Pili Multigemini: Multiple Hairs Growing from a Single Hair Canal

Pili multigemini is a unique dermatological condition characterized by the growth of several individual hair shafts that merge together and then emerge through a single hair canal. Resembling a bouquet of flower stalks in a vase, this rare developmental defect of hair sees multiple hair shafts arising from a single follicular channel, each with its independent matrix, papilla, and inner root sheath. Although prevalent in males with thick hair, particularly in the beard region along the jawlines, cases have been reported from various body parts.

Pili Multimgemini History: The initial observation of this condition dates back to 1883 and 1892 by Flemming and Giovannini respectively. It was described as a scenario where multiple hair shafts emerge from a singular follicle. Surprisingly, most identified cases have been incidental, discovered when patients sought treatment for unrelated dermatological issues. Pili multigemini hair follicles, also sometimes called “composite hairs”, are considered rare. Although there have been no studies to define the actual frequency in the general population, it is believed to be more common in men’s beards and children’s scalps.

Pili Multimgemini Etiology: The exact etiological roots of pili multigemini remain elusive. Flemming’s theory proposed that it arises due to the partial splitting of what was originally a single hair follicle dermal papilla. In contrast, Giovannini suggested its origin could be traced back to the reactivation of long-dormant embryonic epithelial germ cells. Another hypothesis has suggested perhaps the fusion of originally separate papillae into a single large “multi-lobed” dermal papilla that then induces the growth of several hair fibers together.

Role of Hair Follicle Structure and Stem Cells: Current research underscores the importance of the hair follicle’s bulge area in the onset of this condition. This region is a reservoir of epithelial stem cells for new follicle generations, and it is potentially predisposed to drug and chemical alteration during the anagen hair growth phase. Furthermore, it’s postulated that mechanical trauma and inflammation might also stimulate abnormal stem cell multiplication within the bulge region and give rise to pili multigemini.

Pili Multigemini Across Different Hair Types: Hair types in humans, based on form and structure, are categorized into six: head hair, eyebrows and eyelashes, facial hair, body hair, pubic hair, and axillary (armpit) hair. Despite the distinctive nature of these hair types, their genesis does not result from varied follicles, but from hormonal regulation differences of the same basic hair follicle structure. It’s noteworthy that multigeminate hairs have been identified across all hair types and genders. Interestingly, hair density across genders is comparable, though with women’s hair tending to be finer, making multigeminate hairs in females more challenging to locate.

Distinguishing Pili Multigemini from Compound Follicles: It’s crucial to differentiate pili multigemini from compound follicles. While the former emerges from a single papilla, the latter consists of what are multiple follicles at the root, merging at the neck of the hair follicle to exit the skin through a common channel. The key difference is that pili multigemini hairs are all produced in repsonse to signals from a single (albeit probably multi-lobed) dermal papilla; whereas, compound hairs have multiple separate dermal papillae each controlling the growth of a separate hair fiber. The hair plucked from individuals with pili multigemini stems from a common bulb and is invariably more painful during extraction as compared to other hairs.

Evolutionary Perspective and Comparative Analysis: But what does this mean for us? First, considering its rare occurrence in humans, it might be inappropriate to label pili multigemini as a developmental defect. In fact, certain mammals, like chinchillas, naturally grow hair in bundles, suggesting that the real anomaly in nature might be our human singular hair follicles! Second, from an evolutionary standpoint, pili multigemini could be a relic of our more hirsute ancestors. Although humans have lost most of their hair to manage heat and ward off ectoparasites, our follicular density remains consistent with primates.

Associations with Other Conditions: In some instances, the development of pili multigemini has been linked to alopecia areata of the beard, inflammatory nodules, and cleidocranial dysostosis. Another significant observation connects it with combination immunotherapy using dabrafenib and trametinib drugs. This apparent associations suggest a genetic connection, or activation of dormant germ cells in response to inflammation, might play a role in pili multigemini development. Pili multigemini has also been observed after hair transplantation which may suggest that physical damage to hair follicles during the transplant process might also lead to pili multigemini.

Diagnostic Techniques for Pili Multigemini: To diagnose pili multigemini, trichoscopy offers a swift, non-invasive technique, giving a detailed view of hair morphology that often remains invisible to the naked eye. It’s instrumental in gauging the activity and severity of the condition and monitoring post-treatment progress. As an alternative, scanning electron microscopy (SEM) can also distinguish pili multigemini from other conditions like trichoptilosis, but SEM is not widely available and is generally only used in a research lab environment.

Treatment and Management of Pili Multigemini: There is limited information available on treatment of pili multigemini. Plucking is often ineffective due to the deep-rooted nature of these hairs. While some suggest electrolysis for permanent hair removal, there’s no concrete evidence supporting its efficacy. Laser treatments have shown mixed results. Some studies reported folliculitis improvement post-laser hair removal, while others noticed a rise in symptoms post-treatment with Nd:YAG laser.

Conclusion: In summary, pili multigemini, though rare, is a fascinating hair and skin anomaly. As science progresses, it’s hoped that a better understanding of its origins and more effective treatments will emerge.


Pinkus H. Multiple hairs (Flemming-Giovannini; report of two cases of pili multigemini and discussion of some other anomalies of the pilary complex. J Invest Dermatol. 1951 Nov;17(5):291–301.
Mehregan AH, Thompson WS. Pili multigemini. Report of a case in association with cleidocranial dysostosis. Br J Dermatol. 1979 Mar;100(3):315–22.
Cambiaghi S, Barbareschi M, Cambiaghi G, Caputo R. Scanning electron microscopy in the diagnosis of pili multigemini. Acta Derm Venereol. 1995 Mar;75(2):170–1.
Lee JS, Kim YC, Kang HY. The nevoid pili multigemini over the back. Eur J Dermatol. 2005;15(2):99–101.
Lester L, Venditti C. The prevalence of pili multigemini. Br J Dermatol. 2007 Jun;156(6):1362–3.
Ciudad-Blanco C, Montero EC, Heffernan JAJ, Ochaita PL. Extensive pili multigemini over the back. Int J Trichology. 2014 Oct;6(4):180–1.
Sabiq S, Miteva M. Pili Multigemini After Hair Transplantation. Dermatol Surg. 2019 May;45(5):746–9.
Avila C, Hoffman K, Milani-Nejad N, Pootrakul L. Apparent darkening of scalp hair related to pili multigemini Following dabrafenib and trametinib. Dermatol Online J. 2020 Jan 15;26(1):13030/qt9g21p2g9.
Navlani S, Mestha A. A Unique Case of Pili Multigemini Complicated by Folliculitis: Unveiling the Intricacies of a Rare Hair-Follicle Disorder. Cureus. 2023 Jul;15(7):e42280.