Traction Alopecia Research Articles

Trichoscopic Clues for Diagnosis of Patchy Scalp Alopecia in the Egyptian Patients

Background: trichoscopy is a non-invasive office technique used for differentiating cicatricial from noncicatricial alopecia. Trichoscopy helps the dermatologist for diagnosis of alopecia with rarely need of histopathology. Hair loss is distressing problem and associated with psychological complications. Common causes of hair loss include Alopecia areata, Tinea capitis, Traction alopecia and trichotillomania. Objective: this study aimed to assess the trichoscopic features in the Egyptian patients with patchy hair loss and to find sensitive and/or specific trichoscopic findings that can help in their diagnosis and follow up. Methodology: our study included 500 patients categorized into two groups cicatricial (176 cases) and noncicatricial (324 cases). Cicatricial included four types 2ry alopecia 139, DLE 24. FD 5 &LPP 8 and non-cicatricial included five types AA 148, localized androgenetic 21, CTA 15, TC 117 and TTM 23. Results: in our study, the sensitivity and specificity of trichoscopic patterns were evaluated in diagnosis of PCAs and NCAs. We found some trichoscopic patterns that were sensitive and specific for making diagnosis of PCAs. The perifollicular scale had 90% sensitivity and 99.5% specificity for a diagnosis of PCAs. Hair tufting was only observed in LPP and FD. This study showed 100% specificity for the presence of each blood vessel pattern that was seen in PCA. The specificity of tortuous branching vessels was 100% for a diagnosis of DLE. Conclusion: dermoscopy was very useful to identify signs of early clinical response, adverse effects and markers of disease activity even if that couldn’t be detected by unaided naked eyes.

Hair and Scalp Disorders in Children below 2 Years: An Unremarked Sphere.

Context:Hairs contribute significantly to our appearance and are mirror to many systemic diseases. Hair and scalp disorders in children are associated with profound psychological effects arising from concerns of chronicity, severity, and contagiousness, in addition to cosmetic outline. Studies have documented children below 2 years as the most common age group affected by hair and scalp disorders in the pediatric population; however, to the best of our knowledge, none has been carried out exclusively on this age group, so far.Aims:To determine the pattern of hair and scalp disorders and their underlying etiologies in children below 2 years.Settings and Design:Observational and analytical.Subjects and Methods:Fifty consecutive patients, aged 0–24 months presenting with complaints of hair and scalp disorder, to the outpatient department of dermatology of a tertiary care hospital in North India, constituted the study population.Results:The most common disorder was seborrheic dermatitis (SD) 56%, followed by transient neonatal hair loss 22%. We also came across interesting cases of plica neuropathica (PN) 4%, trichotillomania 2%, and traction alopecia 6%, apart from a list of other disorders noted. The most common age group was 0–6 months.Conclusions:Hair and scalp disorders vary greatly with different demographic areas. In this region of the world, we came across cases of PN due to religious practices. SD was the most prevalent disorder as seen elsewhere. Trichotillomania noted in such a young child was not as a mere habit (as popularly believed), rather an act of anger. Hence, with this study, we want to emphasize the role of detailed history and examination, besides outlining the spectrum of disorders in this age group.

Braids or Pony-Tail-Associated Traction Alopecia in Female Children.

Braids or Pony-Tail-Associated Traction Alopecia in Female Children.

Frontal pattern hair loss among Chinese women is frequently associated with ponytail hairstyle.

Female alopecia patients in China often present with a frontal pattern hair loss. This feature is seen less frequently in western women. Women in China frequently style their hair in a ponytail. Thus, we hypothesized that the high prevalence of frontal pattern hair loss in Chinese women is due to traction alopecia. To better understand this, we studied 43 women presenting frontal alopecia at a hair clinic. Among the women presenting frontal alopecia, 79% reported styling their hair in a ponytail four or more days per week for an average period of 10 years. To our knowledge, this is the first study to elucidate the cause of frequent frontal alopecia in Chinese women. Although cultural style changes are difficult to change, we believe that awareness of the medical implications of frequent ponytail styling will reduce the rate of frontal alopecia among Chinese women.

Common causes of paediatric alopecia

Hair loss in children aged 12 years and younger is most often due to a benign or self-limiting condition. This article presents a review of the assessment of common causes of paediatric alopecia and outlines the implications for general practice. The objective of this article is to help readers systematically assess a child presenting with alopecia, manage the most common diseases of paediatric alopecia and identify patients requiring referral to a dermatologist. The most common causes of paediatric alopecia are largely non-scarring. These include tinea capitis, alopecia areata, trauma due to traction alopecia or trichotillomania, and telogen effluvium. Scarring alopecia can also occur in childhood and requires scalp biopsy and further investigation by a dermatologist. General practitioners should treat clear cases of tinea capitis. Referral to a dermatologist is necessary in cases when the diagnosis is uncertain, treatment is failing or there is evidence of scarring alopecia.

Mutually‐induced traumatic alopecia responsive to husbandry modification in two cohabiting donkeys

SummaryCutaneous expression of behavioural processes remains unexplored in donkeys. This case report describes a case of traumatic alopecia in two donkeys secondary to mutual hair plucking behaviour. Two genetically unrelated, male castrated, 4‐year‐old Cotentin donkeys living together were presented for a 2‐year history of alopecic, mainly nummular, nonpruritic lesions developing on the back, loin and croup. The general physical examination and behavioural assessment were unremarkable. Trichoscopy, scrapings and cytology were performed. Superficial bacterial infection was diagnosed but a 2‐week course of antibacterial treatment showed no improvement. Histopathological examination showed features compatible with traumatic alopecia and consistent with several behavioural causes of alopecia resembling human trichotillomania or acute traction alopecia, canine traction alopecia, feline self‐induced alopecia and murine barbering. Separation of the donkeys led to complete long‐term remission. Clinical and histopathological findings in our case share lots of similar features with the different mechanical traumatic alopecic disorders mentioned above, making it impossible to simply classify the described affection. Whether alopecic lesions resulted from an exclusive behavioural process (either abnormal excessive mutual grooming or other social interactions) or were associated with underlying causes of pruritus is uncertain. Mechanical alopecia secondary to a behavioural process should therefore be suspected in cases of permanent patchy alopecic nummular lesions on donkeys living in groups.

Traction alopecia: the root of the problem.

Traction alopecia (TA) affects one-third of women of African descent who wear various forms of traumatic hairstyling for a prolonged period of time. The risk of TA is increased by the extent of pulling and duration of traction, as well as the use of chemical relaxation. The frequent use of tight buns or ponytails, the attachment of weaves or hair extensions, and tight braids (such as cornrows and dreadlocks) are believed to be the highest risk hairstyles. TA can also occur in the setting of religious and occupational traumatic hairstyling. In its later stages, the disease may progress into an irreversible scarring alopecia if traumatic hairstyling continues without appropriate intervention. The most common clinical presentation includes marginal alopecia and non-marginal patchy alopecia. A clue to the clinical diagnosis is the preservation of the fringe sign as opposed to its loss in frontal fibrosing alopecia (FFA). Dermoscopy can be helpful in the diagnosis and can detect the ongoing traction by the presence of hair casts. Histopathology can distinguish TA from alopecia areata, FFA, and patchy central centrifugal cicatricial alopecia. Currently, there is no cure. Therefore, it is imperative that clinicians educate high-risk populations about TA and those practices that may convey the risk of hair loss.

Hairline Restoration: Difference in Men and Woman—Length and Shape

Hair restoration has become increasingly popular in recent years with both men and women. New technologies such as follicular unit extraction and grafting have made it possible for patients to get a natural looking result with minimal downtime. Men usually experience hairline recession as a result of androgenic alopecia, while women most commonly experience thinning of the crown and vertex, with the preservation of the hairline. However, there is a growing population of women who wish to advance their hairline forward because of congenital high hairline, traction alopecia, or previous facial cosmetic surgery. There are several key differences between the female and male hairline. Understanding such differences and following certain guidelines will help the facial plastic surgeon to obtain beautiful and natural appearing results.

Trichoscopy of alopecia areata: An update.

The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or traction alopecia. Trichoscopy as a fast, non-invasive and easy-to-perform technique may help to identify subtle details and establish the correct diagnosis. The aim of this review is to present the spectrum of trichoscopic findings in alopecia areata. A systematic review of the published work was performed by searching the PubMed, Scopus and EBSCO databases, complemented by a thorough hand search of reference lists. Of 427 articles retrieved, 30 studies were eligible for quantitative analysis. The reported features of alopecia areata were: yellow dots (6-100% patients), short vellus hairs (34-100%), black dots (0-84%), broken hairs (0-71%) and exclamation mark hairs (12-71%). Tapered hairs (5-81%) were reported in few studies, but a relatively high frequency of this finding in alopecia areata may indicate their important role in the differential diagnosis of hair loss. Rarely reported features, which include upright regrowing hairs (11-96%), pigtail (circle) hairs (4-61%) and Pohl-Pinkus constrictions (2-10%), may also be helpful in the diagnosis of alopecia areata. There is no pathognomonic trichoscopic marker for alopecia areata and the most common trichoscopic features are not the most specific. Therefore, the diagnosis should be based on the coexistence of several trichoscopic findings, not on the presence of a single feature.

Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

Objective: Frontal fibrosing alopecia (FFA) is a rare type of cicatricial alopecia seen in postmenopausal women characterized with band-type frontal/frontotemporal hair traction and/or significant or complete loss of the eyebrows. We aimed to present the demographic, clinical and laboratory characteristics of female patients diagnosed and followed-up with FFA in our clinic by comparing these with the literature data. Method: A total of 14 patients who admitted to our outpatient clinic with alopecia on the frontotemporal/frontal hairline and were clinically and/or histopathologically diagnosed with FFA between 2011 and 2016 were evaluated in a retrospective manner. The patients were reviewed in terms of the age of lesion onset, localization, accompanying symptom or disease, and treatment options. Results: The ages of the patients who were followed-up in our outpatient clinic with FFA were between 52 and 73 (mean 2 years). Eight patients (57%) had total eyebrow loss,. Laboratory tests were in normal limits or negative. Comorbidities included thyroid disease, hypertension and coronary artery disease diabetes mellitus. For treatment, all patients were given systemic, intralesional and topical steroid, and topical minoxidil at various times. Four patients received hydroxychloroquine, 2 patients acitretin, 2 patients Vitamin E, 1 patient itraconazole, and 1 patient topical tacrolimus. Conclusion: FFA should be considered in middle aged and elderly postmenopausal women presenting with hair loss complaints and were detected to have frontal hairline traction and cicatricial alopecia, and the diagnosis should be supported by biopsy. Thereby, the disease progression may be prevented or delayed with early diagnosis and proper treatment..

Clinical Significance of Trichoscopy in Common Causes of Hair Loss in Children: Analysis of 134 Cases.

Introduction:Hair loss is a common and distressing clinical complaint in the dermatology clinics. Common causes of hair loss in children include alopecia areata, tinea capitis, traction alopecia, and trichotillomania. Newly, trichoscopy allows differential diagnosis of hair loss in most cases and allows visualization of hair shafts and scalps without the need of removing hair.Objective:The main objective is to compare the different trichoscopic features of common causes of patchy hair in children loss including tinea capitis, alopecia areata, traction alopecia, and trichotillomania.Patients and Methods:This study included 134 patients, 63 patients with tinea capitis, 38 patients with alopecia areata, 18 patients with traction alopecia, and 15 patients with trichotillomania. The diagnostic tools for the diagnosis of hair loss problem included a detailed history, evaluation of the child's hair and scalp, fungal scrapping, and trichoscopy.Results:Tinea capitis was the most common, and the trichoscopic features were comma-shaped hairs, corkscrew hairs, short broken hairs, and interrupted hairs. While in alopecia areata patients, the most specific features were yellow dots and black dots, microexclamation mark, hair shafts with variable thickness, and vellus hairs, with uncommon features included: monilethrix, coiled, zigzag, and tulip hairs. Trichoscopy of trichotillomania showed hair with fraying of ends, breakage at different lengths, short and coiled hairs, and amorphous hair residues. The trichoscopic features of traction alopecia were similar to those of trichotillomania. However, flame hairs and coiled hairs were less common.Conclusions:Trichoscopy is a noninvasive method of examining hair and scalp. It allows differential diagnosis of hair loss in most cases.

Use and Misuse of PRP: Clinical Trial Proposal to Help Find PRP’s True Efficacy

Introduction: Since the early 1970s, Platelet-rich plasma (PRP) has been used in many fields as a potential remedy for having regenerative properties. In dermatology, its use is extended to different hair diseases: alopecia areata, traction alopecia, androgenetic alopecia (AGA), and even cicatricial alopecia. Despite its increasing use in the clinical practice, the protocol used to produce PRP differs greatly between researchers and its efficacy has not been clearly demonstrated. Particularly, AGA is an illness characterized by a progressive hair thinning and miniaturization caused by the effect of dihydrotestosterone (DHT) on the hair follicle. This type of alopecia is the most common in men, increasing its incidence with age. Until the date, there are only two efficient treatments approved by the FDA: Finasteride and Minoxidil. PRP seems to be a potential new candidate according to recent studies, but multiple PRP obtaining techniques have raised ambiguous results about the real efficacy of PRP in patients with AGA. Thus, we have elaborated a methodology to help researchers designing future clinical trials on PRP therapy. We propose a randomized clinical trial with a uniformed PRP obtaining technique in order to properly assess the PRP efficacy as a treatment for AGA. Objective: Analyze the objective data published until the date in order to define the real efficacy of PRP as a treatment for AGA, and offer a design of a clinical phase trial with a standardized methodology to obtain proper scientific evidence of PRP efficacy. Methods: Retrospective systematic review of the literature published and a randomized placebo-controlled, double-bind, half-head study clinical trial proposal with a uniformed PRP obtaining methodology to properly assess its efficacy as a future AGA treatment.

Enhancement of Hair Growth through Stimulation of Dermal Papilla Cells in Human Follicular Dermal

Hair gives one of the most memorable images of a person’s identity. Hair loss has an enormous impact on quality of life. Although various treatment strategies are available to prevent hair loss, unfortunately not adequate. Hence, in this context authors performed this study to evaluate the impact of Consciousness Energy Healing (The Trivedi Effect®) Treatment on the test item (DMEM) in human follicular dermal papilla culture cells for the assessment of hair cell growth and development in vitro. The test item, DMEM was divided into three parts. First part did not receive any sort of treatment and defined as the untreated DMEM group. The second and third parts were treated with the one-time and two-times Biofield Energy Treatment by a renowned Biofield Energy Healer, Mahendra Kumar Trivedi and coded as the one-time Biofield Energy Treated DMEM (BT-I) and two-times Biofield Energy Treated DMEM (BT-II) groups, respectively. Results showed that BT-I group exhibited 14.8%, however BT-II group was significantly (p≤0.001) increased cellular proliferation of dermal papilla cells by 124.3% compared to the untreated DMEM group. The results demonstrated that the Biofield Energy Healing Treatment significantly increased the proliferation of human hair follicle dermal papilla cells. Therefore, the Consciousness Energy Healing (The Trivedi Effect®) Treatment could be useful as a hair growth enhancer against different skin injuries like actinic keratosis, necrotizing fasciitis, sebaceous cysts, diaper rash, decubitus ulcer and hair-related disorders like androgenetic alopecia (male and female pattern baldness), alopecia totalis or alopecia universalis, traction alopecia, telogen effluvium, trichodystrophy, scarring alopecias, alopecia areata, etc.

Hair Transplantation into the Nape of the Neck

Background: Hair loss at the nape of the neck causes embarrassment and psychological stress in a number of patients due to a variety of causes including acne keloidalis nuchae and traction alopecia. Objectives: To report a case of hair transplantation into the nape of the neck as a treatment option for scarring resulting from acne keloidalis nuchae. Methods: 700 grafts where transplanted from the occipital donor area and transplanted by follicular unit extraction (FUE) into the nape area of a male patient with recurrent scarring folliculitis in that area. Results: Hair Restoration was successful with natural looking results. More tumescence than usual and skin traction was necessary to stabilize the skin during graft insertion due to soft skin in the nape area. Conclusions: Hair Restoration Surgery into the nape of the neck is an option for patients with hair loss in that area. FUE is the best method of hair transplantation allowing the selection of 1 and 2 hair FUE grafts in order to achieve a natural looking result in the nape area.

The effect of antigen retrieval buffers on MALDI mass spectrometry imaging of peptide profiles in skin FFPE tissue

Abstract Objectives: The success of novel in-situ immunohistoproteomics approaches that employ Matrix-assisted laser desorption and ionization (MALDI) mass spectrometry imaging (MSI) heavily depends on good antigen retrieval efficacy. Methods: We have optimized the effect of various antigen retrieval buffers on peptide profiles acquired from FFPE traction alopecia scalp tissue. Heat-induced epitope retrieval (HIER) was performed using Citrate, Tris, and Tris-EDTA buffers under various conditions. MALDI-MSI analysis of the tissue was performed using a high-throughput, state-of-the-art RapiFlex MALDI TOF/TOF tissue-typer equipped with a smart beam laser. Results: Background matrix peaks were found under most conditions except under Tris-EDTA buffer. Trypsin digestion periods longer than overnight and possibly higher concentrations are needed for Citrate and Tris. The Tris-EDTA buffer performed best for MALDI-MSI antigen retrieval at an incubation period of overnight at 60°C. Conclusions: We have identified in this study that antigen retrieval conditions need to be optimised prior to MALDI MSI analysis of different tissue types.

A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents.

Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions. Diagnostic tools for hair loss in children include a detailed history, physical examination with a focused evaluation of the child’s hair and scalp, fungal screens, hair pull and tug test, and if possible, light microscopy and/or trichoscopy. Management of alopecia requires a holistic approach including psychosocial support because treatments are only available for some hair loss conditions, and even the available treatments are not always effective. This review outlines the clinical presentations, presents a diagnostic algorithm, and discusses management of these various hair loss disorders.

Updates in the understanding and treatments of skin & hair disorders in women of color.

Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).

Traction alopecia: A neglected entity in 2017.

Traction alopecia was first described in 1904 but is still a cause of scarring hair loss in young women worldwide. It is unique in being initially a reversible then an irreversible (scarring) form of alopecia. Linked to tightly-pulled hairstyles, it is seen across all races. The pattern of hair loss depends on the style creating it but most commonly affects the frontotemporal hairline. There are some new examination findings associated with traction alopecia, which are traction folliculitis, the fringe sign and hair casts (pseudonits) on dermatoscopy. These may prove key in prompting early specialist referral. The mainstay of current treatment is cessation of the contributing hairstyles. Camouflage, anti-inflammatory or growth-stimulating topical preparations are second line treatments. In later stages of severe traction alopecia hair transplantation may be the only effective treatment. The evidence basis for medical intervention with topical agents is anecdotal at best. Furthermore, additional research is required to clarify the pathogenesis of this biphasic alopecia. Until then, prompt diagnosis and identification of causative hairstyles are focus of current dermatological practice.

Scalp and hair disorders at the dermatology outpatient clinic of a tertiary hospital

Background: Scalp and hair disorders are common and of immense health and cosmetic significance. Alopecia, the most common presentation of scalp disorders, has been found to impact negatively on the quality of life of patients. Aim: This study aimed to document the spectrum of scalp and hair disorders, with the age and sex distribution, at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) between 2004 and 2012. Methods: This is a retrospective study of patients who presented primarily with hair and scalp disorders. Data was obtained from clinic records and patients clinic notes; and included biodata, diagnoses, age and sex distribution. Results: During the study period, 860 patients (5.3%) of the 16,160 patients presented primarily with scalp and hair disorders. Both children and adult patients are seen at the clinic. Patients seen ranged from 3 months to 80 years of age. More males (67.2%) than females (32.8%) were seen; with ratio 2.05:1. Tinea capitis, dermatophyte infection of the scalp, was the most common disorder (30.5%), with male preponderance in the first decade of life. Chronic inflammatory scalp disorders such as acne keloidalis, dissecting folliculiis and folliculitis decalvans were found predominantly in adult males; while alopecia areata, scalp psoriasis and pityriasis amiantacea were noted to be more common in adult females. Conclusion: This study noted high frequency of chronic inflammatory scalp disorders found predominantly in males. However, disorders of hair care practices such as traction alopecia found commonly in community surveys were not frequent presentations in our practice. Further to determine the epidemiologic factors, aetiology and clinical characteristics of the common scalp and hair disorders will be necessary.

Clinical and trichoscopic characteristics of temporal triangular alopecia: A multicenter study

Clinical and trichoscopic characteristics of temporal triangular alopecia: A multicenter study