10.5826/dpc.1303a196
text/xml
2160-9381
3109
en
Aysel Çakır
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
A Case of Hair Cast After Isotretinoin Treatment
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-12-21
2023-07-31
2023-08-24
e2023196
Dermatol Pract Concept
Aysel Çakır
2023/07/31
10.5826/dpc.1303a196
e2023196
OsmaniyeYedi Mart Hospital, Dermatology and Venereology Clinic; Osmaniye Yeni Hayat Hospital, Dermatology and Venereology Clinic, Ankara, Turkey
2160-9381
en
e2023196
Gutte RM. Adult onset atopic dermatitis with secondary follicular mucinosis with cyclosporine induced spiny follicular hyperkeratosis and hair casts. Indian J Dermatol. 2013;58(3):243. DOI: 10.4103/0019-5154.110863.PMID: 23723501. PMCID: PMC3667313.
A Case of Hair Cast After Isotretinoin Treatment
https://dpcj.org/index.php/dpc/article/download/3109/2246
     A Case of Hair Cast After Isotretinoin Treatment
                                                 Ecem Bostan1, Aysel Cakir2,3


1 Cihanbeyli State Hospital, Dermatology and Venereology Clinic, Konya, Turkey
2 OsmaniyeYedi Mart Hospital, Dermatology and Venereology Clinic, Ankara, Turkey
3 Osmaniye Yeni Hayat Hospital, Dermatology and Venereology Clinic, Ankara, Turkey



Citation: Bostan E, Cakir A. A Case of Hair Cast After Isotretinoin Treatment. Dermatol Pract Concept. 2023;13(3):e2023196.
DOI: https://doi.org/10.5826/dpc.1303a196
Accepted: February 24, 2023; Published: July 2023
Copyright: ©2023 Bostan 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: Ecem Bostan, Dermatology and Venereology Clinic, Cihanbeyli State Hospital, Atceken Avenue, Hastane Street,
Cihanbeyli/Konya, 42850, Turkey. Telephone: +90 0332 673 40 93 E-mail: bostanecem@gmail.com




Case Presentation                                                        solution and ketoconazole 2% shampoo application re-
                                                                         sulted in complete regression. Informed consent was taken
A 20-year-old female patient was referred to the derma-                  from the patient for the publication of case details and clin-
tology outpatient clinic due to the emergence of multiple,               ical pictures.
white, easily removable, irregularly shaped and distributed
concretions along the hair shaft (Figure 1). No accompa-
nying inflammation or alopecia was detected. At the time
                                                                         Teaching Point
of appointment, she was under oral isotretinoin treatment
for acne vulgaris and the white concretions adherent to                  PKC also known as hair cast, is characterized by tiny, white
proximal hair shaft, had started to appear during the fourth             to yellowish, easily removable granules which encircle the
month of the therapy. She was not using any other systemic               hair shaft [1]. Hair casts are usually composed of hyperker-
or topical treatment. The differential diagnoses included                atotic and parakeratotic cells derived from the outer root
peripilar keratin cast (PKC), white piedra, trichonodosis                sheath [1]. The exact etiopathogenesis remains unclear but
and pediculosis capitis. The patient did not report to have              PKC may be seen in association with scalp disorders such as
any other prior hair disease such as seborrheic dermatitis,              psoriasis, seborrheic dermatitis and tractional alopecia [1].
psoriasis or folliculitis decalvans which may also be asso-              Interestingly, Gutte [2] reported a case of scalp hair cast ob-
ciated with hair casts. Potassium hydroxide examination                  served after oral cyclosporine treatment. Herein, we would
was negative, since the white granules were easily removed               like to underline that isotretinoin may also be a cause of
from the hair shaft by gentle pulling, pediculosis capitis was           PKC. We suppose that sebum and hydration reduction in the
also ruled out. She was diagnosed with PKC associated with               hair shaft due to isotretinoin use, might have led to the for-
isotretinoin use, topical betamethasone and salicylic acid               mation of PKC.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023196                                                                            1
    Figure 1. (A) Multiple, scattered, white, easily removable, oval to cylindrical concretions along the hair shaft. (B) Dermoscopic image
    of the hair cast along the hair shaft.




References                                                                2. Gutte RM. Adult onset atopic dermatitis with secondary follic-
                                                                             ular mucinosis with cyclosporine induced spiny fWollicular hy-
1. França K, Villa RT, Silva IR, de Carvalho CA, Bedin V. Hair               perkeratosis and hair casts. Indian J Dermatol. 2013;58(3):243.
   casts or pseudonits. Int J Trichology. 2011;3(2):121-122.                 DOI: 10.4103/0019-5154.110863.PMID: 23723501. PMCID:
   DOI: 10.4103/0974-7753.90834. PMID: 22223977. PMCID:                      PMC3667313.
   PMC3250010.




2                                                                               Image Letter | Dermatol Pract Concept. 2023;13(3):e2023196
