Definition of Traction Alopecia

The term traction alopecia (TA) means hair loss which is caused by continuous pull of hair. At early stages it does not cause scarring, and it is typically characterized with preservation of follicular. In case of prolonged pull of hair and excessive alopecia, it may change its form  to permanent and scarring type, which causes serious hair loss (1). TA is more common in American-African individuals than other ethnicities (2). Although it is still a common hair loss problem, the first TA was reported and named as alopecia groenlandica, since ponytail was common among girls and women in Greenland (3).

The area of hair loss and  effects of TA depend on hair care practices, and it mostly affects the sides of the scalp and front hairline (1). Although TA affects any areas on the scalp, there are two common clinical types of TA which are non-marginal and marginal alopecia (4). Marginal hair loss is common along the parietal, frontal and temporal hairlines and associated with the use of weaves, cornrows, ponytails, and dreadlocks in order to give shape to the hair. Non-marginal alopecia is characterized by foci of tension on the scalp (5). Using grooming accessories for mechanically styling of hair causes patterns of hair losses on the scalp, and hair loss starts just in front of the ears in marginal alopecia (3).

There are several risk factors for TA such as using chemicals to straighten hair of the African type or tight braiding of hair, besides continuously pulling hair (4).

In early stages of TA, pathologic features are biphasic, and diagnosis is mainly related with pathologic-clinical interventions (6). Different from hair loss in frontal fibrosing alopecia, TA preserves fringe signs which may be a clinical sign of TA. Thus, Dermoscopy is used for detection and diagnosis of TA (4). Appropriate and relevant questions of patients increase the chances of  diagnosis of TA (7). Clinical signs of TA are reported as multiple short broken hairs, erythema, folliculitis, scaling or pruritus. Traction folliculitis may be a predictor of later TA (5).

Although TA has a significant prevalence and causes hair loss especially among women, it is a preventable and treatable health problem (7). Prevention of TA includes stopping use of weaves, cornrows, ponytails, and dreadlocks in order to give shape to the hair, which causes marginal alopecia. In early stage of alopecia, oral or topical antibiotics may be used for folliculitis treatment. This treatment may reduce superinfection and inflammation (3). In addition to use of antibiotics to prevent infections, topical steroids are also used for reduce swelling of the scalp. Antifungal shampoos, biotin and vitamin supplements, and use of topical minoxidil solution or foam at 2% to 5% may also help treatment of TA. In case of permanent hair loss, surgical treatments are used to treat hair loss regions. There are two surgical methods including scalp reduction and hair transplantation. The scalp reduction surgery involves surgical removal of the area and the hair transplantation involves the transfer of the healthy hair follicles to the alopecic area.  The result of hair transplantation surgery is much better when compared to scalp reduction surgery.

References

  1. Ngwanya RM, Adeola HA, Beach RA, et al. (2019). Reliability of Histopathology for the Early Recognition of Fibrosis in Traction Alopecia: Correlation with Clinical Severity. Dermatopathology (Basel), 6(2), 170-181.
  2. Jodie Raffi BA, Raagini Suresh BS, Oma Agbai MD. (2019). Clinical recognition and management of alopecia in women of color. International Journal of Women’s Dermatology, 5(2019), 314–319.
  3. Hantash, B. M. and Schwartz, R. A. (2002). Traction Alopecia in Children. Pediatric Dermatology, 71(1), 18-20.
  4. Billero, V. and Miteva, M. (2018). Traction alopecia: the root of the problem. Clinical, Cosmetic and Investigational Dermatology, 11(1), 149–159.
  5. Kaminska, ECN, Francis S and Stein SL (2012). Traction Alopecia: A Clinical Approach to Diagnosis and Management. Cosmet Dermatol, 25(1), 118-124.
  6. Deepika P, Sushama M, Chidrawar VR, Umamaheswara Rao V, Venkateswara Reddy.B (2014). Journal of Global Trends in Pharmaceutical Sciences, 5(1), 1431-1442.
  7. Mirmirani, P and Khumalo NP (2014). Traction Alopecia How to Translate Study Data for Public Education—Closing the KAP Gap? Dermatol Clin, 32 (2014), 153–161.