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June 2009

Marie Antoinette Syndrome

Arch Dermatol. 2009;145(6):656. doi:10.1001/archdermatol.2009.51

Marie Antoinette syndrome designates the condition in which scalp hair suddenly turns white. The name alludes to the unhappy Queen Marie Antoinette of France (1755-1793), whose hair allegedly turned white the night before her last walk to the guillotine during the French Revolution. She was 38 years old when she died. Although the actual incidence is rare, this stigmatizing phenomenon, which has captured storytellers' imagination like few other afflictions, occurs to protagonists as a sign of grave sorrow in religious texts as early as the Talmud. History also records that the hair of the English martyr Sir Thomas More (1478-1535) turned white overnight in the Tower of London before his execution. More modern accounts refer to the turning white of hair in survivors of bomb attacks during World War II. In 1957, an American dermatologist witnessed a 63-year-old man's hair turn white over several weeks after he had fallen down some stairs. The patient noticed loss of hair but no bald patches and 17 months later had extensive vitiligo.1 The term canities subita has also been used for this disorder.2,3 Today, the syndrome is interpreted as an acute episode of diffuse alopecia areata in which the very sudden “overnight” graying is caused by the preferential loss of pigmented hair in this supposedly immune-mediated disorder.4 This observation has led some experts to hypothesize that the autoimmune target in alopecia areata may be related to the melanin pigment system.5

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