Traction Alopecia 1_0313 Derm Dx
Traction Alopecia_0313 Derm Dx
A 16-year-old black female presents to the dermatology clinic with her mother. They complain that she is losing her hair in the front and sides of her scalp. She has had many hairstyles, including braids and a weave.
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Traction alopecia is a very common cause of hair loss in black women. The prevalence of traction alopecia is as high as 17% in African school age girls aged 6 to 21 years, and as high as 32% in African-American women aged 18 to 86 years.
Traction alopecia is a form of hair loss that is caused by excessive pulling on the hair from hairstyles. The margins of the scalp are most commonly affected, especially the frontal and temporal scalp. Tight braids are the most common cause of traction alopecia. The braid places mechanical stress on the hair follicles and results in inflammation.
In the early stages of traction alopecia, the hair will recover and regrow once the traction is eliminated. However, if the alopecia has been present for years then the hair follicles will be destroyed, and there is little hope for the hair to regrow even if the traction is eliminated.
The distribution of hair loss may vary depending on the traumatic styling practice. For example, hair rollers may cause hair loss which is most prominent over the frontal scalp.
Hot-comb alopecia, also called central centrifugal cicatricial alopecia, refers to a particular pattern of traction alopecia and is seen almost exclusively in black patients who have used various hair-straightening techniques. Hot-comb alopecia begins on the vertex and may spread to affect the entire scalp.
Diagnosis & Treatment
The diagnosis is made clinically by the presence of alopecia around the temporal-frontal scalp margins, or in a hot-comb alopecia, based on scalp vertex distribution. Biopsy will demonstrate pigment hair casts and trichomalacia.
Treatment of traction alopecia can be challenging. Patients must discontinue traumatic hair practices. Topical minoxidil may be offered as this has been reported to improve traction alopecia in case reports.
In our practice, we frequently encounter patients with long standing traction alopecia. In these cases, the chances of hair regrowth are slim, since scarring has occurred. Patients must be provided anticipatory guidance. Frequently patients find greatest satisfaction from simply wearing a wig. Hair transplantation can also be effective.
Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.
- Bolognia J, Jorizzo JL, Rapini RP. “Chapter 68: Alopecias.” Dermatology. St. Louis: Mosby/Elsevier, 2008.
- James WD, Berger TD, Elston DM et al. “Chapter 33: Diseases of the Skin Appendages.” Andrews’ Diseases of the Skin: Clinical Dermatology. Philadelphia: Saunders Elsevier, 2006.
- Schachner LA, Hansen RC. “Chapter 11: Hair Disorders.” Pediatric Dermatology. Edinburgh: Mosby Elsevier, 2011.