Naked Hair Shafts as a Marker of Cicatricial Alopecia

    Kristina Doytcheva, Timothy L. Tan, Joan Guitart, Pedram Gerami, Pedram Yazdan
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    TLDR Naked hair shafts are significantly associated with scarring hair loss and may help diagnose it, especially when multiple are found.
    In a 2017 study involving 622 scalp biopsies, researchers found that naked hair shafts (NHS) were present in 20% (69/345) of cicatricial alopecia cases and only 0.72% (2/277) of non-cicatricial alopecia cases, indicating a significant association of NHS with cicatricial alopecias (P < 0.0001). The frequency of NHS correlated with the severity of inflammation and fibrosis. While single NHS could appear in both types of alopecia, multiple NHS were more specific to cicatricial alopecia, suggesting their utility as a diagnostic marker, particularly in challenging cases. However, the presence of a single NHS should not lead to an immediate diagnosis of cicatricial alopecia but should encourage a thorough search for additional diagnostic features.
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