Traction alopecia

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,{{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 }}{{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 }} and has been reported more often in African American women (as some wear their hair tightly pulled back), sometimes causing scarring.{{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 }}{{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 }} It has also been seen in female ballerinas,{{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 }} and seen occasionally in long-haired people who use barrettes to keep hair out of their faces 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. 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.{{Cite journal |last1=Billero |first1=Victoria |last2=Miteva |first2=Mariya |date=2018-04-06 |title=Traction alopecia: the root of the problem |journal=Clinical, Cosmetic and Investigational Dermatology |language=English |volume=11 |pages=149–159 |doi=10.2147/CCID.S137296 |pmc=5896661 |pmid=29670386 |doi-access=free }}

Tight or heavy hairstyles, such as long box braids, can also cause an external-traction headache, previously called a ponytail headache.{{Cite journal |last=Hensel |first=Ole |last2=Kraya |first2=Torsten |date=January 2025 |title=Primary Headache Attributed to External Compression or Traction to the Head: A Narrative Review |url=https://pubmed.ncbi.nlm.nih.gov/39740198/ |journal=Brain and Behavior |volume=15 |issue=1 |pages=e70202 |doi=10.1002/brb3.70202 |issn=2162-3279 |pmid=39740198|pmc=11685174 }}

• Nurses who wear caps which are tightly secured by pins at the side or back of the head can develop traction alopecia.{{Cite journal |last1=Hwang |first1=Sang Min |last2=Lee |first2=Won Soo |last3=Choi |first3=Eung Ho |last4=Lee |first4=Seung Hun |last5=Ahn |first5=Sung Ku |date=March 1999 |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 |pmid=10208613 |s2cid=44404854 |issn=0011-9059|url-access=subscription }}
• Sikh men{{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 }} and women are susceptible to traction alopecia if the hair under the turban is tied too tightly for many years.{{Cite journal |last1=Mehta |first1=Hitaishi |last2=Kumar |first2=Sheetanshu |last3=Bishnoi |first3=Anuradha |date=2021 |title=Turban Tribulations: Triad of Turban Ear, Traction Alopecia, and Traumatic Acne in a Sikh Patient |journal=Indian Dermatology Online Journal |volume=12 |issue=5 |pages=770–771 |doi=10.4103/idoj.IDOJ_798_20 |issn=2229-5178 |pmc=8456239 |pmid=34667772 |doi-access=free }}
• The way in which a hijab is worn and the hairstyle used underneath may also contribute to hair loss.{{Cite journal |last1=Shareef |first1=Sarah J. |last2=Rehman |first2=Rafey |last3=Seale |first3=Lauren |last4=Mohammad |first4=Tasneem F. |last5=Fahs |first5=Fatima |date=2022-01-30 |title=Hijab and hair loss: a cross-sectional analysis of information on YouTube |url=https://pubmed.ncbi.nlm.nih.gov/35094383/ |journal=International Journal of Dermatology |volume=62 |issue=3 |pages=e193–e194 |doi=10.1111/ijd.16092 |issn=1365-4632 |pmid=35094383|s2cid=246428801 }}
• 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}}

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.{{Cite journal |last1=Hatsbach de Paula |first1=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 |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}}

Traction alopecia is characterized by a fringe along the marginal hairline on physical exam, a recession of the hairline due to chronic traction.

Differential diagnosis of this type of patchy alopecia when it is in the non scarring stage includes trichotillomania and alopecia areata, in the late stage, when smooth hairless patches are present with follicular drop out, it can resemble scarring alopecias such as frontal fibrosing alopecia (FFA) and patchy central centrifugal cicatricial alopecia (CCCA).

Frontal fibrosing alopecia can present with an unusual retention of the hairline (pseudo-fringe sign).{{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}}

Treatment is typically not pharmaceutical. Management includes cessation of the chronic traction, cosmeses, with surgical restoration reserved for more severe cases with scarring fibrosis.

• Croydon facelift
• Cicatricial alopecia
• List of cutaneous conditions

{{Reflist}}

• [https://hairpanda.net/19-reasons-of-hair-fall/ Causes of Hairloss] {{Webarchive|url=https://web.archive.org/web/20210112133208/https://hairpanda.net/19-reasons-of-hair-fall/ |date=2021-01-12 }}

{{Medical resources

| DiseasesDB = 32586

| ICD10 = {{ICD10|L|65|8|l|60}} (ILDS L65.852)

| ICD9 =

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| eMedicineSubj = derm

| eMedicineTopic = 895

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{{Disorders of skin appendages}}

Category:Conditions of the skin appendages