This evening, I set to work planning to write an article that our local readers would find interesting and informative and began writing about a skin cancer case that I recently treated. But as the days are getting colder and COVID is still in the air, I thought, wouldn’t it be nice have something fun and pleasant for a change? Which leads me to…. Uncombable Hair Syndrome.

Yes, uncombable hair syndrome is an actual disease. First off, my sincere apologies to anyone afflicted with this malady if I misunderstand any distress it may cause. My only exposure to this condition was to a single case in my residency, the details of which I hope will excuse me for any seeming lack of sympathy:

A beautiful couple presented to clinic with the CUTEST child you ever seen. He was a delight, babbling and smiling and running amok trying to grab everything he shouldn’t have. At first glance, nothing appeared wrong. His arms were free of eczema. His moles looked normal. He didn’t even seem to have a lick of lip licker’s dermatitis. Why was he in a dermatology clinic? Exasperated, his mom lamented, “I can’t comb his hair – you don’t understand it WON’T comb.”

She went on to explain. No matter the mousse, the hair spray, the shampoo or conditioner, his obstinate hair willfully sprung back into a tussled mish-mash of hairs going in every direction. These hairs had a mind of their own. Their position was not random. Instead, a certain hair would always try to go backward. The next, always forward. Push one in a certain direction, and it would spring back to the position that it preferred.

My attending physician exclaimed “your child has uncombable hair syndrome!”

Uncombable hair syndrome is a well-characterized medical condition. One can easily find information on the genes involved by turning to Wikipedia, but I strongly urge the reader to go to Google Image instead and type in “uncombable hair syndrome” and enjoy photos of the dandelion capped rascals running around with uncombable hair

Several types of hair disorders are sometimes lumped together with uncombable hair syndrome but the classic disease occurs because the hair follicles have a notch or a triangular shape, and so the hair grows out with a ridge or a groove resulting in a stiff hair that can only fall one way. The Latin name is pili trianguli et canaliculi, which, if you are a Latin scholar, perhaps means something. Children afflicted with this condition are typically towheaded with very light blonde to white hair.

To be a syndrome, a disease must have two or more features that occur together as a disease “complex.” In this case, the two primary features are the uncombable hair of the child and the frustration of the mother. Scientists still debate whether the smirking laughter of the father playing on his phone in the background constitutes a third feature of this disease. This would make the syndrome a triad.

Fortunately for our patient, his disease has an excellent prognosis. The hair of uncombable hair syndrome typically becomes uncombable early in childhood and normalizes in early adolescence, often at puberty. Our patient was otherwise completely healthy without any signs or markers of other dermatologic disease. Given that our patient is a boy, my attending’s advice was simple: “keep his hair buzzed until he’s about 13 or so.”

“So you don’t have any treatment?!” said the mother.

“Well, I thought the reassurance that it should normalize in 10-11 years and that you could buzz the hair in the meantime is a good treatment plan,” said my attending.

The father laughed. The mother remained frustrated. The child’s hair remained uncombable.

Please note that this syndrome should not be confused with the “wont comb his hair” syndrome as displayed by my son, age 2 (see photo).

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