Breaking the cycle of hair breakage: pearls for the management of acquired trichorrhexis nodosa

Acquired trichorrhexis nodosa (TN) is a common cause of hair loss for patients of all ethnicities. It is especially prevalent in black patients with tightly curled hair types and can present unique diagnostic and therapeutic challenges due to structural differences in these hair types and the combination of various hair care and styling practices that contribute to hair damage. While scalp biopsies can help rule out other etiologies of hair loss, there is a paucity of histologic findings in acquired TN, making this primarily a clinical diagnosis. Instead of more traditional prescription based therapies, the management of this form of hair loss emphasizes protecting the hair shaft and minimizing further damage through the development of a healthy hair care regimen. This involves appropriate selection and use of cleansing products and conditioning agents that help protect the hair from the insults of daily grooming. This paper will review the current literature on acquired TN and will provide guidelines and recommendations for management by reviewing the different types of cleansing and conditioning products that can be used to prevent and/or halt the progression of hair breakage.