Traction alopecia

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Traction alopecia is a type of alopecia or hair loss caused by a chronic pulling force being applied to the hair. [1] It commonly results from a person frequently wearing their hair in a particularly tight ponytail, pigtails, or braids with increased likelihood when hair is chemically relaxed as this compromises the hair shaft's tensile strength resulting in hair breakage. Traction alopecia causes a recession of the hairline due to chronic traction, which is characterized by a fringe along the marginal hairline on physical exam. [2] [3] Diagnosis is clinical and treatment directed at cessation of the chronic traction, while cosmeses, with surgical restoration is reserved for severe cases with scarring fibrosis.

Contents

Cause

Traumatic hairstyle

It is commonly seen with certain hair styles like a particularly tight ponytail, pigtails, braid or braiding pattern that pulls the hairline forcefully towards the vertex of the scalp, [4] [5] and has been reported more often in African American women (as some wear their hair tightly pulled back), sometimes causing scarring. [6] [7] It has also been seen in female ballerinas, [8] and seen occasionally in long-haired people who use barrettes to keep hair out of their faces and in cultural traditions where the hair is voluntarily not cut in religious obeisance, the latter caused by progressively increasing weight of the hair itself.[ citation needed ] Traction alopecia is mechanical in cause, rather than androgenic. [7] Traction alopecia is a substantial risk in hair weaves, which can be worn either to conceal hair loss, or purely for cosmetic purposes. The former involves creating a braid around the head below the existing hairline, to which an extended-wear hairpiece, or wig, is attached. Since the hair of the braid is still growing, it requires frequent maintenance, which involves the hairpiece being removed, the natural hair braided again, and the piece snugly reattached. The tight braiding and snug hairpiece cause tension on the hair that is already at risk for falling out. Dreadlocks and single (extension) braids can have the same effect. Men and women who have had traction alopecia have found that the hair loss occurs most at the hair line—primarily around the temples and the sides of their heads. Traction alopecia is one of the most common causes of hair loss in African American women. [9]

Tight or heavy hairstyles, such as long box braids, can also cause an external-traction headache, previously called a ponytail headache. [10]

Headgear

Chemicals

A condition known as CCCA (central cicatricial centrifugal alopecia), seen almost exclusively in African American women, can cause extensive hair loss. It is caused by a combination of too much stress (traction) on the hair and the use of harsh relaxers and dyes. [15]

Diagnosis

Traction alopecia is characterized by a fringe along the marginal hairline on physical exam, a recession of the hairline due to chronic traction. [2]

Differential diagnosis of this type of patchy alopecia when it is in the non scarring stage includes trichotillomania and alopecia areata, in the late stage, when smooth hairless patches are present with follicular drop out, it can resemble scarring alopecias such as frontal fibrosing alopecia (FFA) and patchy central centrifugal cicatricial alopecia (CCCA). [9]

Frontal fibrosing alopecia can present with an unusual retention of the hairline (pseudo-fringe sign). [16]

Treatment

Treatment is typically not pharmaceutical. Management includes cessation of the chronic traction, cosmeses, with surgical restoration reserved for more severe cases with scarring fibrosis. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Hairstyle</span> Style of hair, usually on the human scalp

A hairstyle, hairdo, haircut, or coiffure refers to the styling of hair, usually on the human head but sometimes on the face or body. The fashioning of hair can be considered an aspect of personal grooming, fashion, and cosmetics, although practical, cultural, and popular considerations also influence some hairstyles.

<span class="mw-page-title-main">Hair loss</span> Loss of hair from the head or body

Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarring is not usually present. Hair loss in some people causes psychological distress.

<span class="mw-page-title-main">Ponytail</span> Hairstyle gathering hair at the back of the head

A ponytail is a hairstyle in which some, most, or all of the hair on the head is pulled away from the face, gathered and secured at the back of the head with a hair tie, clip, or other similar accessory and allowed to hang freely from that point. It gets its name from its resemblance to the tail of a pony.

<span class="mw-page-title-main">Telogen effluvium</span> Medical condition

Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase. It is in this phase that telogen hairs begin to shed at an increased rate, where normally the approximate rate of hair loss is 125 hairs per day.

<span class="mw-page-title-main">Vellus hair</span> Type of hair that is short, thin, slight-colored, and barely noticeable

Vellus hair is short, thin, light-colored, and barely noticeable hair that develops on most of a human's body during childhood. Exceptions include the lips, the back of the ear, the palm of the hand, the sole of the foot, some external genital areas, the navel, and scar tissue. The density of hair – the number of hair follicles per area of skin – varies from person to person. Each strand of vellus hair is usually less than 2 mm long and the follicle is not connected to a sebaceous gland.

The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.

<span class="mw-page-title-main">Pattern hair loss</span> Medical condition

Pattern hair loss is a hair loss condition that primarily affects the top and front of the scalp. In male-pattern hair loss (MPHL), the hair loss typically presents itself as either a receding front hairline, loss of hair on the crown and vertex of the scalp, or a combination of both. Female-pattern hair loss (FPHL) typically presents as a diffuse thinning of the hair across the entire scalp.

Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald". Eyelashes are important in the prevention of bacteria and other foreign objects entering the eye. Some studies found that between 45 and 76 percent of patients with various types of leprosy had madarosis.

Anagen effluvium is the pathologic loss of anagen or growth-phase hairs. Classically, it is caused by radiation therapy to the head and systemic chemotherapy, especially with alkylating agents.

<span class="mw-page-title-main">Loose anagen syndrome</span> Medical condition

Loose anagen syndrome, also known as loose anagen hair syndrome, is a hair disorder related to dermatology. It is characterised by the easy and pain free detachment of anagen staged hairs from the scalp. This hair condition can be spontaneous or genetically inherited.

Scarring hair loss, also known as cicatricial alopecia, is the loss of hair which is accompanied with scarring. This is in contrast to non scarring hair loss.

Central centrifugal cicatricial alopecia (CCCA), is a type of alopecia first noticed in African Americans in the 1950s and reported by LoPresti et al. in 1968 as a result of application of petrolatum followed by a stove-heated iron comb. The original theory was that the hot petrolatum would travel down to the hair root, burn the follicle, and after repetitive injury scarring would result. Later CCCA was realized to affect men and women without a history significant for use of such styling techniques. Consequently, the terms "follicular degeneration syndrome" per Sperling and Sau in 1992 and then CCCA per Olsent et al. in 2003 were evolved. Plausible contributing factors may include other African-American styling techniques such as relaxers, tight braids, heavy extensions, certain oils, gels or pomades.

Erosive pustular dermatitis of the scalp presents with pustules, erosions, and crusts on the scalp of primarily older Caucasian females, and on biopsy, has a lymphoplasmacytic infiltrate with or without foreign body giant cells and pilosebaceous atrophy.

Tufted folliculitis presents with doll's hair-like bundling of follicular units, and is seen in a wide range of scarring conditions including chronic staphylococcal infection, chronic lupus erythematosus, lichen planopilaris, Graham-Little syndrome, folliculitis decalvans, acne keloidalis nuchae, immunobullous disorders, and dissecting cellulitis.

Pressure alopecia, also known as postoperative alopecia, and pressure-induced alopecia, occurs in adults after prolonged pressure on the scalp during general anesthesia, with the head fixed in one position, and may also occur in chronically ill persons after prolonged bed rest in one position that causes persistent pressure on one part of the scalp, all likely due to pressure-induced ischemia.

Non scarring hair loss, also known as noncicatricial alopecia is the loss of hair without any scarring being present. There is typically little inflammation and irritation, but hair loss is significant. This is in contrast to scarring hair loss during which hair follicles are replaced with scar tissue as a result of inflammation. Hair loss may be spread throughout the scalp (diffuse) or at certain spots (focal). The loss may be sudden or gradual with accompanying stress.

<span class="mw-page-title-main">Frontal fibrosing alopecia</span> Medical condition

Frontal fibrosing alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline. It is considered to be a clinical variant of lichen planopilaris.

The growth of human hair occurs everywhere on the body except for the soles of the feet, the palms of the hands, the inside of the mouth, the lips, the backs of the ears, some external genital areas, the navel, and, apart from eyelashes, the eyelids. Hair is a stratified squamous keratinized epithelium made of multi-layered flat cells whose rope-like filaments provide structure and strength to the hair shaft. The protein called keratin makes up hair and stimulates hair growth. Hair follows a specific growth cycle with three distinct and concurrent phases: anagen, catagen, and telogen. Each phase has specific characteristics that determine the length of the hair.

<span class="mw-page-title-main">Box braids</span> Hair braids which are characterized by "boxy" or square-shaped hair divisions

Box braids are a type of hair-braiding style that is predominantly popular among African people and the African diaspora. This type of hairstyle is a "protective style" and is "boxy", consisting of square-shaped hair divisions. Box braids are generally installed by using synthetic hair which helps to add thickness as well as helping the natural hair that is in the braid. Because they are not attached to the scalp like other similar styles such as cornrows, box braids can be styled in a number of different ways. The installation process of box braids can be lengthy, but once installed they can last for six to eight weeks. They are known for being easy to maintain.

Frictional alopecia is the loss of hair that is caused by rubbing of the hair, follicles, or skin around the follicle. The most typical example of this is the loss of ankle hair among people who wear socks constantly for years. The hair may not grow back even years after the source of friction has ended.

References

  1. ↑ Onalaja, Amanda A.; Taylor, Susan C. (2021). "1. Defining skin color". In Li, Becky S.; Maibach, Howard I. (eds.). Ethnic Skin and Hair and Other Cultural Considerations. Switzerland: Springer. p. 14. ISBN   978-3-030-64829-9.
  2. 1 2 Khumalo, N. P. (2012). "The "fringe sign" for public education on traction alopecia". Dermatology Online Journal. 18 (9): 16. doi:10.5070/D31H81C7S1. PMID   23031383.
  3. ↑ Samrao, A.; Price, V. H.; Zedek, D.; Mirmirani, P. (2011). "The "Fringe Sign" - A useful clinical finding in traction alopecia of the marginal hair line". Dermatology Online Journal. 17 (11): 1. doi:10.5070/D325M840MZ. PMID   22136857.
  4. ↑ Ahdout, J.; Mirmirani, P. (2012). "Weft hair extensions causing a distinctive horseshoe pattern of traction alopecia". Journal of the American Academy of Dermatology. 67 (6): e294 –e295. doi:10.1016/j.jaad.2012.07.020. PMID   23158648.
  5. ↑ Urbina, F.; Sudy, E.; Barrios, M. (2009). "Traction folliculitis: 6 cases caused by different types of hairstyle that pull on the hair". Actas Dermo-sifiliograficas. 100 (6): 503–506. doi: 10.1016/s1578-2190(09)70108-8 . PMID   19709556.
  6. ↑ Borovicka, J. H.; Thomas, L.; Prince, C.; Mehregan, D. R. (2009). "Scarring alopecia: Clinical and pathologic study of 54 African-American women". International Journal of Dermatology. 48 (8): 840–845. doi:10.1111/j.1365-4632.2009.04129.x. PMID   19659862. S2CID   25927043.
  7. 1 2 3 Fu, J. M.; Price, V. H. (2009). "Approach to Hair Loss in Women of Color". Seminars in Cutaneous Medicine and Surgery. 28 (2): 109–114. doi:10.1016/j.sder.2009.04.004. PMID   19608062.
  8. ↑ Lillis, J. V.; Guo, C. S.; Lee, J. J.; Blauvelt, A. (2010). "Traction Alopecia in a Ballerina: Clinicopathologic Features". Archives of Dermatology. 146 (8): 918–919. doi:10.1001/archdermatol.2010.183. PMID   20713841.
  9. 1 2 Billero, Victoria; Miteva, Mariya (2018-04-06). "Traction alopecia: the root of the problem". Clinical, Cosmetic and Investigational Dermatology. 11: 149–159. doi: 10.2147/CCID.S137296 . PMC   5896661 . PMID   29670386.
  10. ↑ Hensel, Ole; Kraya, Torsten (January 2025). "Primary Headache Attributed to External Compression or Traction to the Head: A Narrative Review". Brain and Behavior. 15 (1): e70202. doi:10.1002/brb3.70202. ISSN   2162-3279. PMID   39740198.
  11. ↑ Hwang, Sang Min; Lee, Won Soo; Choi, Eung Ho; Lee, Seung Hun; Ahn, Sung Ku (March 1999). "Nurse's cap alopecia". International Journal of Dermatology. 38 (3): 187–191. doi:10.1046/j.1365-4362.1999.00556.x. ISSN   0011-9059. PMID   10208613. S2CID   44404854.
  12. ↑ Karimian-Teherani, D.; El Shabrawi-Caelen, L.; Tanew, A. (2011). "Traction Alopecia in Two Adolescent Sikh Brothers-An Underrecognized Problem Unmasked by Migration". Pediatric Dermatology. 28 (3): 336–338. doi:10.1111/j.1525-1470.2011.01241.x. PMID   21371118. S2CID   205678095.
  13. ↑ Mehta, Hitaishi; Kumar, Sheetanshu; Bishnoi, Anuradha (2021). "Turban Tribulations: Triad of Turban Ear, Traction Alopecia, and Traumatic Acne in a Sikh Patient". Indian Dermatology Online Journal. 12 (5): 770–771. doi: 10.4103/idoj.IDOJ_798_20 . ISSN   2229-5178. PMC   8456239 . PMID   34667772.
  14. ↑ Shareef, Sarah J.; Rehman, Rafey; Seale, Lauren; Mohammad, Tasneem F.; Fahs, Fatima (2022-01-30). "Hijab and hair loss: a cross-sectional analysis of information on YouTube". International Journal of Dermatology. 62 (3): e193 –e194. doi:10.1111/ijd.16092. ISSN   1365-4632. PMID   35094383. S2CID   246428801.
  15. ↑ Hatsbach de Paula, Joane Nathache; Basílio, Flávia Machado Alves; Mulinari-Brenner, Fabiane Andrade (2022). "Effects of chemical straighteners on the hair shaft and scalp". Anais Brasileiros de Dermatologia. 97 (2): 193–203. doi:10.1016/j.abd.2021.02.010. ISSN   1806-4841. PMC   9073307 . PMID   35058079.
  16. ↑ Pirmez, R.; Duque-Estrada, B.; Abraham, L.S.; Pinto, G.M.; de Farias, D.C.; Kelly, Y.; Doche, I. (July 2015). "It's not all traction: the "Pseudo-fringe sign" in frontal fibrosing alopecia". British Journal of Dermatology. 173 (5): 1336–1338. doi:10.1111/bjd.14005. PMID   26138941. S2CID   8233738.
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