Traction alopecia is a type of

alopecia Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scar ...

or hair loss caused by a chronic pulling force being applied to the hair. It commonly results from a person frequently wearing their hair in a particularly tight ponytail,

pigtail A woman with long pigtails and braids. In the context of hairstyles, the usage of the term pigtail (or twin tail or twintail) shows considerable variation. The term may refer to a single braid, but is more frequently used in the plural ("pi ...

s, or

braid A braid (also referred to as a plait) is a complex structure or pattern formed by interlacing two or more strands of flexible material such as textile yarns, wire, or hair. The simplest and most common version is a flat, solid, three-strande ...

s with increased odds when hair is chemically relaxed as this compromises the hair shaft's

tensile strengt In physics, tension is described as the pulling force transmitted axially by the means of a string, a rope, chain, or similar object, or by each end of a rod, truss member, or similar three-dimensional object; tension might also be described as t ...

resulting in hair breakage. Traction alopecia causes a recession of the hairline due to chronic traction, which is characterized by a fringe along the marginal hairline on physical exam. 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,

or braiding pattern that pulls the hairline forcefully towards the vertex of the scalp, and has been reported more often in African American women (as some wear their hair tightly pulled back), sometimes causing scarring. It has also been seen in female ballerinas, and seen occasionally in long-haired people who use

barrette A barrette (American English), also known as a hair slide (British English), or a hair clip, is a clasp for holding hair in place. They are often made from metal or plastic and sometimes feature decorative fabric. In one type of barrette, a cla ...

s 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. Traction alopecia is mechanical in cause, rather than androgenic. Traction alopecia is a substantial risk in

hair weave Artificial hair integrations, more commonly known as hair extensions, hair weaves, and fake hair add length and fullness to human hair. Hair extensions are usually clipped, glued, or sewn on natural hair by incorporating additional human or syn ...

s, which can be worn either to conceal

hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scar ...

, or purely for

cosmetic Cosmetic may refer to: *Cosmetics, or make-up, substances to enhance the beauty of the human body, apart from simple cleaning *Cosmetic, an adjective describing beauty, aesthetics, or appearance, especially concerning the human body *Cosmetic, a t ...

purposes. The former involves creating a

around the head below the existing hairline, to which an extended-wear hairpiece, or

wig A wig is a head or hair accessory made from human hair, animal hair, or synthetic fiber. The word wig is short for periwig, which makes its earliest known appearance in the English language in William Shakespeare's ''The Two Gentlemen of Verona' ...

, 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. * Headgear. **Nurses who wear caps which are tightly secured by pins at the side or back of the head can develop traction alopecia. **

Sikh Sikhs ( or ; pa, ਸਿੱਖ, ' ) are people who adhere to Sikhism, Sikhism (Sikhi), a Monotheism, monotheistic religion that originated in the late 15th century in the Punjab region of the Indian subcontinent, based on the revelation of Gu ...

men and women are susceptible to traction alopecia if the hair under the turban is tied too tightly for many years. **The way in which a

hijab In modern usage, hijab ( ar, حجاب, translit=ḥijāb, ) generally refers to headcoverings worn by Muslim women. Many Muslims believe it is obligatory for every female Muslim who has reached the age of puberty to wear a head covering. While s ...

is worn and the hairstyle used underneath may also contribute to hair loss. **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. * 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.

Diagnosis

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 In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

of this type of patchy alopecia when it is in the non scarring stage includes

trichotillomania Trichotillomania (TTM), also known as hair-pulling disorder or compulsive hair pulling, is a mental disorder characterized by a long-term urge that results in the pulling out of one's own hair. A brief positive feeling may occur as hair is remov ...

and

alopecia areata Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often, it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress and illness are pos ...

, 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).

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.

References

External links

Causes of Hairloss
{{Disorders of skin appendages Conditions of the skin appendages

Cause

Diagnosis

Treatment

See also

References

External links