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==Cause==
==Cause==
* '''Traumatic hairstyle.'''
It is commonly seen with certain hair styles like a particularly tight [[ponytail]], [[pigtail]]s, [[braid]] or braiding pattern that pulls the hairline forcefully towards the vertex of the scalp,<ref>{{Cite journal | last1 = Ahdout | first1 = J. | last2 = Mirmirani | first2 = P. | doi = 10.1016/j.jaad.2012.07.020 | title = Weft hair extensions causing a distinctive horseshoe pattern of traction alopecia | journal = Journal of the American Academy of Dermatology | volume = 67 | issue = 6 | pages = e294–e295 | year = 2012 | pmid = 23158648 }}</ref><ref>{{Cite journal | last1 = Urbina | first1 = F. | last2 = Sudy | first2 = E. | last3 = Barrios | first3 = M. | title = Traction folliculitis: 6 cases caused by different types of hairstyle that pull on the hair | journal = Actas Dermo-sifiliograficas | volume = 100 | issue = 6 | pages = 503–506 | year = 2009 | pmid = 19709556 | doi=10.1016/s1578-2190(09)70108-8| doi-access = free }}</ref> and has been reported more often in African American women (as some wear their hair tightly pulled back), sometimes causing scarring.<ref>{{Cite journal | last1 = Borovicka | first1 = J. H. | last2 = Thomas | first2 = L. | last3 = Prince | first3 = C. | last4 = Mehregan | first4 = D. R. | title = Scarring alopecia: Clinical and pathologic study of 54 African-American women | doi = 10.1111/j.1365-4632.2009.04129.x | journal = International Journal of Dermatology | volume = 48 | issue = 8 | pages = 840–845 | year = 2009 | pmid = 19659862 | s2cid = 25927043 }}</ref><ref name="G">{{Cite journal | last1 = Fu | first1 = J. M. | last2 = Price | first2 = V. H. | doi = 10.1016/j.sder.2009.04.004 | title = Approach to Hair Loss in Women of Color | journal = Seminars in Cutaneous Medicine and Surgery | volume = 28 | issue = 2 | pages = 109–114 | year = 2009 | pmid = 19608062 }}</ref> It has also been seen in female ballerinas,<ref>{{Cite journal | last1 = Lillis | first1 = J. V. | last2 = Guo | first2 = C. S. | last3 = Lee | first3 = J. J. | last4 = Blauvelt | first4 = A. | doi = 10.1001/archdermatol.2010.183 | title = Traction Alopecia in a Ballerina: Clinicopathologic Features | journal = Archives of Dermatology | volume = 146 | issue = 8 | pages = 918–919 | year = 2010 | pmid = 20713841 }}</ref> 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|date=April 2020}} Traction alopecia is mechanical in cause, rather than androgenic.<ref name="G"/>
It is commonly seen with certain hair styles like a particularly tight [[ponytail]], [[pigtail]]s, [[braid]] or braiding pattern that pulls the hairline forcefully towards the vertex of the scalp,<ref>{{Cite journal | last1 = Ahdout | first1 = J. | last2 = Mirmirani | first2 = P. | doi = 10.1016/j.jaad.2012.07.020 | title = Weft hair extensions causing a distinctive horseshoe pattern of traction alopecia | journal = Journal of the American Academy of Dermatology | volume = 67 | issue = 6 | pages = e294–e295 | year = 2012 | pmid = 23158648 }}</ref><ref>{{Cite journal | last1 = Urbina | first1 = F. | last2 = Sudy | first2 = E. | last3 = Barrios | first3 = M. | title = Traction folliculitis: 6 cases caused by different types of hairstyle that pull on the hair | journal = Actas Dermo-sifiliograficas | volume = 100 | issue = 6 | pages = 503–506 | year = 2009 | pmid = 19709556 | doi=10.1016/s1578-2190(09)70108-8| doi-access = free }}</ref> and has been reported more often in African American women (as some wear their hair tightly pulled back), sometimes causing scarring.<ref>{{Cite journal | last1 = Borovicka | first1 = J. H. | last2 = Thomas | first2 = L. | last3 = Prince | first3 = C. | last4 = Mehregan | first4 = D. R. | title = Scarring alopecia: Clinical and pathologic study of 54 African-American women | doi = 10.1111/j.1365-4632.2009.04129.x | journal = International Journal of Dermatology | volume = 48 | issue = 8 | pages = 840–845 | year = 2009 | pmid = 19659862 | s2cid = 25927043 }}</ref><ref name="G">{{Cite journal | last1 = Fu | first1 = J. M. | last2 = Price | first2 = V. H. | doi = 10.1016/j.sder.2009.04.004 | title = Approach to Hair Loss in Women of Color | journal = Seminars in Cutaneous Medicine and Surgery | volume = 28 | issue = 2 | pages = 109–114 | year = 2009 | pmid = 19608062 }}</ref> It has also been seen in female ballerinas,<ref>{{Cite journal | last1 = Lillis | first1 = J. V. | last2 = Guo | first2 = C. S. | last3 = Lee | first3 = J. J. | last4 = Blauvelt | first4 = A. | doi = 10.1001/archdermatol.2010.183 | title = Traction Alopecia in a Ballerina: Clinicopathologic Features | journal = Archives of Dermatology | volume = 146 | issue = 8 | pages = 918–919 | year = 2010 | pmid = 20713841 }}</ref> 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|date=April 2020}} Traction alopecia is mechanical in cause, rather than androgenic.<ref name="G"/> Traction alopecia is a substantial risk in [[hair weave]]s, which can be worn either to conceal [[hair loss]], or purely for [[Beauty|cosmetic]] purposes. The former involves creating a [[braid]] around the head below the existing hairline, to which an extended-wear hairpiece, or [[Wig (hair)|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.<ref name="billero">{{Cite journal |last=Billero |first=Victoria |last2=Miteva |first2=Mariya |date=2018-04-06 |title=Traction alopecia: the root of the problem |url=https://www.dovepress.com/traction-alopecia-the-root-of-the-problem-peer-reviewed-fulltext-article-CCID |journal=Clinical, Cosmetic and Investigational Dermatology |language=English |volume=11 |pages=149–159 |doi=10.2147/CCID.S137296 |pmc=PMC5896661 |pmid=29670386}}</ref>

Traction alopecia is a substantial risk in [[hair weave]]s, which can be worn either to conceal [[hair loss]], or purely for [[Beauty|cosmetic]] purposes. The former involves creating a [[braid]] around the head below the existing hairline, to which an extended-wear hairpiece, or [[Wig (hair)|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. Traction alopecia is one of the most common causes of hair loss in African American women.
Sikh men are also susceptible to traction alopecia if the [[Kesh (Sikhism)|hair under the turban]] is tied too tightly for many years.<ref>{{Cite journal | last1 = Karimian-Teherani | first1 = D. | last2 = El Shabrawi-Caelen | first2 = L. | last3 = Tanew | first3 = A. | doi = 10.1111/j.1525-1470.2011.01241.x | title = Traction Alopecia in Two Adolescent Sikh Brothers-An Underrecognized Problem Unmasked by Migration | journal = Pediatric Dermatology | volume = 28 | issue = 3 | pages = 336–338 | year = 2011 | pmid = 21371118 | s2cid = 205678095 }}</ref>
Sikh men are also susceptible to traction alopecia if the [[Kesh (Sikhism)|hair under the turban]] is tied too tightly for many years.<ref>{{Cite journal | last1 = Karimian-Teherani | first1 = D. | last2 = El Shabrawi-Caelen | first2 = L. | last3 = Tanew | first3 = A. | doi = 10.1111/j.1525-1470.2011.01241.x | title = Traction Alopecia in Two Adolescent Sikh Brothers-An Underrecognized Problem Unmasked by Migration | journal = Pediatric Dermatology | volume = 28 | issue = 3 | pages = 336–338 | year = 2011 | pmid = 21371118 | s2cid = 205678095 }}</ref>


Other causes include:
* '''Hairstyle.''' Although the aforementioned style is one of the culprits, hairstyles such as 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.
* '''Headgear.'''
* '''Headgear.'''
**Nurses who wear caps which are tightly secured by pins at the side or back of the head can develop traction alopecia.<ref>{{Cite journal |last=Hwang |first=Sang Min |last2=Lee |first2=Won Soo |last3=Choi |first3=Eung Ho |last4=Lee |first4=Seung Hun |last5=Ahn |first5=Sung Ku |date=1999-03 |title=Nurse's cap alopecia |url=http://doi.wiley.com/10.1046/j.1365-4362.1999.00556.x |journal=International Journal of Dermatology |language=en |volume=38 |issue=3 |pages=187–191 |doi=10.1046/j.1365-4362.1999.00556.x |issn=0011-9059}}</ref>
**Nurses who wear caps which are tightly secured by pins at the side or back of the head can develop traction alopecia.<ref>{{Cite journal |last=Hwang |first=Sang Min |last2=Lee |first2=Won Soo |last3=Choi |first3=Eung Ho |last4=Lee |first4=Seung Hun |last5=Ahn |first5=Sung Ku |date=1999-03 |title=Nurse's cap alopecia |url=http://doi.wiley.com/10.1046/j.1365-4362.1999.00556.x |journal=International Journal of Dermatology |language=en |volume=38 |issue=3 |pages=187–191 |doi=10.1046/j.1365-4362.1999.00556.x |issn=0011-9059}}</ref>
**Compressive safety helmets worn tightly and closely to the scalp are a cause of traction alopecia. The lining of tightly fitted safety helmets like those worn for activities such as motorcycling, cycling, skiing and snowboarding are responsible for the constant rubbing and tugging of localised areas of the hair and scalp. Frequent wearers or those who use such helmets for prolonged periods seem more likely to develop traction alopecia.{{citation needed|date=August 2012}}
**Compressive safety helmets worn tightly and closely to the scalp are a cause of traction alopecia. The lining of tightly fitted safety helmets like those worn for activities such as motorcycling, cycling, skiing and snowboarding are responsible for the constant rubbing and tugging of localised areas of the hair and scalp. Frequent wearers or those who use such helmets for prolonged periods seem more likely to develop traction alopecia.{{citation needed|date=August 2012}}
* '''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.<ref>{{Cite journal |last=Hatsbach de Paula |first=Joane Nathache |last2=Basílio |first2=Flávia Machado Alves |last3=Mulinari-Brenner |first3=Fabiane Andrade |date=2022 |title=Effects of chemical straighteners on the hair shaft and scalp |url=https://pubmed.ncbi.nlm.nih.gov/35058079/ |journal=Anais Brasileiros De Dermatologia |volume=97 |issue=2 |pages=193–203 |doi=10.1016/j.abd.2021.02.010 |issn=1806-4841 |pmc=9073307 |pmid=35058079}}</ref>
* '''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.<ref>{{Cite journal |last=Hatsbach de Paula |first=Joane Nathache |last2=Basílio |first2=Flávia Machado Alves |last3=Mulinari-Brenner |first3=Fabiane Andrade |date=2022 |title=Effects of chemical straighteners on the hair shaft and scalp |url=https://pubmed.ncbi.nlm.nih.gov/35058079/ |journal=Anais Brasileiros De Dermatologia |volume=97 |issue=2 |pages=193–203 |doi=10.1016/j.abd.2021.02.010 |issn=1806-4841 |pmc=9073307 |pmid=35058079}}</ref>

==Diagnosis==
==Diagnosis==
Traction alopecia is characterized by a fringe along the marginal hairline on [[physical exam]], a recession of the hairline due to chronic traction.<ref name="fringe"/> Even though this "fringe sign" is considered a useful clinical marker of this condition, cases of frontal fibrosing alopecia presenting with an unusual retention of the hairline (pseudo-fringe sign) have been described.<ref>{{cite journal|last1=Pirmez|first1=R.|last2=Duque-Estrada|first2=B.|last3=Abraham|first3=L.S.|last4=Pinto|first4=G.M.|last5=de Farias|first5=D.C.|last6=Kelly|first6=Y.|last7=Doche|first7=I.|title=It's not all traction: the "Pseudo-fringe sign" in frontal fibrosing alopecia|journal=British Journal of Dermatology|date=July 2015|pages=1336–1338|doi=10.1111/bjd.14005|pmid=26138941|volume=173|issue=5|s2cid=8233738}}</ref>
Traction alopecia is characterized by a fringe along the marginal hairline on [[physical exam]], a recession of the hairline due to chronic traction.<ref name="fringe"/> Even though this "fringe sign" is considered a useful clinical marker of this condition, cases of frontal fibrosing alopecia presenting with an unusual retention of the hairline (pseudo-fringe sign) have been described.<ref>{{cite journal|last1=Pirmez|first1=R.|last2=Duque-Estrada|first2=B.|last3=Abraham|first3=L.S.|last4=Pinto|first4=G.M.|last5=de Farias|first5=D.C.|last6=Kelly|first6=Y.|last7=Doche|first7=I.|title=It's not all traction: the "Pseudo-fringe sign" in frontal fibrosing alopecia|journal=British Journal of Dermatology|date=July 2015|pages=1336–1338|doi=10.1111/bjd.14005|pmid=26138941|volume=173|issue=5|s2cid=8233738}}</ref>

Revision as of 10:56, 12 December 2022

Traction alopecia is a type of hair loss caused by a pulling force being applied to the hair.[1] This commonly results from a person frequently wearing their hair in a particularly tight ponytail, pigtails, or braids. It is also seen occasionally in long-haired people who use barrettes to keep hair out of their faces. Traction alopecia is recession of the hairline due to chronic traction, or hair pulling, and 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.

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 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] Sikh men are also susceptible to traction alopecia if the hair under the turban is tied too tightly for many years.[10]

  • Headgear.
    • Nurses who wear caps which are tightly secured by pins at the side or back of the head can develop traction alopecia.[11]
    • Compressive safety helmets worn tightly and closely to the scalp are a cause of traction alopecia. The lining of tightly fitted safety helmets like those worn for activities such as motorcycling, cycling, skiing and snowboarding are responsible for the constant rubbing and tugging of localised areas of the hair and scalp. Frequent wearers or those who use such helmets for prolonged periods seem more likely to develop traction alopecia.[citation needed]
  • 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.[12]

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] Even though this "fringe sign" is considered a useful clinical marker of this condition, cases of frontal fibrosing alopecia presenting with an unusual retention of the hairline (pseudo-fringe sign) have been described.[13]

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

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. ^ a b 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. ^ a b c 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. ^ 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.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  10. ^ 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.
  11. ^ Hwang, Sang Min; Lee, Won Soo; Choi, Eung Ho; Lee, Seung Hun; Ahn, Sung Ku (1999-03). "Nurse's cap alopecia". International Journal of Dermatology. 38 (3): 187–191. doi:10.1046/j.1365-4362.1999.00556.x. ISSN 0011-9059. {{cite journal}}: Check date values in: |date= (help)
  12. ^ 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.
  13. ^ 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.

External links

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