Curly regrowth after alopecia areata was acquired pili torti

Design

Retrospective multicentre case-control study with literature review

Population

29 patients with texture change after regrowth and 145 controls with alopecia areata

Primary outcome

Clinical and ultrastructural features of altered regrowth

Effect

Acquired pili torti on microscopy; 17.2% (5/29) reverted after a median of 7 months

A retrospective multicentre case-control study compared 29 patients with alopecia areata whose hair regrew with a different texture, mostly curly or kinked, with 145 who regrew normally, and added five cases from the literature.

Texture change was more common in women and in severe diffuse disease, totalis or universalis. It usually appeared 4 to 12 weeks after regrowth began, whether that followed JAK inhibitors, systemic steroids or happened spontaneously. Electron microscopy showed flattened, grooved shafts twisted through 180 degrees: acquired pili torti.

About one in six patients returned to straight hair after a median of seven months; the rest remained curly at about a year.

The authors read this as a feature of follicles recovering from severe disease rather than a drug effect, though the small retrospective series cannot prove that. It is a useful thing to warn patients about before starting systemic treatment.

• Warn patients with severe alopecia areata that regrowth may be curly or kinked.
• Expect texture change most often in women and in totalis or universalis.
• Reassure that the change appeared with steroids, JAK inhibitors and spontaneous regrowth alike.
• Check the hair shaft with dermoscopy if texture changes; pili torti is the usual finding.

Why it matters

As JAK inhibitors produce more regrowth in severe disease, more patients will notice their hair has changed.

Don't overread it

A small retrospective series; it cannot establish how often this happens or rule out a treatment effect.

The statistics, in plain English

5 of 29 patients (17%) reverted, a small number with wide uncertainty. Risk factors came from unadjusted comparisons, so they are hints rather than firm predictors.

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