Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2024;14(3):e2024136 1

Bilateral Facial Hair Whorls in a Child
Vincenzo Piccolo1, Ramon Grimalt2, Julia Nowowiejska3, Mario Cutrone4

1 Dermatology Unit University of Campania, Naples, Italy

2 Pediatric Dermatology, Ospedale dell’Angelo Venezia, Ospedale San Bortolo, Vicenza, Italy

3 Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok Poland

4 Universitat Internacional de Catalunya, Barcelona, Spain

Citation: Piccolo V, Grimalt R, Nowowiejska J, Cutrone M. Bilateral Facial Hair Whorls in a Child. Dermatol Pract Concept. 
2024;14(3):e2024136. DOI: https://doi.org/10.5826/dpc.1403a136

Accepted: January 23, 2024; Published: July 2024

Copyright: ©2024 Piccolo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Julia Nowowiejska, MD, PhD, Department of Dermatology and Venereology, Medical University of Bialystok, 
Zurawia 14 St, 15-540 Bialystok. E-mail: julia.nowowiejska@umb.edu.pl

Case Presentation

A 6-year-old Bangladeshi boy, in good general condition, 

presented to the outpatient clinic for a hypopigmented patch 

of the abdominal region, compatible with nevus depigmento-

sus, but there were also two patches of bilateral hair whorls 

in the sideburns area. No other significant dermatological 

signs were observed.

Teaching Point

Hair whorls are a physiological condition well described in 

the literature [1]; they are usually localized on the scalp, in 

the parietal region, usually single and clockwise. Anterior 

localization, different from the more common localizations, 

has been considered a possible marker of NF1 [2]. Several 

pathogenetic theories have been proposed for hair whorls, 

including the most accepted ‘mechanical tension’ theory 

(stretching of the epidermis during the rapid expansion of the 

cranium while the hair follicle grows downward into deeper 

tissues), or ‘inheritance’ theory (genetic predisposition) [1].

We were not able to find another report of localization 

of hair whorls in the beard area in the literature (probably 

also due to the scarcity of facial hair in children) which could 

pose problems in differential diagnosis.

Medline search with the keywords ‘facial hair whorl’, 

‘beard whorl’, ‘facial hair vortex’ does not allow to find re-

ports of this variant.

We describe an unusual case of the presence of bilateral 

hair whorls on the face of a child (apparently healthy except 

for nevus depigmentosus) (Figure 1). Further observations 

will be needed to evaluate if this is a normal variant or if 

the facial hair whorl represents a possible marker of another 

associated genetic condition.



2 Image Letter | Dermatol Pract Concept. 2024;14(3):e2024136

References

1. Samlaska CP, James WD, Sperling LC. Scalp whorls. J Am Acad 

Dermatol. 1989;21(3 Pt 1):553-556. DOI: 10.1016/s0190-

9622(89)70225-5. PMID: 2674215.

Figure 1. (A-D) Bilateral facial whorls (A,B), with correspondent dermatoscopy (C).  

Nevus depigmentosus of the abdomen in the same patient (D).

2. Sechi A, Neri I, Patrizi A, et al. Scalp hair whorl patterns in 

patients affected by Neurofibromatosis Type 1: A case-control 

study. Int J Trichology. 2020;12(2):56-61. DOI: 10.4103/ijt 

.ijt_25_20. PMID: 32684676. PMCID: PMC7362971.