Traction Alopecia in Patients with Darker Skin

00:01 Now we're going to speak about traction alopecia.

00:05 Traction alopecia, traction, as the name says, alopecia hair loss is a form of hair loss that results from prolonged or repetitive tension on hair. It's more common in people of African descent due to biological factors.

00:21 African hair has fewer tensile strength and is more fragile, making it prone to breakage.

00:29 The second point is cultural practices traction in using hairstyles such as individual braids, cornrows, and waves, as well as tight ponytails may trigger traction alopecia.

00:44 It's more common in females than males because commonly females tend to groom their hair more than males. It occurs in both children and adults.

00:57 It's also common in Caucasian and Asians that wear tight ponytails.

01:05 Wearing of turbans among Sikh community is also a cause of traction alopecia.

01:14 A regular wearing of a tight chignon, cornrows, dreadlocks, weaves, and braids can cause traction alopecia.

01:25 Using hair extensions and chemical relaxers and rollers can also cause traction alopecia.

01:34 Clinically, the manifestations depend on the stage and severity of the disease.

01:41 For early stages, there is no or limited hair loss.

01:45 It can be followed by traction folliculitis, perifollicular inflamed papules, or perifollicular sterile pustules.

01:55 Later stages. Due to persistent ongoing traction, one gets marginal traction alopecia and this is the most common presentation, and it may present mainly on the frontal and temporal scalp, usually with hairstyles such as tight ponytails, buns or braids. The fringe sign is is a sign which shows that the residual hairs that are retained at the margin of the anterior hairline, with hair loss posterior to the fringe.

02:28 You can also get what we call non-marginal traction alopecia, where areas other than the frontal and temporal scalp are involved.

02:37 Tight buns and hair extensions also trigger this.

02:43 The diagnosis is mainly on history and observing the hairstyling practices of the patient. Physical examination also assists.

02:54 Usually the biopsy is not necessary.

02:56 However, with increasing cases of frontal fibrosing alopecia, it may be necessary to differentiate between the two.

03:05 So timely detection of traction alopecia within the first year of its onset is essential, since the probability of hair regrowth decreases with longer persistence.

03:17 The differential diagnosis includes trichotillomania, which we have spoken about.

03:22 Tinea capitis and other alopecia like alopecia areata and frontal fibrosing alopecia. The management of traction alopecia.

03:36 It entails discontinuation of traction inducing hairstyles, and adjunctive interventions include use of minoxidil, which can improve the hair growth in traction alopecia if it's used early.

03:51 Local corticosteroids to reduce inflammation, and oral antibiotics in case of secondary infection of primary lesions.

03:59 In later stages, hair transplant may be the only way of getting the hair back.