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Acta Derm Venereol 2014; 94: 609–610

SHORT COMMUNICATION

Segmented Heterochromia in a Single Scalp Hair

Sung Bin Cho, Zhenlong Zheng, Ji Young Kim and Sang Ho Oh*
Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-
752, Korea. *E-mail: oddung93@yuhs.ac
Accepted Nov 4, 2013; Epub ahead of print Dec 19, 2013

Segmented heterochromia in scalp hair refers to a hair approximately 1 cm/month, each portion was shown to
condition resulting in alternating dark and light segments, be correlated with a 6-month, 8-month, and 3.5-month
which predominantly occurs in patients with iron-defi- duration of hair growth, respectively; however, there
ciency anaemia (1, 2). Here, we demonstrate a single hair were no remarkable changes in dietary habits or any
shaft presenting with alternating black and white bands, signs of nutritional insufficiency. The patient had no
which suggests unstable follicular melanocyte viability distinctive lesions anywhere on the body with a chalk-
or a transient interruption of follicular melanogenesis, white appearance by Wood’s lamp examination, and a
without any remarkable underlying conditions. hair pull test was negative. In addition, the results of
laboratory tests, including complete blood count, anti-
nuclear antibody test, serum iron and ferritin level test,
CASE REPORT and thyroid function test were unremarkable.
A black-haired 9-year-old Korean girl presented with Because the legal guardian of the patient declined a
greying of a few scalp hairs, the time of onset of which hair follicle biopsy, we examined a plucked hair shaft
could not be determined. There was no remarkable with transmission electron microscopy after obtaining
past medical history or family history of autoimmune/ informed consent. Transmission electron microscope
autoinflammatory disorders, such as alopecia areata or analysis, showed numerous larger, mature eumelanin
vitiligo. On initial presentation only a few white hairs pigments of various sizes distributed evenly on the
were sparsely distributed among the black scalp hair; cortex of the black distal shaft (Fig. 2 a–c), while
grouped white hairs were not observed. Among the smaller eumelanin granules were sparsely dispersed on
white hairs, a single hair shaft showed signs of pigment the cortex of the white mid-shaft (Fig. 2 d–f). On the
switching, consisting of 3 distinct portions: distal black black proximal end of the plucked hair, numerous but
(6 cm), middle white (8 cm), and proximal black (3.5 small mature eumelanin pigments were evenly distri-
cm) (Fig. 1). With the presumption that scalp hair grows buted on the hair cortex (Fig. 2 g–i). The number and
mean diameter of granules were measured at original
magnification × 10,000 in 33 granules at 31.4 ± 16.7
nm along the cortex of the distal shaft, in 4 granules at
22.0 ± 11.2 nm along the mid-shaft, and 37 granules at
16.8 ± 7.0 nm along the proximal end of the shaft using
ImageJ 1.43u software (National Institutes of Health,
Bethesda, MD, USA).

DISCUSSION
In the current report, we demonstrated a single hair
shaft of a 9-year-old Asian girl presenting with seg-
mental heterochromia, which suggested a transient
interruption of melanosome production in the follicular
melanocytes. Segmented heterochromia in the scalp
hair is a rare pigmentary disorder, which is mostly
associated with iron deficiency anaemia (1, 2). How­
ever, it is also reported to develop without remarkable
underlying haematological disorders as in our patient
(3, 4). Agouti refers to a hair condition resulting in
alternating eumelanin and pheomelanin production that
appears in some non-human mammals. This condition
Fig. 1. Posterior scalp presenting a single hair shaft with segmented clinically presents with cyclic banding of hairs. Unlike
heterochromia (a). The plucked hair shaft (b). the eumelanin-to-pheomelanin switching patterns seen
© 2014 The Authors. doi: 10.2340/00015555-1790 Acta Derm Venereol 94
Journal Compilation © 2014 Acta Dermato-Venereologica. ISSN 0001-5555
610 Short communication

croscopic analysis (10). In this report,

we presented clinically recovered
pigment production in the proximal
part of a hair shaft, which contained
eumelanin pigments that were smaller
than the melanosomes observed in the
distal part of the same hair. However,
eumelanin melanosomes in all 3 parts
of the hair shaft showed mature mela-
nosomes in stage III or IV. In addition,
the pattern of eumelanin distribution
had recovered in the hair cortex of
the proximal shaft as compared to the
distal shaft.
We suggest that the dysregulated
on/off behaviour of follicular mela-
nogenesis in genetically determined
follicular melanocytes may play an
underestimated role in the premature
hair greying process. However, it
Fig. 2. Transmission electron microscopy of a plucked hair follicle with segmented heterochromia. is necessary to further investigate
Distal shaft (a–c), mid-shaft (d–f), and proximal shaft (g–i) of the hair. this phenomenon in a larger study
population.
in other mammals with agouti colouring, we found The authors declare no conflicts of interest.
remarkable changes in the number and size of mela-
nosomes in our patient’s hair sample.
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