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Images in Dermatology
February 27, 2019

Acquired Pili Torti

Author Affiliations
  • 1Division of Dermatology, The Ohio State University College of Medicine, Columbus
JAMA Dermatol. 2019;155(4):488. doi:10.1001/jamadermatol.2018.4677

A woman in her 40s with a history of Roux-en-Y gastric bypass, alcohol abuse, and malnutrition was admitted to the hospital for hepatic encephalopathy secondary to nonalcoholic steatohepatitis.

Cutaneous examination revealed extensive periorificial erosions and widespread erythematous, xerotic patches with superficial desquamation favoring the buttocks, groin, and skin folds, but also present on the extremities. The patient was also noted to have diffuse patchy alopecia with short, brittle, lusterless hair (Figure 1). Several hairs were easily plucked and examined under a microscope (Figure 2). Microscopic evaluation revealed flattened hair with helical twists at irregular intervals, which was consistent with pili torti. Levels of serum copper (23 µg/dL [reference, 70-175 µg/dL]) and serum zinc (47 µg/dL [reference, 60-130 µg/dL]) were found to be decreased.

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