The Answer Is Blowin' in the Wind: Styling Trauma of the Hair Shaft as a Piedra Mimic

Abstract:

Hair shaft disorders/abnormalities are usually easily diagnosed with the help of in-office trichoscopy and, if necessary, electron microscopy. Here we present a distinctive case of damaged, stripped hair cuticles clinically mimicking white piedra in a patient with a history of weekly hair blowout treatments. We demonstrate that staining sampled hair shafts with Periodic Acid-Schiff stain (PAS) and Gomori Methamine Silver stain (GMS) stains can be helpful to highlight cuticle fraying in instances where other explanations for these pseudonits have been ruled out. These “balled up” cuticle fibers in our case presented a unique diagnostic challenge—mimicking an adherent concretion clinically and forming a pathologic pattern not previously documented in this body of literature. Awareness of this pattern and the utility of PAS and GMS stains in highlighting the stripped cuticles can aid in accurate diagnosis of acquired nodules of the hair shaft.