Dermatology: Practical and Conceptual


Letter  |  Dermatol Pract Concept 2020;10(4):2020081 1

Dermatology Practical & Conceptual

Introduction

Bubble hair abnormality describes hair damage character-

ized by the formation of air cavities within the cortex of the 

hair, due to the high temperature of water inside the shaft, 

that induces keratin hydrolysis and local air expansion. It is 

linked to excessive cosmetic treatments, in particular, pro-

longed exposure of damp hair to the high temperatures (> 

125 C°) of blow dryers or electric curlers, and is typically en-

countered in women. We describe the trichoscopic features 

of 3 cases of bubble hair abnormality highlighting the utility 

of trichoscopy.

Case Presentation

A 51-year-old Caucasian woman complained of a 6-month 

history of hair breakage that started with frequent at-home 

hair dyeing. Physical examination revealed a circumscribed 

area of short and broken hairs localized to her vertex. In-

vivo trichoscopy revealed numerous hair shafts containing 

irregularly spaced bubbles and broken hairs. We made a di-

agnosis of bubble hair abnormality and advised her to dis-

continue all dye and heat-related practices. 

A 42-year-old Caucasian woman complained of increased 

hair shedding. Trichoscopy showed signs of telogen efflu-

vium, and upon careful observation of the anterior region of 

the fringe, some bubble hairs were discovered (Figure 1). The 

patient admitted to wrapping the hair of the frontal hairline 

over a round metal brush for several minutes while blow 

drying it.

A 35-year-old Caucasian woman complained of diffuse 

hair loss and the presence of damaged strands of hair that re-

sulted after hot-combing the hair while it was still wet. A tuft 

of short broken hairs, paler than the surrounding hair, was 

evident in the affected area. Trichoscopy showed the presence 

of broken and bubble hair in the site of the thermal trauma.

Conclusions

Cosmetic hair treatments, such as hair straighteners and re-

laxers, cleave disulfide bonds and can cause hair damage to 

the superficial cuticles. The loss of lipids on the hair surface 

during chemical hair treatments may lead to loss of cohe-

siveness between cuticle cells, and the reduction in the hair 

shaft cysteine levels correlates to a greater susceptibility to 

hair weathering and hair fragility. For a correct diagnosis in 

cases of hair fragility, direct examination of hair shafts with 

trichoscopy is recommended.

In the literature, previous reports have underlined the 

utility of trichoscopy for bubble hair abnormality  and de-

scribe white oval spaces with Swiss-cheese structure and dys-

morphia of the distal hair shaft [1,2].

Bubble Hair and the Usefulness of Trichoscopy
Aurora Alessandrini1, Michela Starace1, Francesca Bruni1, Bianca Maria Piraccini1

1 Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Italy

Key words: bubble hair, hair ironing, hair shaft, hair fragility, hair disorders 

Citation: Alessandrini A, Starace M, Bruni F, Piraccini BM. Bubble hair and the usefulness of trichoscopy. Dermatol Pract Concept. 
2020;10(4):e2020081. DOI: https://doi.org/10.5826/dpc.1004a81

Accepted: April 30, 2020; Published: October 26, 2020

Copyright: ©2020 Alessandrini et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Aurora Alessandrini, MD, Department of Experimental, Diagnostic and Specialty Medicine, Division of 
Dermatology, University of Bologna, Via Massarenti, 1, 40138 Bologna, Italy. Email: aurora.alessandrini3@unibo.it



2 Letter  |  Dermatol Pract Concept 2020;10(4):2020081

In conclusion, bubble hair abnormality is an acquired 

hair shaft disorder that can present as a circumscribed area 

of broken hairs that do not grow, especially when there is a 

history of frequent cosmetic or thermal hair practices.

References

1. Wallace MP, de Berker DA. Hair diagnoses and signs: the use 

of dermatoscopy. Clin Exp Dermatol. 2010;35(1):41-46. DOI: 

10.1111/j.1365-2230.2009.03383.x. PMID: 19549236.

2. Albers LN, Maley AM, MacKelfresh JB. Blowing bubbles: der-

moscopy of bubble hair. Int J Trichology. 2017;9(3):122-123. 

DOI: 10.1111/10.4103/ijt.ijt_11_17. PMID: 28932065.

In 2 of our patients, there was a history of blow drying 

wet hair, while 1 patient had only bleached it with an at-

home procedure. When wet, the hair fiber can expand up 

to 30% in diameter and it retains water within its structure, 

resulting in the formation of expanding and destructive bub-

bles within the fiber. As reported in Case 1, chemical treat-

ments and previous hair damage may also precipitate the 

onset of bubble hair abnormality and lower the threshold 

for bubble formation [2]. 

All our patients improved after discontinuation of hot 

blow drying or avoiding the application of chemicals, con-

firming the acquired nature of the disease.

Figure 1. (A) Clinical picture of a female patient affected by bubble hair abnormality in the anterior region of the fringe. (B) Clear evidence of 

bubble hair with trichoscopy at ×20 magnification, blue circle. (C) A broken hair and a bubble hair at ×70 magnification; FotoFinder Systems.