Hair tourniquet syndrome in a neonate: a case report highlighting bedside diagnosis and preventative strategy in a resource-limited setting, Woldia, Ethiopia, 2025

Abstract

Background: Hair tourniquet syndrome (HTS) is a rare but potentially serious condition where a strand of hair or fiber constricts an appendage, leading to ischemia and tissue damage. It most commonly affects infants, with toes, fingers, and genitalia being the most frequently involved sites. Due to its rarity and nonspecific presentation, diagnosis may be delayed, leading to complications. This case report contributes to the limited literature on HTS by highlighting the importance of early recognition in atypical presentations and emphasizing innovative, non-invasive diagnostic and management approaches. Case presentation: A 23-day-old previously healthy male was brought to the emergency department with excessive crying and swelling of the right fourth toe. The mother noticed the swelling after removing his socks, with no history of trauma, insect bites, or prior similar episodes. Examination revealed a circumferential groove, mild cyanosis, swelling, and delayed capillary refill. Under magnification, a tightly wrapped maternal hair was identified, confirming HTS. The hair was carefully removed under local anesthesia, and the child’s symptoms resolved completely within 24 hours, highlighting the importance of early recognition and intervention in HTS cases. Clinical Discussion: HTS is a rare pediatric emergency, typically affecting infants under 6 months. It occurs when a hair or fiber constricts an appendage, leading to pain, swelling, and possible ischemia. Diagnosis is mainly clinical but may be supported by dermatoscopy or ultrasonography. Prompt removal of the constricting material, either manually or surgically, is crucial to prevent tissue loss. This case highlights diagnostic challenges and underscores the need for parental awareness and preventive inspection to avoid recurrence. Conclusion: HTS, though rare, is a significant pediatric emergency that requires prompt recognition and intervention. Increased awareness among healthcare providers enhances early detection and treatment outcomes. Parental education is a preventive strategy to reduce its incidence.