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International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2 63
INTRODUCTION
The process of graying or whitening hair is called Canities
and normally occurs as one of the signs of aging.
Pigment production by melanocytes in the hair matrix
area surrounding the dermal papilla is thought to cease
gradually, resulting in slow outgrowth of graying hair at the
pace of normal hair growth. Yet, not all hair bulbs decrease
pigment incorporation in the growing hair at the same
time – instead, single gray hairs start appearing interspersed
among the pigmented ones, colloquially called “salt and
pepper pattern”. As the differentiated hair shaft contains
no live cells, it is not thought to be able to undergo any
active changes. In contrast to this, unusually rapid loss of
hair color has been reported in the medical and non‑medical
literature. The prevailing theory states that apparent sudden
graying may occur because of a selective loss of pigmented
hairs due to alopecia areata diffusa.[1,2] However, along with
other authors, one of us (A. A. N.) observed the case of a
54‑year‑old woman whose hair had allegedly turned white
Address for correspondence:
Dr. Emily Williams Kelly,
Department of Psychiatry and
Neurobehavioral Sciences,
Division of Perceptual Studies,
University of Virginia Health
System, 210, 10th Street,
NESuite100,Charloesville,
VA 22908, USA.
E‑mail: ewc2r@virginia.edu
Canities Subita: A Reappraisal of
Evidence Based on 196 Case Reports
Published in the Medical Literature
Michael Nahm, Alexander A Navarini1, Emily Williams Kelly
Department of Psychiatry and Neurobehavioral Sciences, Division of Perceptual
Studies, University of Virginia Health System, Charlottesville, VA, USA,
1Dermatology, University Hospital of Zurich, Zurich, Switzerland
ABSTRACT
We have reviewed the medical literature on unusually rapid Canities of body hair to assess
whether the reported clinical evidence can be explained with the current hypotheses of
pathogenetic mechanisms. We screened the medical literature from 1800 onward, searching
for as many case reports as possible. We assessed literature in Dutch, English, French,
German, Italian and Spanish and included all cases, which contained an explicit mention
ordescriptionofunusuallyrapidgrayingorwhiteningofhair.Casereportswereclassied
into three categories: Cases are “authenticated” when the authors personally observed the
rapid color change, “non-authenticated” when they saw the subject only after the alleged
color change and “anecdotal” when authors were told about the case by a third party. In
total, we found 196 cases of which 44 were authenticated. These studies reported the
graying of human hair in the context of aging, somatic diseases, emotional trauma or stress
and psychiatric disorders. Numerous cases involved not only scalp hair, but also beards,
eyelashes and other body hair. Several authors stressed that there was no alopecia. Although
plausible explanations exist to explain Canities subitaoccurringtogetherwithanefuvium,
the observation of viable hair losing color along the axis within a timespan shorter than its
growth rate remain as yet unexplained.
Key words: Alopecia areata diffusa, Canities subita, sudden hair blanching
within “a few weeks” without her having noticed the loss
of hair.[3] Because this patient’s observations may have been
incomplete, we decided to survey the medical literature on
unusually rapid whitening of hair, limiting our collection
to case reports published from 1800 to the present. We
assessed Dutch, English, French, German, Italian and
Spanish publications and included all cases containing an
explicit mention or description of unusually rapid graying
or whitening of hair. We found reports of 196 cases. Of
these, 44 were reported by physicians who saw their patients
before and after the color change, often witnessing the
graying process (authenticated cases) and we will focus our
presentation primarily on these rst‑hand accounts. Many
of these authors were renowned physicians of national and
international reputation. In addition, 82 cases were reported
by physicians who saw or treated the patients only after
the alleged sudden color change (non‑authenticated cases),
sometimes on the next day and 37 cases were merely reported
to the physicians (anecdotal cases). In the remaining 33 cases,
the precise circumstances of the observation were unclear.
Review Article
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DOI:
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Nahm, et al.: Canities subita: Cases reported in the medical literature
64 International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2
OVERVIEW OF CASES OF UNUSUALLY RAPID
WHITENING OF BODY HAIR
Studies concerning color changes of single hairs due
to aging
When Neurologist Brown‑Séquard was 45 years of age,
he rst discovered white hairs in the anterior parts of
his beard and plucked them out.[4] After a few days, he
discovered new white hairs in his beard and plucked them
out. He repeated this procedure throughout the 5‑6 weeks,
always nding after 2‑5 days fully developed new white
hairs in his beard that had blanched on their entire length,
apparently overnight. Brown‑Séquard stressed that his
observations were beyond doubt. Around the same time,
Pincus presented the results of detailed investigations of
single hairs that women of different ages had lost.[5] After
microscopic analyses, Pincus stated that the graying of
hairs usually began at their base because pigments would
cease to be produced in the scalp and the hair would then
grow without pigmentation. However, he also found that
in the white sections of several hairs, their ne structure
was swollen and lled with air. Pincus concluded that
in these cases, the change of color had occurred in the
already existing and pigmented matter of the hairs by the
inclusion of air. Later, Naegeli studied the graying process
in women with a long black hair.[6] He observed that the
color change began both at the base and at the tips of the
hairs and that it would often progress fast, up to 1 cm in
2 days. Thus, entire hairs would be blanched within a few
weeks and often faster. Galewsky similarly stated that entire
hair shafts can gradually become white due to the aging.[7]
Ephraim questioned several hairdressers on this topic. They
held the opinion that pigmented hairs can become white
on their entire length.[8]
Cases reported in the context of intense pain or
somatic diseases
Like Brown‑Séquard, Anstie reported color changes in his
own hair.[9] Whenever he suffered severe neuralgia attacks,
a part of his right eyebrow and scalp hairs on the right side
of his head turned white. Yet, the original hair color was
always restored after a few days. Anstie stressed that there
was no alopecia and that he observed this phenomenon
in several of his patients as well. Similarly, Urbantschitsch
described a case in which, in addition to brittleness and
alopecia, many hairs turned white during severe attacks
of neuralgia.[10] In this case, the discoloration of hairs was
permanent. Raymond witnessed the rapid color change
in the hair of a 38‑year‑old woman together with his
colleague Vulpian, the discoverer of adrenalin.[11] Patient
suffered from extreme neuralgia and emotional anxiety. The
physicians observed that her hair changed its color almost
entirely within 5 h and they excluded the possibility that her
hairs had been dyed before. The process of decoloration
of hair continued during the following 2 days, after which
her hair started to fall out. Gowers reported the case of
a man who suffered a traumatic meningeal hemorrhage
over the left hemisphere.[12] During the 3 days, he lived
after the injury, the right half of his brown moustache
and beard became almost white. The scalp hair was not
affected. A similar non‑authenticated case was described
by Brissaud, who reported a perfect Hemicanities in a
63‑year‑old man, which had developed within 1 day after
a hemorrhage.[13] Perry related 2 other cases of this kind,
one involving a 12‑year‑old boy.[14] The Hemicanities in
the non‑authenticated case described by Loeb was said
to have followed a hemorrhage within 8 days.[15] Other
remarkable authenticated cases, in which rapid poliosis
was attributed to somatic causes include Dewees (during
parturition),[16] Compagne (during a severe fever in a
36‑year‑old woman),[17] Brée (coinciding with progressive
vitiligo in a 22‑year‑old man)[18] and Lieber (during several
cycles of menstruation in a 16‑year‑old teenager).[19]
A peculiar subset of 30 cases concerns the rapid whitening
of eyelashes [Table 1]. Eighteen of these were related to
severe pain in this region or to diseases of the eye. The
remaining cases were reported in the context of emotional
trauma (9 cases) or without discernible trigger (3 cases).
A classic case concerning eye diseases was reported by
Schenkl.[20] He reported that 5‑6 cilia had turned white
within 3 days in a 9‑year‑old boy whose left eye had been
enucleated. Schenkl had observed the wound closely and he
paid special attention to the lashes, many of which turned
toward the interior of the eye socket.
Cases reported in the context of emotional stress or
trauma
Of the 196 cases in our collection, 126 were attributed to
frightful or emotionally shattering experiences [Table 1].
For example, in March 1923, a 62‑year‑old widow was
injured and suffered extreme fright when she slipped
and fell.[21] She remained in the hospital for 3 months.
The woman had dark hair, which measured 80 cm at the
occipital region of her head. On the morning of the second
day in hospital, the basal areas of the hairs of the frontal
hemisphere of her head had turned white on a length of
1 cm. Initially, the hair of the occipital hemisphere of her
head showed no change. While the whitening progress on
her frontal hemisphere continued, but declined in velocity,
the 80 cm long hairs of the occipital skull hemisphere
Nahm, et al.: Canities subita: Cases reported in the medical literature
International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2 65
of his wife, just before he reached his 30th year.[26] Parry
reported the case of a 54‑year‑old man whose black hair
turned gray within half an hour during a frightening
military examination by his captors.[27] Perry saw a man
whose black hair turned gray 1 day after he was met with
a “terrible calamity.”[14] Ferguson observed the graying of
a black‑haired acquaintance over 5 days when the latter
suffered from emotional distress.[28] Laumonier saw a
young mother appear with white hair at the funeral of her
12‑year‑old daughter, who had died from a u.[29] Gomer
observed sudden Canities in a soldier at the front.[30]
Cases reported in combination with alopecia
We have already mentioned cases, which involved unusual
Canities accompanied by alopecia.[10,11,21,23‑25] Similarly,
Groeger related a case, in which there was total whitening
of black scalp hair within 3 days, but in which alopecia
occurred only in the eyebrows and eyelashes.[31] It was
unclear whether the Groeger was a direct witness of these
changes. Ephraim described the case of a 63‑year‑old
patient whom he had seen the day after a fall and again
6 weeks later.[8] The man reported that he had noticed
hair loss 2 weeks after the accident and that he had turned
almost entirely white within the 3rd week. Initially, patient
had had only a few white hairs on top, with some graying
at his temples. Stankler and Bewsher reported analogous,
but non‑authenticated case of a 50‑year‑old patient.[32] His
wife, his medical practitioner and a neighbor who worked
at the hospital to which the man was referred, conrmed
began to show a different kind of color change. When
patient left the hospital after 90 days, these hairs consisted
of an irregular mixture of hairs that had remained dark
and that had blanched at different locations. Many of the
hairs had blanched only in their distal regions. On the
last examination of the woman, performed 92 days after
her release from the hospital, the basal whitening of her
frontal hair was 10 cm and the occipital area of her head
had turned entirely gray. Only a few weeks before, the
woman had rst noticed a loss of hair. She stated that
she never used hair dye and according to enquiries that
Sticker made among the people who knew her, she had
always had the long dark hair that she had at the time she
slipped. Similarly, Baelz has reported that the hair of a
female patient of his changed from dark to largely gray
within 6 months.[22] Irregular strands of white hairs were
mixed with darker hairs. The white hairs were blanched on
their entire length of about 25 cm. The color change began
after the woman was rescued from a shipwreck. Another
case, reported by Pöhlmann, involved a 34‑year‑old man
who was rescued with difculty after a mountaineering
accident.[23] He visited Pöhlmann because of frostbite on
his hands and feet. Pöhlmann observed that patches of
poliosis and alopecia areata developed during the course
of several weeks in the man’s beard and scalp hair. These
patches had begun to appear 3‑4 days after the accident.
Similarly, Bertrand in Bernard and Dubreuilh observed
the development of both poliosis and patches of alopecia
areata in patients after emotional strain.[24,25] Vogel stated
that his own hair turned white overnight after the death
Table1:Overviewofspecicfeaturesof196casesofunusuallyrapidcanities reported in the medical
literature from 1800 onward
Features of the cases Authenticated cases Non‑authenticated cases Anecdotal cases Unclear Sum
Total number of cases 44 82 37 33 196
Aected type of hair
Scalp hair 38 68 36 28 170
Eyebrows 3 15 1 3 22
Eyelashes 7 15 2 6 30
Beard 7 8 2 2 19
Other body hair 2 7 0 1 10
Apparent trigger of the onset of Canities
Aging, or no discernible trigger 513 1 2 21
Intense pain or somatic disease 12 19 4 4 39
Psychiatric disorder 6 3 1 0 10
Emotional stress 21 47 31 27 126
Associated specics
Alopecia 6 16 1 0 23
Poliosis 15 34 6 3 58
Vitiligo 2 7 0 0 9
Subject 4-18 years old 7 12 2 1 22
Nahm, et al.: Canities subita: Cases reported in the medical literature
66 International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2
that his hair had turned from black to white within 3 weeks
for unknown reasons. In addition to this progressive
Canities, alopecia was noted. A case reported by Hoff also
involved both alopecia and Canities.[33] Hoff, then director
of the Medical University Clinic in Frankfurt, examined
the patient 7 months after the reported color change of his
hair, but the case was well authenticated by direct witnesses,
among them Professor Walter Parissius, chief physician
of the Knappschafts‑Hospital in Essen, Germany, who
had referred the patient to Hoff. Patient, a 40‑year‑old
miner with dark blond hair, became ill, collapsed and was
visited by a physician. During the night, the man and his
wife noticed that when he ran his ngers through his hair,
much of his dark hair came out in tufts. The hairs that
remained on his head had turned white. His skin displayed
vitiligo universalis. The next day, he was admitted to the
Knappschafts‑Hospital. He remained hospitalized for
several days, during which time the whitening of other body
hair progressed. Within 3 days, his eyebrows and eyelashes
had turned white and after 10 days, the hair on his chest
and abdomen had whitened. His pubic hair had turned
completely white a few days later. Finally, about 1 month
after the onset of his disease, the axillary hairs had also
turned white. Moreover, the color of his irides had changed
from dark brown to a light blue. The miner was presented
at a dermatological convention on May 27, 1955 in Essen,
where Hoffmann met and talked with him as well.[34]
Hernández y Vázquez reported a similar non‑authenticated
case, in which a 52‑year‑old man developed total whitening
of all scalp, beard, axillary and pubic hair as well as alopecia,
within 2 days after a severe emotional afiction.[35] Two
other sources reported non‑authenticated cases, in which
alopecia occurred shortly after sudden whitening of scalp
hairs of their patients.[36,37]
In nine non‑authenticated reports, unusually rapid Canities
was attributed to alopecia alone. Their authors argued
that predominantly pigmented hairs were lost, but white
hair remained on the scalp.[2,38‑40] In this way, the false
impression that the hairs had turned white was created.
This process of whitening due to the rapid alopecia took
between 3 days and 3 weeks; in one case the process
took 3 months.[41] None of these cases was preceded by
sudden emotional strain; although, one patient reported
a distressing period of family trouble.[40] Thus, just as
there are case reports of rapid Canities without alopecia
and cases involving both rapid Canities and rapid alopecia,
there are cases of only rapid alopecia (areata diffusa) of
predominantly pigmented hairs. This nding highlights
the multifaceted phenomenology of disorders of the hair
and scalp as stressed by Dubreuilh.[25] Some physicians may
have failed to note that some of the “only alopecia” cases
might have involved unusual Canities as well. For example,
in one case patient’s scalp hair, measuring about 10 cm in
length, had whitened strikingly and progressively within
3 months, beginning on the crown of her head.[41] She had
reported loss of hairs, but the authors did not specify their
color. Still, they speculated that the progressive graying
resulted from the progressive, selective loss of pigmented
hairs. A hair count performed by the authors themselves;
however, showed that the average hair density was in fact
greater in the crown area, which displayed maximum
whitening, compared to the areas in which the hairs were
not yet affected by the progressive Canities and which
contained only “rare” gray hairs.
Cases reported in the context of psychiatric disorders
Rapid whitening of hair has also been reported in the
context of psychiatric disorders. As in some cases involving
intense periodic pain,[9,19] reversible color changes were
reported in this category. For example, Reinhard reported
a periodic change of hair color in a 13‑year‑old patient with
severe mental disabilities who also suffered from apparent
epileptic ts.[42] Her hair color changed repeatedly from a
yellowish blond to a reddish‑golden color and back again.
The reddish color lasted for 7 or 8 days, always correlating
with periods of mental agitation. There was no alopecia,
the possibility of hair dyes was excluded and several
caregivers and physicians witnessed these repeated color
changes. A similar case involved a 21‑year‑old woman
who suffered from schizophrenia.[43] During the phases
of intense emotional agitation, a 3 cm wide strand of her
blond hair turned white. It resumed its original color after
4 days, but it returned during four more attacks of mental
disturbance. Heinicke stressed that there was no alopecia.
Other well‑documented observations of hair color change
during psychotic ts were made by Mirto and Räuber.[44,45]
Lastly, the head and beard of an extremely frightful
34‑year‑old man who suffered from delirium tremens and
hallucinations had turned from blond to gray overnight
on the morning of the 4th day in hospital as noted by the
attending physicians and by other patients who had seen
him before.[46] Upon closer investigation, inclusions of
air were discovered in the blanched hair shafts that were
removable by incubation in water, ether or turpentine oil
with subsequent restoration of the original hair color.
DISCUSSION
In a survey of the medical literature about sudden or
unusually rapid whitening of fully developed hair shafts,
we found reports of 196 cases. The collection contains
Nahm, et al.: Canities subita: Cases reported in the medical literature
International Journal of Trichology / Apr-Jun 2013 / Vol-5 / Issue-2 67
numerous apparently well‑authenticated case reports by
direct eyewitnesses. In only 6 of 44 authenticated and 16
of 82 non‑authenticated cases was alopecia reported to be
associated with the rapid color change. Thus, the selective
loss of pigmented hair by alopecia areata diffusa may not
explain all these cases. Several other hypotheses have been
put forward,[47‑49] most prominently inclusion of air in
hair shafts without pigment destruction.[46] Conspicuous
alterations of the internal ne structure of hair shafts,
usually associated with the inclusion of the air, have been
reported in 16 cases of this review. Such alterations were
not reported by others, but they did not have access to hair
from cases with rapid Canities.[49] However, air inclusions in
the hair cortex can denitely create a loss of color intensity
as is known from the disease pili annulati that produces dark
and bright stripes in the hair.[50] Interestingly, this process
is reversible as more distal pili annulati lose their bands
eventually, which is explained by the collapse of the air‑lled
cortex. However, whether the new air inclusions can be
created by internal processes in the fully differentiated hair
remains unclear and will be interesting to investigate. It
will be relatively easy to determine prospectively whether
the new cases of rapid Canities contain air inclusions in
the cortex and what physical inuences could lead to this
phenotype. This must be differentiated from air in the
medulla, which is a common phenomenon. Although no
conclusive proof exists that rapid Canities can occur without
concomitant alopecia areata diffusa, the sheer number of
authenticated cases suggesting this call for a more systematic
investigation of what factors may prompt loss of hair color.
Such an investigation may provide new insights into the
process of physiologic Canities.
ACKNOWLEDGMENTS
We are indebted to Massimo Biondi, Renaud Evrard, Gerd
Hövelmann and Pascal Le Maléfan for their help in obtaining
copies of rare publications.
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How to cite this article: Nahm M, Navarini AA, Kelly EW.
Canities subita : A reappraisal of evidence based on 196
case reports published in the medical literature. Int J Trichol
2013;5:63-8.
Source of Support: Nil, Conict of Interest: None declared.
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