Whisker Hair above the Ears and its Implications in Pattern Baldness

Whisker hair, a unique dermatological phenomenon, was first highlighted by Norwood in 1979. This condition involves the development of coarse, curly hair typically above and behind the ears, differing from the standard hair growth pattern. This article delves into the nature of whisker hair, its potential implications for pattern baldness, and the psychological impact on individuals.

Whisker Hair Development: Only a few reports have been published in the medical literature about this condition. However, it seems that people (usually men, but potentially also women) who grew straight or wavy scalp hair in their child and teen years, begin to see their hair above and behind the ears progressively replaced with coarse, kinked hair. The extent of the kinky hair is variable, but the condition can progress to cover much of the sides of the scalp. Notably the change in hair is symmetrical; that is, it affects the areas of scalp hair above and behind both ears at the same time.

Characteristics of Whisker Hair: Whisker hair exhibits distinctive features: it is short, curly, and dark (darker than the affected person’s usual hair color), resembling beard hair, and typically appears in men aged 18 to 25. Historically, it has been variously termed as “symmetrical circumscribed allotrichia” and “allotrichia circumscripta capillitii”. Some dermatologists consider it a variant of “acquired progressive kinking of the hair” (APKH), a condition observed in early stages of male pattern baldness. However, APKH can be much more extensive, and the affected areas of scalp are not always symmetrical.

Correlation with Androgenetic Alopecia: There is a prevailing belief among dermatologists that whisker hair above and behind the ears is an early predictor of androgenetic alopecia, commonly known as pattern hair loss. Cases documented by Tosti et al. and others suggest a strong correlation between the emergence of whisker hair and the subsequent development of rapid onset androgenetic alopecia. The underlying mechanism, though not fully understood, is presumed to be related to the influence of androgen hormones.

Differential Diagnosis: Whisker hair must be differentiated from conditions like familial woolly hair syndromes, woolly hair nevus, uncombable hair syndrome, and diffuse partial woolly hair. The latter is acquired and features woolly hairs interspersed among normal hairs across the scalp, unlike the localized emergence of whisker hair around the ears. It’s difficult to say whether whisker hair is a subtype of APKH or a distinct entity that should be diagnosed separately from APKH.

Pathophysiology: The pathophysiological aspects of whisker hair are intriguing. Studies have shown higher concentrations of dihydrotestosterone, a potent androgen, in the scalp of affected individuals. This hormonal change, along with follicular miniaturization and altered hair growth cycles (anagen to telogen ratio), seems to play a significant role in the development of the condition. Norwood also hypothesized that whisker hair could signal not only typical pattern baldness, but also a loss of hair in areas where this unique hair type develops on the sides of the scalp.

Clinical Observations: At least one report suggests the whisker hair disappears as people get older, possibly after the affected hair follicles enter a permanent telogen (resting) phase. This disappearance, combined with “senile alopecia”, seen in elderly people beyond age 70 years old, can lead to complete periauricular (around the ears) and occipital (back of the head) alopecia.

Psychological Impact: The change in hair appearance due to whisker hair development can lead to psychological stress in the affected individual. Recognizing these conditions is vital for dermatologists to inform patients about the increased risk of developing androgenetic alopecia and to provide appropriate psychological support.

Whisker Hair Treatment: As whisker hair has been connected to androgen hormone activity, and subsequent development of androgenetic alopecia, treatments such as minoxidil and finasteride have been used by affected people. However, the few published case reports don’t say whether these treatments were effective.

Conclusions: Whisker hair represents a unique dermatological condition with significant implications for pattern hair loss. Understanding its characteristics, differential diagnosis, and potential psychological impact is crucial for effective management and patient support. Further research into the underlying causes and mechanisms is necessary to fully elucidate this phenomenon and to improve treatment strategies for those affected.

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