Red nodule on the finger of an immunosuppressed woman.

Abstract

A 4-year-old healthy Hispanic girl presented with a 2-year history of a change in hair quality. Her once-straight, darkbrown hair (Figure 1) had become shinier and lighter in color and was dry, coarse, and difficult to brush. Hair conditioners had failed to improve her hair texture. No history of chemical or other trauma to the hair, or family history of hair disorders, was elicited. Physical examination revealed light-brown, shiny hair that was coarse and disorderly (Figure 2). Examination of the skin, including teeth and nails, revealed no other abnormalities. Hair samples were obtained for scanning electron microscopy (Figure 3 and Figure 4). What is your diagnosis?