Adult Onset Hair Casts: Nits Which Do Not Itch

January 2017 in “ PubMed ”

Archana J Lokhande, Amita Sutaria

hair casts androgenetic alopecia parakeratotic peripillar casts nonparakeratotic peripillar casts psoriasis seborrheic dermatitis pediculosis capitis salicylic acid head lice salicylic acid shampoo

TLDR Hair casts are harmless but can be mistaken for head lice.

Hair casts (HCs) are firm, whitish cylindrical concretions that ensheath the hair shaft and can be easily dislodged. They are often misdiagnosed due to their resemblance to pediculosis capitis, also known as head lice. This case study reports a 22-year-old male patient with androgenetic alopecia who also had HCs on his scalp and body hair. His sister was similarly affected. HCs are of two types: parakeratotic and nonparakeratotic peripillar casts. The former is more common and often coexists with scalp conditions like psoriasis and seborrheic dermatitis. The latter is less common and not associated with any disease or scalp condition. HCs are often underdiagnosed due to their resemblance to pediculosis capitis. The patient's HCs reduced after using a salicylic acid-containing shampoo but did not completely disappear. The study concludes that HCs are benign and not associated with any morbidity, but their resemblance to other conditions often leads to diagnostic confusion.

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Research cited in this study

3 / 3 results

research Acantholytic Hair Casts: A Dermoscopic Sign of Pemphigus Vulgaris of the Scalp

15 citations, January 2012 in “International Journal of Trichology”

Hair casts on the scalp may be a sign of ongoing pemphigus vulgaris and could suggest a need to adjust treatment.

research Is Propionibacterium Acnes Associated With Hair Casts And Alopecia?

19 citations, January 2012 in “International Journal of Trichology”

Propionibacterium acnes might be linked to hair casts and possibly alopecia.

research Hair Casts

15 citations, August 1985 in “Archives of dermatology”

Tretinoin lotion can remove hair casts, which come from a specific part of the hair follicle and can be classified into two types.

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