What is Tufted Hair?
Tufted hair describes a dermatological phenomenon where multiple hair shafts emerge from a single follicular opening on the scalp. This occurs when individual follicles become conjoined or grouped, often due to scarring or significant inflammation within the scalp tissue. This structural alteration is a characteristic of various scalp conditions.
Underlying Causes and Related Conditions
Tufted hair is not a condition in itself but rather a distinctive sign often linked to specific inflammatory and scarring scalp disorders. These conditions share a common pathway of causing inflammation that ultimately leads to the destruction of hair follicles and subsequent scarring, which can then result in multiple hairs emerging from a single opening.
Folliculitis decalvans is a chronic inflammatory condition that frequently presents with tufted hairs. It is characterized by pustules, crusts, and scarring alopecia, primarily affecting the vertex and occipital scalp. The persistent inflammation in folliculitis decalvans leads to the gradual destruction of hair follicles and the formation of fibrotic tissue, which causes the remaining viable follicles to group together and share a common opening.
Another condition associated with tufted hair is lichen planopilaris, an autoimmune disorder that targets hair follicles. This condition causes inflammation around the upper part of the hair follicle, leading to progressive scarring hair loss. The chronic inflammation and subsequent scarring can lead to the clustering of follicular units, presenting as tufted hairs within the affected areas of the scalp.
Dissecting cellulitis of the scalp is a rare chronic inflammatory condition that can manifest with tufted hair. This condition involves deep inflammatory nodules, abscesses, and sinus tracts that can coalesce and lead to significant scarring. The severe inflammation and subsequent scarring cause the remaining hair follicles to become aggregated, resulting in the characteristic tufted appearance.
Acne keloidalis nuchae is another condition where tufted hairs can be observed. This disorder is characterized by chronic inflammation, papules, pustules, and keloidal scarring. The continuous inflammatory process and fibrotic changes in the skin lead to the entrapment and aggregation of hair follicles within the scar tissue, forcing multiple hairs to exit through a single opening.
Diagnosis and Management
Diagnosing tufted hair and its underlying causes involves a thorough clinical examination. A dermatologist will visually inspect the scalp, noting the pattern of hair loss, the presence of inflammation, redness, scaling, or pustules, and specifically identify areas where multiple hair shafts emerge from a single pore.
To further investigate, trichoscopy, a non-invasive technique using a handheld dermatoscope, is often employed. This magnified view of the scalp allows for detailed visualization of follicular openings, peripilar inflammation, and vascular patterns, which can help differentiate between various scarring alopecias.
In many cases, a scalp biopsy is performed to confirm the diagnosis and identify the specific type of scarring alopecia. A small tissue sample is taken from an affected area and examined under a microscope. This histological analysis can reveal the characteristic inflammatory infiltrate, the degree of follicular destruction, and the presence of fibrotic scarring that are hallmarks of the underlying conditions causing tufted hair. Patient history, including symptoms like itching, pain, or pus, and the progression of hair loss, also provides valuable diagnostic information.
Management of tufted hair primarily focuses on controlling the underlying inflammatory process to prevent further hair loss and alleviate symptoms. Treatment strategies are tailored to the specific diagnosis and often involve anti-inflammatory medications. These may include topical corticosteroids, oral antibiotics, or oral anti-inflammatory agents to reduce scalp inflammation and suppress disease activity.
Intralesional injections of corticosteroids can be administered directly into affected areas to deliver concentrated anti-inflammatory effects. For conditions with a bacterial component, such as folliculitis decalvans, long-term antibiotic therapy may be prescribed to manage infection and inflammation. The aim of treatment is to halt the progression of the condition and minimize scarring, as hair regrowth in areas of established scarring is often not possible.