Subgaleal haematoma due to hair pulling: Review of the literature

Abstract

Subgaleal haematoma (SGH) is a collection of blood in the potential space covered by the galea aponeurotica from the orbital ridges anteriorly to the nuchal ridge of the neck posteriorly ( Figure 1). Subgaleal haematoma is most commonly found in the setting of birth trauma as well as in blunt head trauma, but has rarely been described as consequence of non-abusive pulling of the hair. We review the literature for all cases of SGH as a result of non-abusive hair straightening or pulling without evidence of coagulopathy. Our literature review describes the pattern of SGH as a result of hair pulling, and we discuss the potential complications of this entity. | LITER ATURE RE VIE WSubgaleal haematoma is most commonly found in the setting of birth trauma and can be fatal in neonates. 1 In older children, SGH Abstract Aim: To identify all cases of subgaleal haematoma (SGH) as a result of non-abusive hair straightening or pulling without evidence of blunt trauma or coagulopathy. Methods:We conducted a search in the English-language literature of all cases of SGH in children. We excluded those in neonates, those in which the child was abused by a caregiver, those in which blunt trauma was not excluded, and those in which a coagulopathy or other blood dyscrasia was found.Results: Sixteen cases were identified in children from a range of ages. Time to presentation ranged from several days to a week and a half. In most cases, management is conservative, though SGH can cause fever, symptomatic anaemia and can threaten vision. Conclusion:Subgaleal haematoma can occur in otherwise healthy children, can accumulate slowly and can result in sequelae. However, most cases of SGH are managed conservatively.

Massive subgaleal hematoma in a 62-year-old man treated with apixaban as a consequence of mild head trauma

“…On the contrary, it is an extremely rare entity in the adult population and usually associated with severe head trauma and skull base fractures, coagulation disorders and traumatic or abusive hair pulling. 1,[3][4][5] In our case, a 62-year-old man receiving treatment with apixaban developed a massive subgaleal hemorrhage expanded to the orbital and neck subcutaneous tissue, several hours following blunt head trauma. To our knowledge, this is the first case of massive subgaleal hematoma in a patient after mild head trauma with no other concomitant bleeding risk factors than the anticoagulant treatment with apixaban.…”

“…Subgaleal hematoma is a life-threatening condition characterized by the accumulation of blood in the space between the pericranium and the galea aponeurotica of the skull by the rupture of the emissary veins, connecting the extracranial venous system with the intracranial venous sinuses. [1][2][3] In the vast majority of cases, it is observed in newborns more frequently as a catastrophic complication of instrumental delivery. On the contrary, it is an extremely rare entity in the adult population and usually associated with severe head trauma and skull base fractures, coagulation disorders and traumatic or abusive hair pulling.…”

Hematoma subgaleal espontáneo en lactantes, una enfermedad subestimada, serie de casos

“…Con relación a este punto, en tres de los cuatro casos se documentó antecedente de traumatismo trivial con más de 48 horas de anticipación, lo cual desestima su relación causal. Cabe resaltar que en estos casos algunos autores conjeturan que la causa directa podría ser un traumatismo menor inadvertido como peinar o halar el cabello, donde también se rompen vénulas (8)(9)(10)(11).…”

“…Los casos en lactantes mayores, escolares y adolescentes usualmente involucraron traumatismos directos, evidentes en su mayoría y espontáneos sólo en un 7.5% de los reportes (7 de 106 casos, Tabla 2). Se reportaron peores desenlaces cuando se intervinieron (el hematoma mismo se comporta como un tapón hemostásico y drenarlo facilitó la recurrencia), recuperaciones espontáneas entre dos y cuatro semanas, algunas asociaciones con trombopatías transitorias y un ligero predominio en el sexo femenino (Tabla 2) (1,4,9,11,12). El diagnóstico diferencial se establece con caput sucedaneum, cefalohematomas, angioedema, celulitis y neoplasias (12,13).…”

Subgaleal hematoma evacuation in a pediatric patient: A case report and review of the literature

“…and included 16 pediatric cases involving hair pulling or straightening. [ 32 ] In total, 29 pediatric case reports of SGH were identified, comprising 32 pediatric patients in the literature, 20 of which were found to be associated with hair pulling, combing, or braiding. [ 6 , 7 , 8 , 9 , 11 , 16 , 20 , 27 , 31 , 39 ] We also identified several cases secondary to unknown causes or causes other than hair pulling or combing.…”