Definition of Traction Alopecia

The term traction alopecia (TA) means hair loss which is caused by continuously pulling hair. It does not cause scare, and typically characterized with preservation of follicular stem cells at early stages. In case of prolonged and excessive alopecia, it may return to permanent and scarring form, which causes serious hair loss. TA is more common in American-African individuals than other ethnicities. 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.

The location of hair loss or effects of TA depends on hair care practices, and common sides of the scalp and front hairline. Although TA affects any areas on the scalp, there are two common clinical types of TA which are non-marginal and marginal alopecia. Marginal hair loss is common along the parietal, frontal and temporal hairlines and associated with 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. Using grooming accessories for mechanically styling of hair causes patterns of hair loses on the scalp, and hair loss starts just in front of the ears in marginal alopecia.

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

In early stages of TA, pathologic features are biphasic, and diagnosis is mainly related with pathologic-clinical interventions. 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. Appropriate and relevant questions of patients increase diagnosis of TA. Clinical signs of TA are reported as multiple short broken hairs, erythema, folliculitis, scalling or pruritus. Traction folliculitis may be a predictor of later TA.

Although TA has a significant prevalence and causes hair loss especially among women, it is a preventable and treatable health problem. 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. 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 topcal 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 lost regions. There are two surgical methods including scalp reduction and hair transplantation. Although scalp reduction surgery which involves surgical removal of the area, it does not gives a sophisticated solution than hair transplantation.

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