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I sometimes see patients in my practice with wiry, dull, slimy-feeling hair. These patients usually have bleached blonde hair and they complain of hair loss. What is wrong with their hair? I do not see any scalp problems on examination.
This is an excellent description of someone who has completely removed the cuticle from the hair shaft due to excessive chemical processing.
Hair that is devoid of the cuticle has a dull appearance. This is due to loss of an even, light-reflective surface. There may be a few scattered remnants of the cuticle remaining, but not enough to create a smooth surface.
The last symptom that was mentioned is slimy hair. This is the tactile feel of a distal hair shaft that is completely devoid of a cuticle. It has a peculiar smooth feel and fractures easily with minimal stress.
How did the hair get in this condition? From too much exposure to chemicals that remove the cuticle as part of the cosmetic procedure.
For example, it is mentioned that the patient has blonde hair. The most common reason for hair with this degree of cuticle damage is hair bleaching. It is likely that the patient is a natural brunette who decided to dye her hair blonde. In order to remove enough eumelanin from the hair shaft to change the brown hair to blonde, high volumes of peroxide must be used to create enough holes in the cuticle to remove the eumelanin pigment. These holes are never repaired by the nonliving hair shaft. Thus, with repeated bleaching procedures to maintain the blonde color and to bleach new growth, eventually the cuticle is severely fragmented or removed. The hair appears dull, feels wiry at the scalp and feels slimy at the hair ends.
This over-bleached hair devoid of the cuticle is so severely weakened that it cannot sustain the mechanical stress of simple brushing and combing. The hair continues to break and cannot be strengthened back to its original condition by any cosmetic procedure. Thus, patients with over-bleached hair will complain either that their hair is falling out or that their hair is not growing.
The proper diagnosis is chemically damaged hair, and the dermatologist, unfortunately, has little to offer except to tell the patient to discontinue the bleaching procedures and slowly cut away the damaged hair shafts.