47-Year-Old Female with Alopecia on the Frontal and Temporal Scalp

Abstract

Traction alopecia (TA) is a commonly encountered cause of hair loss that results from repetitive pulling forces on the hair root. TA may present in both adults and children. Hair styling behavior that induces traction results in mechanical damage to the hair follicle and dermal papilla. The initial presentation of patients afflicted with TA involves hair loss in the areas subjected to increased tension with retained hair along the frontotemporal area. TA may be diagnosed clinically or upon histological analysis. When addressed at the early onset of disease, TA may be reversible. However, chronic TA as evidenced by scarring and fibrosis is typically irreversible. Early diagnosis and treatment are imperative, as treatment is dependent upon the stage of disease. The histological findings of early-stage TA may display hair follicle loosening with evidence of inflammation and folliculitis. Additional clinical findings may include trichomalacia and increased number of telogen and catagen hairs. Preventive education involving the avoidance of behaviors increasing tension on the hair should accompany pharmacotherapy. Educational interventions may include counseling on the avoidance of hairstyles causing pain as well as promoting hairstyles that will reduce traction. Patients should be counseled on avoiding brushing, chemicals, or heat, as these practices can increase the risk of hair follicle damage. The goal of treatment in TA is to reduce inflammation and promote hair regrowth. The mainstay of treatment in the pediatric population is education and prevention. Adults in the early stages of TA may be treated with regimens including topical or injectable corticosteroids. Potential side effects include dyschromia and hypopigmentation. Topical minoxidil use may also be considered in the adult population. If pustules or folliculitis is evident, topical antibiotics such as topical or systemic antimicrobial therapy may be considered. Later stage TA management includes surgical options, hair transplantation, or camouflaging techniques. Investigational therapies include topical alpha-antagonist, platelet-rich plasma, and laser-assisted drug therapies.