short, regularly coiled oval or circular hair with a tapered end mimicking a pig’s tail representing the rapidly growing hair	An irregular oval hair with a jagged end	- A hair with multiple twists and coils forming a corkscrew-like structure - May be found trapped in keratinaceous debris in hair follicle together with surrounding non-blanchable perifollicular hemorrhage in scurvy patients
Histopathology	-“River bed” dilated infundibular part of the hair follicle -Entrapped hair shaft -No perifollicular inflammation -No tapering of hair shaft diameter	-Follicular hyperkeratosis -Perifollicular inflammation	-	-	-
Associated conditions	-None	-Mechanical trauma -Corticosteroids, cyclosporine therapy -Keratosis pilaris, xerosis, neurodermatitis, palmoplantar keratoderma, lupus erythematosus, alopecia areata, and hypertrichosis	-Repilation after acute diffuse hair loss in chemotherapy-induced alopecia and alopecia areata -Telogen effluvium -Trichotillomania -Tinea capitis -Syphilitic alopecia -Triangular alopecia -Hair-bearing margin of cicatricial alopecia	-Trichotillomania -Traction alopecia -Healthy individuals resulting from hair pulling during the hairstyling process	-Tinea capitis -Ascorbic acid deficiency