Pili Torti: Clinical Findings, Associated Disorders, and New Insights Into Mechanisms of Hair Twisting
This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. Review date: August 2009.
Drs. Mirmirani, Samimi, and Mostow report no conflict of interest. The authors report no discussion of off-label use. Dr. Fisher reports no conflict of interest. The staff of CCME of Albert Einstein College of Medicine and Cutis® have no conflicts of interest with commercial interest related directly or indirectly to this educational activity. Dr. Mirmirani is a dermatologist, The Permanente Medical Group, Kaiser Permanente Vallejo Medical Center, California; Assistant Clinical Professor, Department of Dermatology, University of California, San Francisco; and Adjunct Professor, Department of Dermatology, Case Western Reserve University, Cleveland, Ohio. Dr. Samimi was a medical student and currently is an intern, University of Pennsylvania, Philadelphia. Dr. Mostow is Head of the Dermatology Section and Professor, Northeastern Ohio Universities College of Medicine, Rootstown.
Paradi Mirmirani, MD; Sara S. Samimi, MD; Eliot Mostow, MD, MPH
Pili torti is a hair shaft disorder characterized by hair that does not grow long and is easily broken; the hair often has a coarse or spangled appearance. A diagnosis is made by light microscopy of flattened hair twisted 180° along its axis. Although pili torti may be isolated, it is commonly associated with other congenital defects and therefore, if identified, further evaluation for possible neurologic deficits and ectodermal disorders is an important part of the clinical evaluation. Alterations of the inner root sheath likely lead to the abnormal molding and twisting of the hair shaft. More recent research suggests that these alterations may occur in the face of mitochondrial dysfunction and may be influenced by the presence of reactive oxygen species.