Causes of Corkscrew Hair

Corkscrew hair is a term doctors use for hairs that are abnormally coiled, like a tightly wound spring. They are best known as a sign of vitamin C deficiency (scurvy). They can also appear in fungal scalp infection, where they are often only visible when a doctor magnifies the hair with a dermatoscope. Corkscrew hairs are a clue rather than a diagnosis, so the aim is to find out what is causing them.

They are not the same as pili torti, a change in which the hair shaft is flattened and twisted on its own axis. Pili torti is the typical hair finding in Menkes disease. To the naked eye the two can look alike, which is one reason a doctor may need to examine the hair closely.

How It Differs From Natural Curls

Naturally curly or Afro hair is common and healthy, and a tight curl on its own is not a sign of illness. Curly hair can also turn up in a family where most people have straight hair, because of the way genes are inherited.

Abnormal twisting is more likely if hair has changed from how it used to grow, if a few odd hairs stand out among normal ones, or if hair breaks easily. Hair that seems to stop growing at a short length usually means it is snapping off, and that has many possible causes. Looking at the hair is not enough to work out why it has changed. If you notice changes like these, ask your GP to take a look. Corkscrew hairs can appear on the scalp or elsewhere on the body, including the arms and legs.

Possible Causes

Abnormally twisted hairs can occur in several conditions, including vitamin C deficiency, fungal scalp infection and some inherited hair shaft disorders. Each affects the hair in a different way.

Vitamin C deficiency. Scurvy is uncommon in the UK but still occurs, particularly in people with very restricted diets, people who drink heavily, older people living alone and people with conditions that affect absorption. Corkscrew hairs typically appear on the arms and legs, often with small red or purple spots around the hair follicles. Other signs can include tiredness, sore or bleeding gums and bruising easily.

Fungal scalp infection. Tinea capitis, or scalp ringworm, is most common in children. It causes scaly or itchy patches with broken hairs, and a doctor may find corkscrew hairs on close examination. It spreads through close contact, shared combs and hats, and from infected animals. A painful, swollen or boggy lump on the scalp, especially with pus or a fever, needs prompt assessment. This is called a kerion, and it can leave scarred patches where hair does not grow back.

Menkes disease. This rare inherited condition stops the body moving copper around properly, so copper does not reach the brain and other tissues that depend on it. It mainly affects boys and usually becomes noticeable within the first few months of life. Babies may have sparse, pale, fragile hair with pili torti, along with poor feeding, poor growth, floppiness or seizures. It can cause severe damage to the nervous system.

Inherited hair shaft disorders. Some people are born with pili torti. In some forms only the hair is affected, and it can sometimes improve with age. In others it is one feature of a wider condition that may include hearing loss, so a child with pili torti may be offered further checks.

Other causes of fragile hair. Low levels of protein, copper or other nutrients can make hair brittle or change its texture or colour, but this is different from the classic corkscrew hair of scurvy. It can be linked to a poor diet, eating disorders, some types of weight loss surgery or bowel conditions that reduce absorption. Copper deficiency acquired in this way is a separate problem from Menkes disease.

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Babies and Children

If a baby has unusual, fragile or twisted hair but otherwise seems well, book an appointment with your GP or speak to your health visitor. Most children with unusual hair do not have a serious illness. If Menkes disease is suspected, the baby needs urgent specialist assessment, because treatment may be more beneficial before neurological symptoms develop.

If hair changes come with poor feeding, poor weight gain, unusual sleepiness or floppiness, get medical advice the same day from your GP, NHS 111 or your local urgent care service. Call 999 if a baby has a first seizure, has difficulty breathing, is unresponsive or is hard to wake.

In older children, a scaly or itchy scalp with broken hairs is more likely to be a fungal infection. A GP can assess this and start treatment, often after sending hair or scalp samples to a laboratory. Severe or uncertain cases may need a specialist's opinion.

Diagnosis and Treatment

A GP will usually ask about diet, general health, medicines and family history, and examine the hair and skin. They may arrange blood tests for vitamin and mineral levels or take samples to check for infection. Some people are referred to a dermatologist, and babies with a suspected inherited condition to a paediatric specialist.

Treatment depends on the cause. Scurvy and other deficiencies are corrected with diet changes and supplements once the cause is known. Hair that is already damaged will not repair itself, but new hair may grow normally as the deficiency is corrected; how long this takes varies. Do not take high dose mineral supplements, particularly copper, without medical advice. Scalp ringworm needs antifungal tablets. A medicated shampoo is often used as well to reduce spread, but shampoo alone will not cure it. When an inherited condition affects only the hair, care is mainly gentle handling and advice. Conditions that affect other parts of the body need care specific to the diagnosis.

Meanwhile, avoid tight hairstyles, harsh brushing and heat styling, and use a mild shampoo.

The NHS website has pages on scurvy and on ringworm, and the British Association of Dermatologists publishes a patient leaflet on tinea capitis. If you are pregnant or have young children, you may be able to get free vitamins. Healthy Start covers England, Wales and Northern Ireland, while Scotland has Best Start Foods and its own vitamin scheme, so check the NHS or government page for your nation. These vitamins are not a treatment for suspected scurvy or any diagnosed deficiency.