Traction alopecia

This is a localised, non-scarring alopecia caused by constant traction on the hair. Unlike in Trichotillomania the hair loss in traction alopecia is unintentional (1).

The hair margins are particularly affected. Common causes include tight hair styles eg. pony tails, tight plaiting; hair setting equipment eg. rollers.

• is a form of hair loss caused by prolonged or repetitive tension on the hair due to tight braids, locks, and other hairstyles
• occurs across different ethnicities, affecting men, women, and children
  • note though that is most often seen in women of African descent, affecting up to one-third of this population (2)
    • in the early stages there is no scarring and this form of alopecia is reversible - however long-term traction alopecia can be associated with permanent scarring hair loss

Hair loss depends on the hairstyle used but most commonly frontal and temporal areas are affected (1)

• early stages of traction alopecia
  • hair loss may be mild, with minimal thinning in the frontal hairline
  • hair regrows after discontinuing the traction-related hairstyles
  • there may be associated tenderness, stinging, or pain in the area of hair loss
  • in areas of the highest tension, acne-like pimples or bumps are common (2)
    
    
• later stages of traction alopecia
  • is increased hair loss along the frontal hairline
  • commonly there are fine hairs remaining in the area of increased hair loss
    • fringe sign - is used to describe remaining fine hairs along the edges of the original hairline that may occur in traction alopecia
    • there may be some permanent scarring hair loss

Diagnosis

• generally via clinical examination
• the affected area may be visualised by a dermatoscope
• rarely a skin biopsy may be performed to rule out other forms of alopecia

Management:

• can be prevented if tension-related hairstyles are discontinued early when hair loss is first noticed
• medical treatment for early cases includes topical corticosteroid medications (liquids, ointments, or oils) (2)
  • occasionally these are combined with corticosteroid injections directly into the areas of hair loss by the physician
  • antibiotics may be used as anti-inflammatory agents
  • topical and oral minoxidil may also be used
  • hair transplant/restoration surgery may be an option for traction alopecia with permanent scarring

Reference:

• 1. Springer K. Common Hair Loss Disorders. AFP 2003;68(1)
• 2. Larrondo J, McMichael AJ. Traction Alopecia. JAMA Dermatol. Published online May 03, 2023. doi:10.1001/jamadermatol.2022.6298