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Program Assignment

Dermatology Discussion

University Hospitals of Cleveland, Richmond Heights

August 2004

Presenters:  Scott A. Smith, D.O.; Mary Veremis-Ley, D.O.; Michelle L. Endicott, D.O.; Melissa Camouse, D.O.; Mary A. Evers, D.O.
 

Program Director: Monte Fox, DO


Clinical Presentation

2 year old Caucasian female

History

Chief Complaint: A now,2 year-old girl, presented to the clinic at the age of 11 months. She had a 4-month history of change in the color and texture of her hair. Per the patient’s mother, her hair had gradually gotten lighter, kinkier, and more difficult to comb. Mother denies any hair loss or breakage. Patient is otherwise healthy. Growth and development have been normal. Patient takes no medicines. The patient’s 1 year-old sister is now experiencing similar complaints. Patient’s great aunt had similar hair complaints as a child, which subsequently improved with her age.

Physical Examination

Involving the entire scalp, there are coarse, blonde hairs that are standing away from the scalp. The hairs are resistant to combing flat.

Dermatohistopathology

Light microscope shows normal hair shafts, without evidence of grooves.
Scanning electron microscope, on cross sectioning, reveals triangular shaped hairs with indentation, giving the hairs a reniform to heart shape.

Differential Diagnosis