Hair tourniquet syndrome: a seasonal phenomenon occurs mainly between 2-6 months. A cohort study and literature review.

Introduction: hair thread tourniquet or hair strangulation is an emergency phenomenon among infants. A human hair or a thread strangulates a body appendage and causes tissue necrosis. Not many risk factors were described in literature. Previous studies suggested that infants aged 2-6 months are considered to be at a higher risk due to a maternal phenomenon called telogen effluvium which describes an excessive post-partum maternal hair lost.

Materials and methods: Data was gathered and analyzed by 2 methods and then compared. The first method was searching the Galilee medical center ER archive between the years 2008-2018. The second method was reviewing published case reports between the years 1832-2018.

Results: Searching the hospital archive a total of 41 cases were found. Most cases involved only one toe. Most cases were in December, January and February (68%). There were no reports between April to August. The mean age was 4.97 and there were twice more female than male patients (29:12). 9 patients had more than one digit effected and only one case with fingers involved. Toes were more affected than fingers (38:3) and the 3rd toe was the most involved (58%).

Upon researching literature, 33 articles were found presenting a total of 65 case reports.

The range of age was 12 days to 4 years with the majority below 6 months. The average age was 4.9. The female to male ratio was approximately 3:5. Toes were more involved than finger and the most frequent toe involved was the third. There was no data found regarding the month of the year.

Discussion:

Hair tourniquet syndrome is a seasonal phenomenon occurs predominantly in winter. It may be explained by the fact infants are covered and there is a higher chance parents will not notice a swollen toe. It is also possible hair threads may be hidden inside socks. At the time of writing this article, no previous published studies had discussed this epidemiological detail.

This study’s findings are in line with previous studies: Infants aged 4 months (±2 months) are at greater risk – possibly for the maternal phenomenon of telogen effluvium.

Conclusions:

1. Hair tourniquet syndrome occurs predominantly in winter.

2. infants between 2-6 months are in greater risk.

3. No gender seemed to be at a higher risk.

4. Toes were more involved than finger and the most frequent toe involved was the third.