Journal of the American Academy of Dermatology · 2026
Acquired Hair Texture Alteration After Regrowth in Alopecia Areata: A Distinct Clinical and Ultrastructural Phenotype.
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Yang Sai, Shi Wei, Wu Fangfang, Tang Rong, Wang Tingting, Yang Shuxia, Xie Jie, Zhang Xingqi, Wang Fang, Luo Ying
Аннотация
BACKGROUND: Post-regrowth hair texture alteration between straight and curly or kinked hair is rare and poorly understood in alopecia areata (AA).
OBJECTIVE: To characterize clinical and ultrastructural features of this phenomenon.
METHODS: A retrospective multicenter case-control study of AA patients and a systematic literature review were performed. Clinical, dermoscopic, and scanning electron microscopy (SEM) findings were analyzed.
RESULTS: Twenty-nine cases and 145 controls were enrolled. Univariable analysis showed hair texture alteration was more frequent in females and those with severe-to-very-severe diffuse AA or totalis/universalis. Most hair texture alterations occurred 4-12 weeks following Janus kinase (JAK) inhibitors and/or systemic steroid therapy, or following spontaneous hair regrowth. SEM revealed acquired pili torti, characterized by flattened hair shafts, segmental longitudinal grooves, and 180° axial twisting. The literature review identified five additional cases, expanding the therapeutic spectrum to topical/intralesional glucocorticoids and diphenylcyclopropenone (DPCP). In our series, 17.2% (5/29) of patients reverted to their original straight texture after 7 (7.0, 12.5) months, while others remained curly at a median follow-up of 12 (6.0, 18.0) months.
LIMITATIONS: Retrospective design.
CONCLUSION: Hair texture alteration after AA regrowth represents a distinct, underrecognized phenotype, likely reflecting intrinsic hair shaft abnormalities during follicular recovery rather than treatment effects.
OBJECTIVE: To characterize clinical and ultrastructural features of this phenomenon.
METHODS: A retrospective multicenter case-control study of AA patients and a systematic literature review were performed. Clinical, dermoscopic, and scanning electron microscopy (SEM) findings were analyzed.
RESULTS: Twenty-nine cases and 145 controls were enrolled. Univariable analysis showed hair texture alteration was more frequent in females and those with severe-to-very-severe diffuse AA or totalis/universalis. Most hair texture alterations occurred 4-12 weeks following Janus kinase (JAK) inhibitors and/or systemic steroid therapy, or following spontaneous hair regrowth. SEM revealed acquired pili torti, characterized by flattened hair shafts, segmental longitudinal grooves, and 180° axial twisting. The literature review identified five additional cases, expanding the therapeutic spectrum to topical/intralesional glucocorticoids and diphenylcyclopropenone (DPCP). In our series, 17.2% (5/29) of patients reverted to their original straight texture after 7 (7.0, 12.5) months, while others remained curly at a median follow-up of 12 (6.0, 18.0) months.
LIMITATIONS: Retrospective design.
CONCLUSION: Hair texture alteration after AA regrowth represents a distinct, underrecognized phenotype, likely reflecting intrinsic hair shaft abnormalities during follicular recovery rather than treatment effects.