Diagnostic Value of Exclamation Mark Hairs

January 1993 in “ Dermatology ”

Chull‐Wan Ihm, Joseph Han

exclamation mark hairs trichotillomania alopecia areata light microscopy frayed distal ends blunt distal ends EM hairs AA

TLDR Exclamation mark hairs are not exclusive to alopecia areata.

The study compared exclamation mark (EM) hairs from 2 cases of trichotillomania and 9 cases of alopecia areata (AA) under light microscopy. It found that 77.8% of EM hairs from AA had frayed distal ends, while 82.2% of EM hairs from trichotillomania had blunt distal ends. The findings indicated that EM hairs, even those with frayed distal ends, were not exclusively indicative of AA, challenging the notion that they are pathognomonic for the condition.

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