Corkscrew Hair: Definition and Causes
Corkscrew hair is a distinctive hair shaft abnormality characterized by twisted, spiral-shaped hairs that appear coiled like a corkscrew, and it is most commonly associated with tinea capitis infections in Afro-Caribbean children, though it can also be a manifestation of vitamin C deficiency (scurvy) or certain genetic ectodermal dysplasia syndromes. 1, 2, 3
Corkscrew Hair in Fungal Infections
Tinea Capitis Association
- Corkscrew hairs have been specifically reported in Afro-Caribbean children with tinea capitis (fungal scalp infection) 1
- They serve as a distinctive dermoscopic feature that can aid in diagnosis
- In contrast, "comma-shaped" hairs are more commonly observed in white children with ectothrix fungal infections 1
Diagnostic Value
- Dermoscopy is recommended as a useful adjunctive tool for visualizing these characteristic hair changes
- When examining a patient with suspected tinea capitis, identification of corkscrew hairs can support the diagnosis and may indicate the need for further testing 1
Corkscrew Hair in Nutritional Deficiencies
Scurvy (Vitamin C Deficiency)
- Corkscrew hairs are a classic cutaneous manifestation of scurvy 2, 3, 4
- These hairs develop due to defective collagen synthesis resulting from vitamin C deficiency
- They typically appear alongside other characteristic findings such as:
Corkscrew Hair in Genetic Conditions
Ectodermal Dysplasia Syndromes
- Corkscrew hair can be a distinctive feature in certain rare autosomal recessive ectodermal dysplasia syndromes 5, 6
- In these genetic conditions, corkscrew hair represents an exaggeration of pili torti (twisted hair)
- Associated findings may include:
- Scalp keloids
- Follicular plugging
- Keratosis pilaris
- Xerosis
- Palmoplantar keratoderma
- Distinctive facial features
- Dental abnormalities 5
Diagnostic Approach
Physical Examination
- Careful examination of the hair shaft using dermoscopy can reveal the characteristic spiral pattern
- Look for associated findings that might point to the underlying cause:
- Scalp inflammation and scaling (tinea capitis)
- Perifollicular hemorrhage and gingival disease (scurvy)
- Syndactyly, facial abnormalities, and dental issues (ectodermal dysplasia)
Laboratory Investigations
- For suspected tinea capitis:
- Collect specimens by hair plucking, scalp scraping, or brushing
- Perform microscopy with potassium hydroxide preparation
- Culture on appropriate media 1
- For suspected scurvy:
- Serum vitamin C levels
- Nutritional assessment
Clinical Significance
Understanding the cause of corkscrew hair is important for proper diagnosis and treatment of the underlying condition, whether it's an infectious process requiring antifungal therapy, a nutritional deficiency requiring supplementation, or a genetic syndrome requiring multidisciplinary management.