Breaking the cycle of hair breakage: pearls for the management of acquired trichorrhexis nodosa.

Acquired trichorrhexis nodosa (TN) is a common cause of hair loss for patients of all ethnicities. It is especially prevalent in black patients with tightly curled hair types and can present unique diagnostic and therapeutic challenges due to structural differences in these hair types and the combination of various hair care and styling practices that contribute to hair damage. While scalp biopsies can help rule out other etiologies of hair loss, there is a paucity of histologic findings in acquired TN, making this primarily a clinical diagnosis. Instead of more traditional prescription based therapies, the management of this form of hair loss emphasizes protecting the hair shaft and minimizing further damage through the development of a healthy hair care regimen. This involves appropriate selection and use of cleansing products and conditioning agents that help protect the hair from the insults of daily grooming. This paper will review the current literature on acquired TN and will provide guidelines and recommendations for management by reviewing the different types of cleansing and conditioning products that can be used to prevent and/or halt the progression of hair breakage.

Ethnic hair disorders.

The management of hair and scalp conditions is difficult in any patient, especially given the emotional and psychological implications of hair loss. This undertaking becomes even more challenging in the ethnic patient. Differences in hair care practices, hair shaft morphology, and follicular architecture add complexity to the task. It is imperative that the physician be knowledgeable about these practices and the phenotypic differences seen in ethnic hair in order to appropriately diagnose and treat these patients. In this chapter, we will discuss cultural practices and morphologic differences and explain how these relate to the specific disorders seen in ethnic populations. We will also review the most prominent of the ethnic hair conditions including acquired trichorrhexis nodosa, traction alopecia, central centrifugal cicatricial alopecia, pseudofolliculitis barbae, dissecting cellulitis, and acne keloidalis nuchae.