Exclamation Mark Hairs

A popular term for the short—3 mm in length—irregularly thickened and terminally dilated hairs with tapered proximal ends, which are characteristic of alopecia areata
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Exclamation mark hairs (EH) were found in 16.6% of patients at initial visit (Figure 1, 5).
Short, easily extractable broken hairs, known as exclamation mark hairs, are often seen at the margins of the bald patches during active phases of the disease.
[21] BDs are remnants of exclamation mark hairs or BHs.
Other findings observed were as follows: honeycomb pigmentation (HCP) 10 (48%), yellow dots (YD) 10 (48%), white dots (WD) 15 (71%), circular hairs (CH) 10 (48%), coudability signs (CS) 9 (43%), short vellus hair (SVH) 15 (71%) and exclamation mark hairs (EH) 10 (48%).
In AA, dermoscopy of active disease shows yellow dots, dystrophic hair, as well as cadaverized hair and exclamation mark hair.
Black dots as remnants of exclamation mark hairs or broken hairs occur when hair shaft, fractured before emerging from the scalp, provides a sensitive marker for disease activity as well as severity of AA [18].
[18] found that a combination of cadaverized hairs, exclamation mark hairs, broken hairs, and yellow dots could sensitively detect difficult-to-clinically diagnose types of AA like alopecia areata incognita, and broken hairs may be found in tinea capitis and trichotillomania.
Exclamation mark hairs are absent and the hair pull test is negative (7).
A characteristic finding that is frequently seen in (or at the border of) the patches is 'exclamation mark hairs'.
Such a hair is termed an exclamation mark hair because of the gradual thinning of the broken stub toward the base, which consists of an unpigmentedtelogen club.
In alopecia areata trichoscopy shows regularly distributed "yellow dots" (hyperkeratotic plugs), micro- exclamation mark hairs, and "black dots" (destroyed hairs in the hair follicle opening.
they remain in the growing phase, anagen, unlike exclamation mark hairs) are distinguishing features.