An Overview of Marie Antoinette Syndrome (Canities Subita)

While it might sound like something out of a fairy tale or ghost story, several people really have claimed that stress made their hair turn completely white overnight. In fact, the nickname given to the peculiar occurrence comes from one of the most well-known examples in history.

According to a review published in the Journal of the Royal Society of Medicine in 2008, the earliest account goes back to 83 AD with a story in the Talmud of a 17-year-old scholar who was said to have worked so hard his hair turned white.

One of the most oft-repeated tales comes from 18th-century France. Marie Antoinette was just 37 when she was sentenced to death in 1791. As legend has it, the night before she was to be executed by guillotine, her hair turned white. The story has been around for so long that when others have made similar claims, it’s been referred to as “Marie Antoinette syndrome.” 

Interestingly, the ill-fated French queen wasn’t the only well-known historical figure to make such a claim. Mary Queen of Scots and Sir Thomas More are also said to have emerged for their executions with an inexplicably white head of hair.

Although reported cases of Marie Antoinette syndrome have been few in modern medical literature, they continue to be intriguing for doctors and researchers. With help from historians, these professionals have managed to unravel some of the mysteries behind the fascinating condition—which may not be quite what it seems.

Symptoms

Marie Antoinette syndrome is characterized by the sudden, somewhat inexplicable, and usually permanent whitening of hair on the head or another part of the body. 

Unlike the natural graying of hair that takes place as people get older, Marie Antoinette syndrome has been reported in people of all ages, including the relatively young. The condition is also said to differ from the natural graying process in timing: most cases claimed to occur suddenly (often “seemingly overnight”) rather than gradually. 

Doctors generally regard Marie Antoinette syndrome as the stories define it as being a myth. However, when medical professionals do encounter cases akin to the condition today, it’s usually referred to as canities subita (Latin for “sudden gray hair”).

A 1957 a review of literature on rapid whitening of the hair provided several anecdotes, though few were witnessed by medical professionals. The stories had common themes, including unexpected traumatic and/or life-threatening events (house fires, accidents, or the sudden death of a loved one).

Some people had other symptoms at the time their hair went white, such as hair loss or patches of discoloration on their skin. A few people were thought to have specific conditions, such as alopecia or vitiligo.

More recent accounts of the syndrome have had a more gradual than sudden onset. For example, in 2009 researchers at the University of Zurich wrote a short case note on a female patient with alopecia areata. The 54-year-old’s hair turned white over the course of several weeks. However, unlike the legends and other cases, the woman was healthy, not under extreme stress, and hadn’t experienced a recent trauma. 

While the case was unusual and went medically unexplained, doctors didn’t regard it as being impossible—especially since it hadn’t happened overnight.

Causes

Scholars suspect that the appearance of rapidly graying hair in the famous historical anecdotes was most likely attributed to very simple causes. For example, prior to her execution Marie Antoinette had been imprisoned and would not have had access to cosmetics or hair dye.

In other cases, severe hair loss may have been to blame. Even people who are relatively young (in their teens and 20s) can have gray or white hair in places. If the colored hair were to fall out or thin, the hair lacking in pigment would be more visible and stark. 

It's also important to understand how hair pigment works. Hair gets its color from melanin. One kind of melanin determines how dark the hair is while the other gives it undertones (usually red or yellow). Gradually, as people get older, the body makes less melanin.

There may also be another key factor that leads to gray hair. Mouse studies have suggested that the cells responsible for making melanin might also produce hydrogen peroxide (which is commonly used to bleach hair).

An enzyme called catalase can break down the hydrogen peroxide and prevent it from having an effect on pigmented strands of hair—at least until we start to get older. Like melanin, the body also produces less catalase as we age. It’s been suggested that the combination of less melanin and more hydrogen peroxide is a mechanism through which hair becomes white.

When, and to what extent, someone starts to “go gray” depends on several different factors, including genetics. In 2016, researchers identified a specific gene responsible for gray hair.

Everything from stress hormones to free radicals has been implicated as potentially hastening the graying process. However, this doesn’t quite explain how someone’s hair could go white as in accounts of canities subita.

Strands of hair that are visible on a person’s head (referred to as the hair shaft) don’t contain any living cells. Therefore, the hair on the head isn’t considered vulnerable to the direct effects of physiological stress.

While this stress can make changes to the process before hairs emerge (during the bulb/follicle part of the hair growth cycle), that doesn’t seem to fully explain the mechanism behind the hair changes in Marie Antoinette syndrome.

Alopecia areata has also been linked to stories of hair going suddenly white. One of the major reasons for the connection is that people with alopecia may lose hair in response to stress (which is thought to be an immune response). In fact, hair loss may be so extreme that it causes bald patches.

In 2013, another review of medical literature on canities subita proposed that alopecia could be a potential explanation for the phenomenon. The reviewers noted that many authors observed that only pigmented hair was affected by the condition, whereas white hairs appeared to be spared. If the white hairs are not lost when a patient with alopecia goes through a period of sudden shedding, that could explain why someone’s hair appears to go white “all of a sudden.”

There have also been cases where only some of a person's hair turns completely white (such as one patch or just one side of the head) or hair elsewhere on the body turns white (pubic hair and eyelashes).

For example, in 2015 researchers published a case report on a 48-year-old man who had gray hairs on only one leg. He had no pain, no skin discoloration, no hair loss, and was otherwise healthy. Doctors were not certain of a cause, though they suspected it could have been an early sign of vitiligo.

Diagnosis

The characteristic feature of canities subita is the sudden appearance of white hair, which may be obvious to both the patient and their doctor. 

The diagnosis is mainly clinical, meaning a doctor will exam a patient and ask questions about what was going on around the time they noticed changes to their hair. For example, a doctor may ask about shampoo and other hair products used, medications and supplements being taken, potential environmental exposures, and food allergies. 

A medical professional will also want to determine if someone has another health condition, especially one that can affect hair and skin. As mentioned, conditions like alopecia and vitiligo may be linked to canities subita. 

Asking about other symptoms such as hair loss, skin discoloration, or signs of an autoimmune disease can help a doctor diagnose an underlying condition that could explain the change in a person’s hair color. 

While a doctor might ask someone about their stress levels, the patient may be the first to bring it up as they explain the circumstances surrounding the unusual occurrence. 

For example, a patient might state that their hair change took place directly after they witnessed a traumatic event or began to change rapidly after the unexpected death of a spouse. 

There are no tests that can determine what caused a person’s hair to go white. In most cases, a doctor won’t be able to say for sure why (or how) it happened. However, if a doctor suspects a specific medical condition is a cause, there are tests they may run to help them make a diagnosis.

For example, there are many different types of blood tests they could order to look for changes suggestive of an underlying disease. These tests also help doctors assess a person’s overall state of health by checking for conditions like anemia and malnutrition. 

• Hormone and thyroid levels 
• Blood counts, electrolytes, and chemistry 
• Inflammatory or other specific markers for autoimmune diseases

If a doctor suspects a person’s hair changes could be the result of a specific allergy, they may refer them to an allergist for additional testing. Other specialists, such as a dermatologist, may also be consulted to help determine the cause of a person’s white hair. 

Treatment

Most adults will have some white hair on their head by the time they reach middle age, but when a person starts to go gray and how much white hair they get will be unique to each individual.

It’s considered normal for some people to start noticing white hair popping up while they are still in their 20s. In fact, Caucasians tend to start going gray in their 30s, while Asians and African-Americans start when they are closer to middle age.

Research has indicated that starting to go gray earlier doesn’t necessarily mean someone will have more gray hair. Other factors, such as biological sex and even smoking habits, can also influence the rate of hair whitening.

If someone is diagnosed with an underlying medical condition like alopecia, there are several different approaches to treatment, including steroids and anti-inflammatory drugs. 

Hair changes, including color and quantity, is a normal (and for most people, inevitable) part of the aging process. It doesn’t generally require any type of medical treatment, but if someone is distressed by hair changes, there are innumerable cosmetic products available. 

Hair dye options range in price and quality from salon-professional grade to inexpensive boxed brands that can be found at any grocery store or pharmacy. There are also alternatives like henna, which doesn’t contain chemicals (like bleach) which are common in most traditional hair dyes.

A Word From Verywell

Stories of people getting a full head of white hair overnight have fascinated medical science, historians, and the general public, for centuries. While cases like Marie Antoinette’s stark white hair at her execution are felt to be myths (or at least, best explained by a lack of cosmetic maintenance) there have been cases of unusual hair color changes that proved difficult to explain. The majority of adults will have some white hair by the time they reach middle age. Factors like genetics, ethnicity, and even lifestyle habits can influence how old a person is when they start to go gray, as well as how much gray hair they will have on their head as they age.

While changes to hair color, thickness, and quantity are usually a normal part of the aging process, in some cases these changes can be a sign of an underlying health condition. Indeed, many cases of purported Marie Antoinette syndrome may have been caused by alopecia areata or vitiligo. There is no specific test to diagnose the unusual or unexpected appearance of white hair, nor is there any specific treatment. However, there is a vast array of cosmetic products that can be used to color hair, as well as treatments for conditions that can affect hair.