A case of uncombable hair syndrome: light microscopy, trichoscopy and scanning electron microscopy.

Uncombable hair syndrome (UHS) is a rare structural anomaly of the hair shaft, which is characterized by dry, frizzy, tangled and rough hair (1). It is usually isolated finding without associated abnormalities. Although most disorders of hair shaft can be diagnosed by light microscopy, UHS requires scanning electron microscopy (SEM) evidence for diagnosis (2). A few recent reports suggest the utility of trichoscopy in hair disorders including shaft abnormalities (3-6). We report on a patient with UHS whose hair was not only analyzed with light microscopy and trichoscopy, but changes were also confirmed by electron microscopy. We emphasize the features of this rare case of UHS, and we think that trichoscopic examination would be an easier way for diagnosing hair shaft abnormalities and should be used routinely in the diagnosis of hair disorders. A 24-year-old male Caucasian presented to our outpatient clinic for multiple nevi on his trunk. His nevi were examined by dermoscopy and those suspected to be dysplastic were totally excised for histopathologic examination. On clinical examination, the patient was observed to have blonde, unruly and unmanageable hair. His mother stated that his hair had always had that texture since first months of his life and that his hair not only seemed to grow slowly, but also was difficult to comb. He was born to a consanguineous couple. Family history did not reveal similar hair findings. On dermatologic examination, the entire scalp was affected with yellowish, dry, frizzy hair that projected outward (Fig. 1a and b). Neither alopecia nor hypotrichosis was present and no evidence of scalp abnormalities was detected. Eyebrows, eyelashes and body hair were not involved. Mucosae, teeth, nails and sweating of the patient were normal. Systemic and laboratory examinations were also within the normal limits. The hair pull test demonstrated that hairs could not be easily extracted. Light microscopic examination of the hairs revealed pathognomonic characteristics of UHS, canal-like longitudinal