J. Nguyen1,2, S. Smithson3, S. Shen1, D. Gin1, H.S. Tay4
We report a novel observation of corkscrew hairs in a case series of three organ transplant patients at a tertiary Der- matology-Transplant clinic.
Corkscrew hairs are coiled hair commonly associated with vitamin C deﬁciency.1 In the scalp, the presence of cork- screw hair has been associated with tinea capitis.2,3
In our case series, all of the three patients were inciden- tally observed to have corkscrew hair on the trunk or limbs. This occurred as a solitary clinical ﬁnding, with no other associated ﬁndings such as perifollicular hyperker- atosis or haemorrhage or gingival abnormalities that may suggest vitamin C deﬁciency. This was conﬁrmed by blood work-up with all cases vitamin C replete. Common, how- ever, amongst all patients was the history of organ trans- plantation, namely lung or renal transplantation, as well as concurrent immunosuppression which included tacroli- mus, azathioprine and mycophenolate mofetil.
Histopathology was unremarkable, with a skin punch biopsy performed of a corkscrew hair showing coiled hair with normal epidermis and dermis, thus devoid of features to suggest nutritional deﬁciency or a perforating dermato- sis.
Whilst it has long been thought that corkscrew hair is pathognomonic for scurvy, we report its presence as a phe- notypic marker of organ transplantation. The underlying mechanism of its manifestation in this group of patients is uncertain. Further testing such as vitamin C levels may not be required if there are no other clinical signs to sug- gest nutritional deﬁciency.Lessing JN, LaMotte ED, Moshiri AS, Mark NM. Perifollicular haemorrhage.
1. Bolognia J, Schaffer J, Cerroni L. Dermatology – fourth edition. China, Elsevier; 2017. 798 p.
2. Hughes R, Chiaverini C, Bahadoran P, Lacour JP. Corkscrew hair: a new dermoscopic sign for diagnosis of tinea capitis in black children. Arch Dermatol. 2011;147:355–6.
3. Neri I, Starace M, Patrizi A, Balestri R. Corkscrew Hair: A Tri- choscopy Marker of Tinea Capitis in an Adult White Patient. JAMA Dermatol. 2013;149(8):990–991.