Trichorrhexis nodosa is a problem in which thickened or weak points (nodes) along the hair shaft cause your hair to break off easily.[i] I’ve noticed a recent trend in the healthy hair world – mostly among relaxed girls – of not being able to retain “nice” ends beyond a certain length. It does not seem to matter the hair type, texture or length for some of us once we hit a certain point (myself included), our ends begin to thin leaving us puzzled as to what went wrong and whether or not it was preventable.
The cause of trichorrhexis nodosa is physical or chemical trauma. It can be congenital as well (meaning inherited at birth, genetic) but trauma may make the condition apparent or even worse. If congenital, the hair shaft is abnormally fragile and breaks after minimal injury. More commonly, trichorrhexis nodosa is acquired from excessive or repeated trauma[ii]. Also, the problem may be nutritional or physiological, resulting from malnutrition, anemia (iron deficiency), hypothyroidism, or other endocrinopathies.
If you have a medical issue, you will need to speak with your health care provider to determine the best solution. Now let’s discuss preventable causes of trichorrhexis nodosa. Physical traumas that may cause sufficient damage to the hair shaft include excessive brushing, back combing, stressed hairstyles, the application of heat, and prolonged exposure to UV light. Chemical traumas include excessive exposure to salt water, shampooing, perming, bleaching, and dyeing of hair.
How does it look?
Women who have trichorrhexis nodosa notice white flecking along the strands, abnormally fragile hair and a lack of length retention (even to “normal” lengths). When you examine the individual strand, you will see one or more white specks (nodes) along the affected hair shaft(s). Microscopically, the breakage occurring along the shaft resembling two brush ends aligned in opposite directions. Also visible are the whitish nodes and/or gaps along the hair shaft[iii].
Who Gets It?
Acquired trichorrhexis nodosa falls into 3 basic categories: proximal, distal, and localized. Blacks primarily acquire trichorrhexis nodosa resulting from use of relaxers. Over time the affected hairs develop the characteristic nodes and break break a few centimeters from the scalp in areas subject to friction from combing or sleeping. This breakage results in areas of alopecia. Some people appear to be more susceptible than others, perhaps on a genetic basis. Distal trichorrhexis nodosa occurs mostly in whites and Asians.
Minimize trauma. This is where we healthy hair journeyers have it correct – low manipulation styles, limiting direct heat usage, finger combing over brushing and combing all limit the amount of trauma our hair suffers. If the problem is severe, long term protective styling such as braids, twists, weaves and wigs may be the best solution to avoid manipulation altogether for weeks at a time.
If the problem is medical, see your health care provider so the underlying metabolic condition may be properly treated.
Trichorrhexis nodosa may explain why many – not all – relaxed haired ladies have a hard time achieving length or maintaining thickness beyond a certain point. Though I obviously believe women can absolutely grow long healthy relaxed hair – I also know that relaxers do cause chemical trauma to the hair. Stretching your relaxers, taking extreme caution not to overlap or over process hair, and limiting manipulation all help avoid excessive trauma which may lead to trichorrhexis nodosa. If it becomes apparent that your hair cannot tolerate the straightening process of a relaxer – simply transition to natural hair or rock a short cut. Naturalistas, you are not immune either. Many natural girls, while vowing never to relax their hair again, will bleach in a heartbeat which is actually a much more damaging process to the hair shaft. You need to take the same precautions relaxed women do while coloring your hair. Avoiding excessive manipulation whether you have trichorrhexis nodosa or not is a great healthy hair habit we should all practice.
[ii]Miyamoto M, Tsuboi R, Oh-I T. Case of acquired trichorrhexis nodosa: scanning electron microscopic observation. J Dermatol. Feb 2009;36(2):109-10. [Medline]
[iii] Rudnicka L, Olszewska M, Rakowska A, Slowinska M. Trichoscopy update 2011. J Dermatol Case Rep. Dec 12 2011;5(4):82-8. [Medline]. [Full Text]
Medscape [Internet]. Schwartz R, James W, et. al. Trichorrhexis nodosa. Available from: http://emedicine.medscape.com/article/1073664-overview