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Urban Rosenqvist

Scalp hypertrichosis

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Twin, w31+4, SGA 994g. Short time on ventilator/RDS and later CPAP. Now on HFNC. Now 6 weeks old.  

Since roughly 2 weeks age this girl has a patch of hypertrichosis in her scalp. This is surrounded by an area of slightly less hair. The patch has crusta-like borders so it feels like a scab. The dermatologist speculated a month ago of it being caused by the CPAP. It looks the same now after a month and I´m not familiar with wounds that has excessive hair growth in them?

I´ve looked up "nevoid hypertrichosis" as an alternative diagnosis but of course a reaction after a wound is much more common... 

I have the parents consent to post the pics here

Any ideas?

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84391800_473074333365460_2760974199580262400_n.jpg

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Hello, did you consider cranial imaging to rule out underlying scalp defect or intracranial communication? 
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This could be an isolated localized hair overgrowth. However, it can be associated with neuroectodermal anomalies. CPAP has no relation to the hair tuft.

Hair collar sign has been described. Below are some references.

References
1. Commens C, Rogers M, Kan A. Heterotropic brain tissue presenting as bald cysts with a collar of hypertrophic hair: the ‘hair collar’ sign. Arch Dermatol. 1989;125(9):1253–1256
2. Drolet BA, Clowry L Jr, McTigue MK, Esterly NB. The hair collar sign: marker for cranial dysraphism. Pediatrics. 1995;96(2 pt 1):309–313
3. Stevens CA, Galen W. The hair collar sign. Am J Med Genet A. 2008;146A(4):484–487
4. Held I, Rose C, Hamm H, Fölster-Holst R. The hair collar sign: a possible indication of cranial dysraphism. J Dtsch Dermatol Ges. 2011;9(2):136–138
5. Bessis D, Bigorre M,Malissen N, et al;Groupe de Recherche Clinique en Dermatologie Pédiatrique. The scalp hair collar and tuft signs: a retrospective multicenter study of 78 patients with a systematic review of the literature. J Am Acad Dermatol. 2017;76(3):478–487
6. Harrington BC. The hair collar sign as a marker for neural tube defects. Pediatr Dermatol. 2007;24(2):138–140

 

An additional reference
 
Alexander K.C. Leung and Benjamin Barankin. Visual Diagnosis: A Ring of Long, Dark, Coarse Hair on the Scalp of a 5-month-old Girl. Pediatrics in Review July 2018, 39 (7) e31-e32; DOI: https://doi.org/10.1542/pir.2017-0094
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