| Hair Tourniquets
Case A two month old infant is brought to your office by the parents because of inconsolable crying for 6 hours. The child is breast fed and has been doing well. There is no vomiting, diarrhea, constipation, or increased gas. The mother has not changed her diet and the infant is on no medications. There has been no fever. On physical examination the child is active and screaming. There is no fever. The physical exam is completely normal except for the right third toe is swollen, tender, erythematous, and there is an circumferential indentation proximal to the redness. A thread is seen in the indentation. Hair tourniquet syndrome is a relatively common finding in infants. The infant usually presents with excessive crying or the caretaker notices the redness of the extremity. It is an emergency because failure to remove the tourniquet promptly can lead to a serious infection or amputation. Usually affects the toes, fingers, or external genitalia. The third toe and third finger are most commonly involved. Hair is more commonly associated with toes and external genitalia while threads are more often found around fingers. There is an association with older frequently washed clothes and the wearing of mittens. Diagnosis
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