Flame Hair

<b><i>Background:</i></b> ‘Flame hairs' is a trichoscopic feature described as hair residue from pulling anagen hairs in trichotillomania. <b><i>Objective:</i></b> To detect whether flame hairs are present in other hair loss disorders. <b><i>Methods:</i></b> We retrospectively, independently and blindly reviewed the trichoscopic images of 454 consecutive patients with alopecia areata (99 cases), trichotillomania (n = 20), acute chemotherapy-induced alopecia (n = 6), acute radiotherapy-induced alopecia (n = 2), tinea capitis (n = 13), lichen planopilaris (n = 33), frontal fibrosing alopecia (n = 60), discoid lupus erythematosus (n = 30), dissecting cellulitis (n = 11), central centrifugal cicatricial alopecia (n = 94) and traction alopecia (n = 86) for the presence of flame hairs. We prospectively obtained trichoscopy-guided scalp biopsies from flame hairs in trichotillomania, alopecia areata, traction alopecia and central centrifugal cicatricial alopecia (1 case each). <b><i>Results:</i></b> Flame hairs were detected in 100% of the acute chemotherapy- and radiotherapy-induced alopecias, where they were the predominant hair abnormality. They were also found in trichotillomania (55%), alopecia areata (21%), traction alopecia (4%) and central centrifugal cicatricial alopecia (3%). On pathology, they corresponded to distorted hair shafts. <b><i>Conclusion:</i></b> The flame hair is a type of broken hair which can be seen in various hair loss disorders. It results from traumatic pulling of anagen hairs or from anagen arrest due to inflammation or drugs.