Traumatic alopecia in Adult
In traction alopecia, if the stimulus causing the traction is removed early, affected hair will recover. However, chronic long-term friction can cause permanent hair loss. Traction alopecia secondary to braids often results in hair loss on the scalp margin. It is more common in females and Black individuals due to hair-styling practices for tight braids or the use of chemical hair straighteners.
Trichotillomania is usually diagnosed in adolescents and preteens, although it also occurs in adults. It is characterized by irregular patches of alopecia without evidence of scarring. Adults with trichotillomania may have other comorbid diagnoses such as anxiety disorder, depression, or attention deficit hyperactivity disorder (ADHD).
Pressure-induced alopecia refers to hair loss induced by localized pressure on the scalp due to prolonged immobilization. This results in a focal area of hair loss occurring several days to weeks after the initial trigger. The alopecia may be nonscarring (if diagnosed early) or scarring (if diagnosis is delayed). Any age group may be affected.
Alopecia from abuse is classically associated with other signs of trauma such as scalp bruising and tenderness.
L65.9 – Nonscarring hair loss, unspecified
67488005 – Traumatic alopecia
Differential Diagnosis & Pitfalls
- Alopecia areata
- Tinea capitis
- Seborrheic dermatitis
- Telogen effluvium (diffuse hair loss often following illness or a stressful event 6 weeks to 3 months prior)
- Endocrine disorders of the thyroid and adrenal gland
- Exposure to toxins such as radiation or chemotherapy (see also drug-induced alopecia)
- Collagen vascular diseases, including lupus erythematosus
- Malnutrition, including anorexia nervosa, gluten enteropathy, acquired zinc deficiency, and iron deficiency
- Alopecia neoplastica