Pediatric Dermatology Vol. 31 No. 6 e122–e123, 2014

suggested that the feature might be characteristic of this condition.

Nonsyndromic Whorled Eyebrows in a Healthy 6-Year-Old Girl

CASE

Abstract: Whorled eyebrows are an unusual and rarely described finding of unknown clinical significance. We present such a case in a 6-year-old healthy girl.

Whorled eyebrows are a rarely described facial feature of unknown clinical significance. Typical eyebrows have a morphology characterized by an arched pattern divided into three regions: medial, middle, and lateral (1). In the medial third of the eyebrow, hairs grow vertically; in the middle third, horizontally, and in the lateral third, in an oblique inferolateral direction that completes the arch. Our literature search uncovered only two references to whorled eyebrows. In 1912, Virchow described a nonsyndromic whorl in the medial region of the left eyebrows in eight members of a single family over two generations (Online Mendelian Inheritance in Man [OMIM] 138800) (2). One hundred years later, Kumada et al. described bilateral whorls at the junction of middle and lateral parts of the eyebrows in four Japanese children with trisomy 18 (3). They

A 6-year-old otherwise healthy girl presented with a new wart on her right eyebrow and was incidentally observed to have bilateral whorls at the junction of the middle and lateral thirds of each eyebrow (Fig. 1). Like the eyebrows that Kumada et al described, the lateral thirds of our patient’s eyebrows had a sparse hair distribution. Her scalp had a normal occipitoparietal hair whorl. The only other anomaly observed was brachyonychia of her right middle finger. The patient’s mother reported that the pregnancy had been uncomplicated, that her daughter had no chronic medical conditions, and that no other family members had a similar eyebrow hair pattern. Whorled eyebrows are unusual. This feature may have an association with trisomy 18, but our case would suggest that this characteristic is not exclusive to that chromosomal disorder. In addition, photographs in the report by Kumada et al. appear to show eyebrows with a more-peaked appearance than our case’s spiral morphology. Tented eyebrows (OMIM 611426) (4), a normal variant, have a peaked appearance, not whorled, and occur in the middle third of the eyebrow. In Virchow’s family reported in 1912, the whorled eyebrows appear to have an autosomaldominant inheritance pattern but occurred only on the left eyebrows. The number, location, and distribution of scalp whorls have been associated with a variety of

Figure 1. 6-year-old girl with whorled eyebrows. Left: Patient’s chief complaint of a new wart on the right brow, which is superimposed on the congenital hair whorl. The erythema is due to liquid nitrogen treatment immediately before the picture was taken. Note that her right eyebrow (i.e., the one with the wart) swirls in a clockwise fashion but the left eyebrow swirls in the opposite direction.

DOI: 10.1111/pde.12470

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syndromic conditions, but attempts to correlate the growth direction of occipito-parietal scalp whorls (clockwise vs counterclockwise) with handedness, hemispheric language dominance, and sexual orientation remain inconclusive (OMIM 139400) (5). Our patient’s eyebrows swirled in opposite directions; the right eyebrow (the one with the wart) swirled in a clockwise fashion, and the left in a counterclockwise direction, providing mirror-image symmetry. Although whorled eyebrows are rarely described in the medical literature, we would be remiss to announce that this is a once-in-a-century observation. It is likely that this trait is more common than the few reports suggest but that it goes unnoticed because of the innocuous and subtle nature of the finding. Future observations may or may not lead to clinically relevant associations, but the feature is worth noting if only for its phenotypic novelty. REFERENCES 1. Hall BD, Graham JM Jr, Cassidy SB et al. Elements of morphology: standard terminology for the periorbital region. Am J Med Genet A 2009;149A:29–39.

2. Virchow H. Stellung der Haare im Brauenkopf. Ztschr Ethnol 1912;44:402–403. 3. Kumada T, Miyajima T, Fujii T. Whorled eyebrows: a common facial feature of children with trisomy 18. Pediatrics 2012;161:962–963. 4. Itin PH, Kirtschig G, Gilli L et al. Superciliary upsweep or tented eyebrows: a distinct mendelian trait. J Am Acad Dermatol 1997;37:295–297. 5. Online Mendelian Inheritance in Man. OMIM Entry 139400: Hair Whorl [on-line]. http://omim.org/entry/ 139400. Accessed January 2, 2014. Sanjai Jalaj, B.A., M.S.* Mamina M. Turegano, M.D.† Scott A. Norton, M.D., M.P.H‡ *School of Medicine, Georgetown University, Washington, District of Columbia, †Departments of Dermatology and Medicine, Georgetown University and Washington Hospital Center, Washington, District of Columbia, ‡Department of Dermatology, Children’s National Health System, Washington, District of Columbia Address correspondence to Scott A. Norton, M.D., M.P.H., Department of Dermatology, Children’s National Health System, 111 Michigan Avenue, NW, Suite 300, Washington, DC 20010, or e-mail: [email protected].

Nonsyndromic whorled eyebrows in a healthy 6-year-old girl.

Whorled eyebrows are an unusual and rarely described finding of unknown clinical significance. We present such a case in a 6-year-old healthy girl...
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