ABSTRACT
120Traction alopecia (TA) results from the use of high-tension hairstyles. The extent and the duration of the pulling forces increase the risk of irreversible TA.
It is most common in African American women (30%).
The frequent use of tight buns or ponytails, the attachment of weaves or hair extensions and tight braids (such as cornrows and dreadlocks) are the highest-risk hairstyles for irreversible TA.
Chemical relaxation is an additional risk factor.
Patients may report tenderness, paresthesias and headache.
The hair loss can occur at any area depending on the configuration of the hairstyle and the bulk of the pressure induced, but it is most common on frontal and temporal scalp and less common on the vertex and occipital scalp.
The clinical pattern can be marginal traction alopecia (a band-like alopecia along the margins of the fronto-temporal scalp and the temples that leave a margin of vellus hairs marking the preexisting hairline known as “fringe sign”) (Figure 17.1) and non-marginal traction alopecia: patches throughout the scalp at the site of installment of the hairstyles with tension such as micro-braids or cornrows (Figure 17.2A–C). Marginal traction alopecia showing vellus hairs retained in a band-like fashion at the edge of the hairline. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429457609/a1a07c34-5530-453d-aca4-02e4ee680a4a/content/fig17_1.tif"/> Three cases of non-marginal traction alopecia showing one (A, B) and numerous ill-defined patches (C) at the site of installment of the braids. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429457609/a1a07c34-5530-453d-aca4-02e4ee680a4a/content/fig17_2a-c.tif"/>
