Overview
Traction alopecia is a type of hair loss caused by prolonged or repetitive tension on the scalp hair. First described in 1907 among individuals from Greenland who wore tight ponytails, it results from hairstyles that pull on the hair roots over time.
Causes of Traction Alopecia
Traction alopecia occurs due to several hair practices that exert tension on the hair, including:
- Regularly wearing tight hairstyles such as chignons, cornrows, dreadlocks, weaves, and braids.
- Using hair extensions.
- Applying chemical relaxers and rollers.
- The weight of excessively long hair.
It is commonly seen in African American females who wear tight braids, leading to hair loss on the temporal scalp. It can also occur in Sikh males who twist their uncut hair tightly on the scalp or beard. While traction alopecia can affect individuals of any ethnic background or age, its likelihood increases with age due to a prolonged history of these hair practices.
Symptoms of Traction Alopecia
The clinical presentation of traction alopecia varies widely. Common symptoms include:
- Itching
- Redness
- Scaling
- Folliculitis (inflammation of hair follicles) or pustules
- Multiple short broken hairs
- Thinning and hair loss
Traction alopecia primarily affects the frontal and temporal regions of the scalp. A typical sign is the “fringe sign,” where some hair is retained along the hairline’s rim. Initially, the condition is non-scarring (non-cicatricial), but prolonged tension can lead to permanent hair loss due to hair follicle destruction.
Diagnosis of Traction Alopecia
Clinical Diagnosis
Diagnosis of traction alopecia is primarily clinical, based on the patient’s history and physical examination. If the condition is suspected, a detailed history of hair care practices is crucial.
Diagnostic Tools
- Dermatoscopy: This non-invasive tool helps visualize hair and scalp structures, aiding in the diagnosis.
- Skin Biopsy: If there is diagnostic uncertainty, a biopsy may be performed. Histological findings vary depending on the stage of progression. Early stages show thinned-out hair (trichomalacia), an increased number of catagen and telogen hairs, and preserved sebaceous glands. Later stages show vellus hairs, reduced sebaceous glands and terminal hair follicles, and the presence of fibrotic tracts.
Treatment of Traction Alopecia
Preventing further hair loss involves changing hair care and styling practices:
- Loosen hairstyles.
- Cut long hair to reduce weight.
- Avoid chemicals and heat on affected hair and scalp.
Medical Treatments
Various treatments can help manage traction alopecia:
- Antibiotics: To prevent or treat infection.
- Topical and Intralesional Steroids: To reduce inflammation.
- Topical Antifungal Shampoos: To manage scalp infections.
- Biotin Supplements: To strengthen hair.
- Minoxidil (Rogaine): To promote hair regrowth.
- Hair Replacement Surgery: For cases with significant hair loss where hair does not regrow.
Complications of Traction Alopecia
Complications of traction alopecia include:
- Redness of the scalp
- Bumps
- Soreness or stinging
- Itching
- Scaling
- Folliculitis
- Pus-filled blisters
The hair follicles can become so damaged and scarred that they can no longer produce new hair. Unlike other forms of alopecia, traction alopecia usually affects only the hair that has been pulled.
References
Mayo Clinic. (2023). Traction Alopecia. Retrieved from https://www.mayoclinic.org/diseases-conditions/traction-alopecia/symptoms-causes/syc-20355859
National Health Service (NHS). (2023). Traction Alopecia. Retrieved from https://www.nhs.uk/conditions/traction-alopecia/
DermNet New Zealand. (2023). Traction Alopecia. Retrieved from https://dermnetnz.org/topics/traction-alopecia
Stanford Health Care. (2023). Traction Alopecia. Retrieved from https://stanfordhealthcare.org/medical-conditions/skin-hair-and-nails/traction-alopecia.html
