Traction Alopecia

Traction Alopecia:  hair shafts are extracted from their host follicles due to tight hair styling techniques e.g. pony tails, top knots, hair extensions, chignons, pleats, plaiting, tracks, cornrowing etc.   Hair follicles do not tolerate these traumatic potentially injurious activities well and many are destroyed thereby. Needless to say this can cause significant regions of permanent baldness.

Sites affected:  anywhere, however the the anterior and occipital margins, parietals and auriculars are frequently seen areas of such needless injury.

THE TRICHOLOGICAL SOCIETY

 Traction Alopecia

Dr Ruth Benjamin MB BS LTTS

INTRODUCTION:

Traction alopecia (TA) in women is also known as ballerina baldness that is caused by excessive tension or hair being pulled too tight in the same direction. 

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EPIDERMIOLOGY:

  • This is the most common form of alopecia seen in black community because of traditional method of hair styling. 
  • It is also seen in Asian Sikh boys who twist their hair and turbans very tightly on the scalp.
  • However, it can affect  any ethnic background or age. 

PREDISPOSING FACTORS AND PATHOGENESIS:

This type of alopecia can be caused by:

  • Chemical relaxers and rollers.
  • Regularly wearing tight cornrows, dreadlocks, chignon, weaves and braids
  • Hair extensions

All the above methods can cause mechanical damage of the hair follicles. Thus in area of traction inflammatory response is seen which presents as perifollicular erythema with pustules and papules. In case of chronic and repeated traction, atrophy of hair follicles occur which causes permanent hair loss. 

CLINICAL FEATURES:

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Early Stage: 

  • Itching
  • Redness
  • Folliculitis or perifollicular pustules and papules
  • Multiple short broken hairs
  • Thinning 
  • and hair loss 

Late stage:

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  • Scarring alopecia with decrease hair follicular marking occurs.

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  • Generally, traction alopecia affects the hair line. Thus the most common sites of hair loss in TA are frontal and temporoparietal areas but any area of the scalp can be affected because it depends on an individual’s hair hairstyle.  
  • “Fringe sign” is present, that means some hair is retained along the frontal and temporal rim of the hairline.   

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Fringe sign: Black arrows show the Diminutive hairs and white arrow show the region of hair loss along the temporal scalp.  

DIAGNOSIS:

PHYSICAL EXAMINATION AND HISTORY: 

  • TA people often complain the scalp hurts in the areas of increased tension.

DERMOSCOPY EXAMINATION: