Onycholysis associated with subungual manifestation of barber's hair sinus

Abstract

A female hairdresser presented with hair fragments embedded under her fingernails in association with yellow-brownish discoloration and distal detachment of the nails. Based on these findings, we made the diagnosis of subungual barber's hair sinus with onycholysis. To our knowledge, this unique clinical picture has not been reported previously. A detailed medical history revealed several risk factors that might have contributed to the disease. Here, we briefly review what is known about barber's hair sinus, an occupational disease that is usually encountered in male hairdressers and only rarely manifests in women.

Subungual ectopic hair studied by scanning electron microscopy

“…We should note that the presence of subungual terminal cut hair has been often described as having an occupational source in hairdressers, this condition being totally distinct from ectopic growth of hair under the nail plate. 6 To the best of our knowledge, our case was the first to be studied using scanning electron microscopy. This allowed us to fully demonstrate that the filamentous structure beneath the nail plate was in fact a complete hair follicle, with the bulb oriented proximally and the tip distally.…”

“…2,5 In previous treatment guidelines, 'hypertrophic' and 'hyperkeratotic' appear to be synonymous with thicker lesions, but there was no clear distinction as to whether these represent different clinical AK entities. 3,4,6 The AKTeam TM expert clinicians addressed the semantics of both terms in their editorial and prefer to use the term 'hyperkeratotic' for clinically unsuspicious AK with thicker scale in their proposed treatment algorithm. AK is usually managed based on clinical diagnosis if there is no diagnostic ambiguity.…”

Onycotrychia?: subungual hair follicle as another cause of longitudinal melanonychia or pigmentation – Hair follicle as cause of melanonychia

“…In 2007, Gül et al suggested that oral PT is more sensitive than skin PT. 3 All respondents were using the forearm for pathergy testing. Only 13 dermatologists were using gluteal region and 1 was using the lower lip mucosa as an additional region.…”

“…The presence of a brown cylindrical structure emerging on the tip of the nail plate and the presence of a follicle in haematoxylin‐eosin colouration, along with the absence of melanocyte proliferation, led us to consider that this ridge could be caused by a subungual hair structure. Contact with short, sharp hair clippings was excluded, a well known cause of hair fragments under fingernails in hairdressers, 3 usually associated with paronychia. To our best knowledge, subungual hair has not been reported in the literature and we decided to perform immunocytochemistry to hair keratins.…”

Subungual ectopic hair

“…The differential diagnosis of a longitudinal pigmentation mainly includes melanocytic lesion (i.e. nevus, lentigo, melanoma), splinter haemorrhages, trauma and drug induced lesions, fungal and bacterial infections, Laugier–Hunziker syndrome, non‐melanocytic nail tumours, endocrine diseases, nutritional deficiency, barber’s hair sinus among others 4–6 . Subungual hair growth is a very rare entity reported in literature.…”