Traction alopecia in Adult
TA usually involves the temporal region bilaterally, but the condition can be found on any area of the scalp where hair is pulled tightly in various hairstyles, eg, braids, weaves, ponytails, and dreadlocks. Symptoms of a tender, itchy scalp and headaches may be reported.
TA is more common in women and girls, particularly of African descent. This is attributed to the unique mechanical features of African hair and the type of hair grooming that is practiced in certain cultures. African hair is drier, asymmetrical, and helical in shape, which lead to points of weaknesses along the hair shaft. This makes it more susceptible to breakage during combing and to TA when hair is worn in tight styles for prolonged periods. TA is worsened if the hair is chemically relaxed because relaxers weaken the tight disulfide bonds, rendering the hair shaft thinner and drier.
TA is seen in indigenous populations in Western Greenland, young Danish girls with ponytails, ballet dancers, and any ethnic group that styles hair with tension to the frontal region of the scalp. TA also occurs with work-related gear such as helmets, hair caps, headbands, and nurses' caps. It is also seen in religious gear, eg, nuns' coifs and Sikh men who wear turbans.
L66.8 – Other cicatricial alopecia
67488005 – Traumatic alopecia
Differential Diagnosis & Pitfalls
- Alopecia areata – Usually causes round areas of nonscarring hair loss. However, the ophiasis type of alopecia areata is hard to differentiate clinically.
- Trichotillomania – The patient is pulling hair out.
- Telogen effluvium – Nonscarring hair loss as a result of medication or severe illness.
- Frontal fibrosing alopecia – Scarring alopecia with absence of fringe sign.