Congenital Hypotrichosis

Hypotrichosis is the name dermatologists use to explain a condition of no hair growth. Different from alopecia, which describes hair fall where formerly there was hair growth, hypotrichosis describes a condition where there wasn't any hair growth in the first place. Hypotrichoses (plural) then are conditions that affect individuals right from birth and generally stay with them during their life.

The first reason of hypotrichoses are connected with genetic aberrations or defects of embryonic development. There are a lot of types of genetic hypotrichoses. Generally, affected individuals have other physical or mental issues beyond a lack of hair. Conditions such as hypotrichosis, Marie Unna hypotrichosis, and metaphyseal chondrodysplasia, from others, can involve the symptom of hypotrichosis. Treating hypotrichoses is very difficult. Most cases involving hypotrichosis have no known cure.

Congenital Aplasia

Aplasia cutis congenita is a developmental cure where, for reasons not understood, the skin does not completely form as an embryo develops. A baby may be born with a patch of skin that is similar an open wound or an ulcer. Generally this defect occurs at the rear part of the scalp, at the center of the "whorl pattern" of hair growth. If the defect is small, the skin will scab over and the baby has a scar during whole life. Sometimes this occurs in the womb and all that can be seen at birth is a patch of scalp where there aren’t any hair follicles. Also, if a baby is born with a large congenital aplasia, it generally needs an operation to cut out the affected area and close up the skin. This is often done quickly,  to prevent the open wound  potential hemorrhage and infection. The quicker the defect heals is more useful.

Triangular Alopecia

Triangular alopecia (alopecia triangularis) is a defect which is similar to congenital aplasia. It is generally apparent from birth and  potential to affect a triangular patch of skin and hair above the temples. For unknown reasons, the skin fails to grow hair follicles in this part in a few people. While babies are not born with open ulcers as with aplasia cutis congenita, the long-time result are not so different -- a bald patch where hair does not grow. The affected part can be surgically removed or implanted with hair follicles taken from somewhere on the scalp.

Congenital Atrichia

Congenital atrichia or papular atrichia is one  condition in terms of the hair fall pattern. It was the first human hair fall problem researchers determined was caused by a single gene defect. Although the case is usually regarded as a hypotrichosis, it is not strictly so.

The mechanism of congenital atrichia is not understood, but it seems that as the hair follicles enter their first resting (telogen) phase in early childhood, the two cell types get separated from each other. The epithelial cell ingredient of the hair follicle retracts, as it should when hair follicles go into the resting part of the hair cycle.

Instead the dermal papilla cells take left behind deep in the skin and far from the epithelial cells to talk to them. Without this conversation a new anagen growth phase cannot consist and hair never grows again. While congenital atrichia is genetic and seen some family members, it is a gene defect that can spontaneously develop in some embryos born to parents who do not have this problem. 

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