10.5826/dpc.1204a204
text/xml
2160-9381
2372
en
Ramon M Pujol
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Hair heterochromia, pili annulati, microscopy
Isolated patchy heterochromia with pili annulati features on light and electron microscopy
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2022-02-06
2022-10-31
2022-12-05
e2022204
Dermatol Pract Concept
Ramon M Pujol
2022/10/31
10.5826/dpc.1204a204
e2022204
Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
2160-9381
Hair heterochromia, pili annulati, microscopy
en
e2022204
Feldmann KA, Dawber RP, Pittelkow MR, Ferguson DJ. Newly described weathering pattern in pili annulati hair shafts: a scanning electron microscopic study. J Am Acad Dermatol. 2001;45:625-7.
Isolated patchy heterochromia with pili annulati features on light and electron microscopy
https://dpcj.org/index.php/dpc/article/download/2372/1785
    Isolated Patchy Heterochromia With Pili Annulati
       Features on Light and Electron Microscopy
                         Alejandro Lobato-Berezo1, David Pesqué1, Ramon M Pujol1


1 Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain



Key words: hair heterochromia, pili annulati, microscopy
Citation: Lobato-Berezo A, Pesqué D, Pujol RM. Isolated patchy heterochromia with pili annulati features on light and electron
microscopy. Dermatol Pract Concept. 2022;12(4):e2022204. DOI: https://doi.org/10.5826/dpc.1204a204
Accepted: March 17, 2022; Published: October 2022
Copyright: ©2022 Lobato-Berezo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Alejandro Lobato Berezo, M.D, Department of Dermatology 1.-Hospital del Mar, Barcelona, Passeig Marítim,
25-29, 08003 Barcelona, Spain. Telephone: (+34) 616717411 Fax: (+34) 932483328 E-mail: allobe@hotmail.es




Introduction                                                             of cavitation within the hair cortex which after exposure to a
                                                                         10% potassium hydroxide solution, induced disappearance
Isolated patchy heterochromia is a rarely described distribu-            of the dark areas within 5 minutes (Figure 1C). In order to
tion of hair scalp mosaicism, where 2 distinct hair colors are           perform TEM, the hair samples were mounted on stubs and
present in the same person. We present the case of a patient             sputter coated with gold palladium. TEM of the hairs shafts
with light microscopy and transmission electron microscopy               showed a circular to oval cross-section. The cuticle consisted
(TEM) features that corresponded to pili annulati.                       of a cobblestone pattern with overlapping cells. The micro-
                                                                         fibers composing the cortex of the red hair shafts presented
                                                                         large gaps between them (Figure 1D). The clinical findings
Case Presentation
                                                                         could correspond to isolated patchy heterochromia with pili
A 12-year-old boy presented with a band of red hair over                 annulati microscopic features.
the interparietal region that was present since birth and had
become more obvious over the years (Figure 1A). The rest
                                                                         Conclusions
of his scalp hair, eyebrows and eyelashes were brown. No
previous traumas on the area, no treatments neither scalp                Heterochromia of the hair represents a variant of pigmen-
inflammation were reported. The underlying scalp was nor-                tary mosaicism that can present in different distributions
mal. He had no diseases and the rest of physical exploration             (patchy, segmental, diffuse or blaschkoid). First described in
revealed no alterations. Light microscopy of both the red                2001 by Restano et al, isolated patchy heterochromia has
hair and brown hair showed light and dark segments under                 been rarely reported, with less than 25 cases in the litera-
reflected light (Figure 1B). The latter corresponded to areas            ture [1-3]. It is usually a benign condition not related to any




Research Letter | Dermatol Pract Concept. 2022;12(4):e2022204                                                                           1
                 Figure 1. (A) Isolated patch of red hairs surrounded by a background of brown hairs. (B) Light and dark
                 segments alternating in the hair shaft. (C) Progressive disappearance of the dark areas after 5 minutes of
                 exposure to a 10% potassium hydroxide solution. (D) Multiples cavities in the cortex and cobblestone
                 pattern in the cuticle.


genetic abnormalities of melanocyte migration (piebaldism,              light microscopy and TEM. These explorations should be
Waardenburg syndrome, Tietze syndrome, Vogt-­Koyanagi-                  routinely practiced to a get a better characterization of hair
Harada syndrome), genetic diseases affecting pigmentation               heterochromia.
(tuberous sclerosis), inflammatory conditions damaging the
melanocyte (vitiligo, halo nevus, regrowth in alopecia areata,
                                                                        References
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vus), metabolic/nutritional defects (severe iron deficiency,             1. Restano L, Barbareschi M, Cambiaghi S, Gelmetti C, Ghislanzoni
vitamin B12 deficiency, kwashiorkor, phenylketonuria, Men-                  M, Caputo R. Heterochromia of the scalp hair: a result of pig-
                                                                            mentary mosaicism? J Am Acad Dermatol. 2001;45(1):136-139.
kes syndrome), drugs (diazoxide, minoxidil, or chloroquine)
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origin that is usually inherited in an autosomal dominant                4. Giehl KA, Ferguson DJ, Dawber RP, Pittelkow MR, Foehles J,
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                                                                            PMID: 15482289.
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                                                                         5. Feldmann KA, Dawber RP, Pittelkow MR, Ferguson DJ. Newly
tex of the hair shaft. Altered hair growth and fragility are not
                                                                            described weathering pattern in pili annulati hair shafts: a
clinical features in this condition [5].                                    scanning electron microscopic study. J Am Acad Dermatol.
    In conclusion, we report the first case of isolated patchy              2001;45(4):625-627. DOI: 10.1067/mjd.2001.114748. PMID:
heterochromia with pili annulati microscopic changes on                     11568760.




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