A Hispanic woman brings her 15-year-old daughter to the office for evaluation of hair loss at the front of her scalp. The condition has been slowly progressing for several months. The girl is otherwise healthy, and her history is negative for thyroid disease. On physical examination, the scalp appears normal. Diffuse thinning of the frontal and temporal regions is noted.
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Traction alopecia (TA) is a type of hair loss associated with specific hairstyles. It is most commonly seen in African Americans. TA is the result of repeated tension on the hair root, which causes damage to the follicle.1 The most common hairstyles responsible for TA are tight ponytails, braids, cornrows, hair extensions, and religious head coverings.2 The frontal and parietal areas of the scalp are sites that are typically involved. The early stages of TA are reversible. Patient education should be aimed at changing hairstyle practices. Hair styles should be loosened and chemical and heat treatments avoided. Early-stage TA may be benefited by minoxidil and intralesional steroid injections. Hair transplantation is the treatment of choice for patients with dermal scarring.3
Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
- Haskin A, Aguh, C. All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). J Am Acad Dermatol. 2016:75;606-611.
- Ahdout J, Mirmirani P. Weft hair extensions causing a distinctive horseshoe pattern of traction alopecia. J Am Acad Dermatol. 2012:67;294-295.
- Lawson CN, Hollinger J, Sethi S, Rodney I, Sarkar R, Dlova N, et al. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol. 2017;3(Suppl 1):S21-S37.