Review and new case reports on scanning electron microscopy of pili annulati, Monilethrix and Trichothiodystrophy

Pili annulati, Monilethrix and Trichothiodystrophy are uncommon conditions in which the hair shaft has a distinct appearance as seen by optical microscopy and scanning electron microscopy (SEM). We report several new cases and review the characteristic ultrastructural abnormalities investigated by SEM. Pili annulati: abnormal areas which show a longitudinal, "curtain-like" folding of the cuticular cells, alternating with normal areas. The latter present regularly non-systematized, superficial depressions. Hair specimens of the patient's mother show the same surface irregularities. Monilethrix: most hair shafts show variations in thickness giving a typical nodal appearance. In the isthmus area we noticed longitudinal ridging and cuticular scales that are extended lengthwise in a fish-scale-like pattern. In the nodus area a smooth surface due to a complete loss of cuticular cells, was observed. Trichothiodystrophy: the hair morphology observed by SEM is characterized by severe cuticular and secondary cortical degeneration along the entire length of the flattened hair shaft, with longitudinal ridging, cuticle loss, trichlorrhexis nodosa formation and trichoschisis. SEM observations show morphological abnormalities which are characteristic for each pathological condition described. This method may provide data that add some clarity in the surface changes of the different hair shaft anomalies.