Beware the Hair Tourniquet

During my pediatrics rotation in medical school, we were taught that if an infant ever presented to the clinic or emergency room with excessive crying or fussiness, we should always check for a condition called hair tourniquet as part of the physical exam. (Warning: the above link has a pretty graphic photograph of this condition, so only click if you aren't easily grossed out.) I remember thinking at the time, Seriously? That must be a one in a million diagnosis. How can that even happen unless some abusive parent goes and deliberately ties the hair around the appendage?

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This is what I still believed until yesterday, when I found that a clump of my long brown hair had somehow balled up in Masha's hands while she was playing on the floor. It didn't get tangled around any of her fingers, but from the way it had tangled around itself, it wasn't too hard to see that it easily could have happened. My thick hair is notorious for tangling and always has been. Anyone who knew me as a child will remember the lovely bowl cuts that freed my mother from having to deal with my long matted tresses.

Come to think of it, I have been losing a lot of hair lately. And it isn't all because of Masha's newfound predilection for grabbing and pulling it with all her might whenever I forget to tie it back. It is a well-known phenomenon that pregnant women have thicker and fuller hair throughout pregnancy and then generally lose the extra hair postpartum due to hormonal changes. This postpartum alopecia is a type of telogen effluvium, or sudden diffuse hair loss. With this in mind, I had been patiently waiting for my hair to start falling out since Masha's birth. When I didn't notice any appreciable loss at all the first few months, I let my guard down to keep watching for it. Since yesterday, though, I have been thinking back over the last week and realizing how many clumps of hair have suddenly appeared in the shower, in my comb, and in my clothes. Ilya even joked a few days ago that I should start throwing it all in the composter (which I then did - we already throw in all the cat hair we find).

Which makes me wonder...it seems logical that the incidence of hair tourniquet in infants would peak at about the same time that postpartum moms start losing all their hair. A quick Google search brought up this AAP article, which (sort of) confirmed my suspicion that both conditions tend to peak around 4 months postpartum and are probably linked. I write "sort of" because the article, published in 2003, is a case report and therefore only describes the condition as it was observed in one infant. In fact, the author notes that this is the only described case report linking hair tourniquet and maternal hair loss in the literature. It is of course plausible that MOST cases are a direct result of increased maternal hair loss, but this would require a large, well-designed, randomized controlled trial to confirm.

[On an aside, I will go out on a professional limb and point out that a quick search of the term "hair tourniquet" in my favorite online medical references DynaMed, PubMed, and MDConsult - through which I have access to full texts as a medical student and for which the university pays thousands of dollars each year - did not contain this article in the first 20 items returned. Where did I find it? Google of course. To be fair, adding the term "maternal hair loss" brings the article right up in PubMed and confirms that it is indeed the only article in the database that describes a possible link between the two conditions.]

Why do I feel the need to blog about this? I'm not sure. It's strange to me that the seemingly obvious clinical correlation between hair tourniquet and maternal hair loss hasn't been established yet in the medical literature or, from my very limited experience, in clinical practice. Maybe it's too obvious to fund a study to investigate. I guess I'm just surprised that this condition that I once thought was so remote and rare could actually be very prevalent, and what's more, could easily affect my child. Not to mention that it is quite preventable. Now anytime I put Masha down to play I scour the area for stray hairs. Every one of her freshly laundered little socks gets turned inside out to check for hair before going back into the sock drawer. Whenever she so much as yelps, I'm at her bedside in a matter of seconds pulling off her sleeper, socks, and mitts to find the offending strand. A bit OCD? Definitely. But in any case it is something that I will remember to watch for in my patients and will regularly warn new parents about in my practice.