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Hair disorders, including central centrifugal cicatricial alopecia (CCCA), traction alopecia (TA), and acquired trichorrhexis nodosa (ATN), commonly occur in individuals with curly textured hair. Curly textured hair in individuals of African descent has unique properties and can present diagnostic and therapeutic challenges. CCCA has been linked to uterine leiomyoma and type 2 diabetes mellitus, as well as fibroproliferation. TA often presents with a fringe sign and can arise from high‐tension hairstyles presumed to be protective. Trichoscopy is useful in establishing a diagnosis; perifollicular halos are more commonly seen than perifollicular erythema or scale in CCCA. In TA, miniaturized follicles, hair casts, and "flambeau sign" can be seen. Hairstyling practices likely contribute to TA and ATN; however, the data are mixed on the role of chemical relaxers and heat styling in CCCA. Unique considerations in the presentation of frontal fibrosing alopecia in curly textured hair have also been published recently. This review provides a comprehensive, up‐to‐date summary of these disorders with an emphasis on their unique properties, as well as considerations in hair care for curly textured hair. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to detect additional underlying hair loss disorders in patients with postpartum telogen effluvium. METHODS: We completed clinical and dermoscopic evaluations on 200 female participants experiencing postpartum hair loss. RESULTS: 9.5 percent of patients were diagnosed with telogen effluvium (TE), 56.0 percent patients were diagnosed with TE with androgenetic alopecia (AGA), 6.5 percent patients were diagnosed with TE and TA, and 28.0 percent patients were diagnosed with TE, AGA, and TA. In the central area, patients with TE displayed upright regrowing hair and single pilosebaceous unit in 100 percent and 94.7 percent of patients, respectively. While patients with TE and AGA, displayed upright regrowing hair, single pilosebaceous unit, and hair diameter diversity greater than 20 percent. In patients diagnosed with TE and TA, the trichoscopic findings were similar in the TE group to the patients diagnosed with TE, AGA, and TA were also similar to the patients with TE and AGA. Regarding the area of traction, there was no difflerence observed between the patients with TE and TA and patients with TE, AGA, and TA. The frequent findings were hair diameter diversity, empty follicles, and vellus hair. CONCLUSION: Postpartum TE may be associated with other hair loss disorders. Awareness of this is critical to appropriate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Traction alopecia (TA) is very common in Africa but few studies on African population are available. We sought to determine factors associated with TA and measure the association between these factors and TA. Methods We carried out an analytical cross-sectional study in 29 hairdressing saloons in the city of Yaoundé. A questionnaire was administered and scalp exams were performed in order to look for TA and determine Marginal TA severity score if present. Participants were separated in two groups: TA group and a group without TA. Results We finally included 223 women (77 having TA and 146 without TA). The median age was 26 years for women with TA and 24 years for women without TA. The factors associated with traction alopecia we found included: age ≥ 35 years (adjusted OR = 4; p = 0.016). Hairdressing undertaken by hairdressers only (adjusted OR = 0.2; p = 0.008), the avoidance of the regular use of nets, caps and head ties (OR = 0.2; p = 0.006) and relaxing hairs once a year or less (adjusted OR = 0.2; p = 0.005) could be protective factors. As well, we found a positive correlation between age and TA severity (r = 0.235; p

Little is known about hair loss associated with wearing the hijab, a religious head covering worn by Muslim women. We performed a single-center analysis to investigate the association between various forms of non-scarring alopecia and wearing the hijab. This study included 125 patients who wore the hijab and 40 race/ethnicity-matched women who did not wear the hijab. Among the 165 total patients diagnosed between January 2015 and March 2022, 71 had telogen effluvium, 78 had female pattern hair loss, and 16 had traction alopecia. We found patients who wore the hijab had a younger mean age of alopecia onset than patients who did not wear the hijab (31.5 vs. 37.3 years; P = 0.02). Our study suggests that vitamin D deficiency (OR 4.1; 95% CI 1.2–14.1; P = 0.02) and seborrheic dermatitis (OR 2.9; 95% CI 1.1–8.1; P = 0.03) may significantly impact the development of telogen effluvium in patients who wear the hijab. Targeting these risk factors among patients who wear the hijab may be considered to prevent hair loss. [ABSTRACT FROM AUTHOR]

This article discusses a novel cosmetic formulation that has been developed to rapidly reduce hair shedding in females. Hair shedding is a common issue for women, and while addressing the underlying causes is important, topical treatments are still needed to prevent hair loss. The formulation combines an alpha-1 adrenergic receptor agonist and a trace amine-associated receptor agonist, which have been shown to reduce hair loss after just 5 minutes of application. The study found that the formulation significantly reduced hair shedding compared to a placebo, with no observed adverse events. Further research is needed to compare the formulation to other treatments and assess its long-term use. [Extracted from the article]

This article discusses the use of low-dose oral minoxidil (LDOM) as a treatment for traction alopecia (TA) in women. TA is a condition that primarily affects women of African descent and is caused by prolonged tension on the hair follicles due to certain hair grooming practices. The study presents a case series of four patients who experienced significant hair regrowth after using oral minoxidil. The treatment was found to be effective and safe, with improvements in hair thickness and volume observed after just three months of therapy. The article suggests that oral minoxidil may be a viable option for treating TA in both the early and late stages. [Extracted from the article]

Traction alopecia is prevalent in patients of color. Its significance in clinical practice may be underemphasized due to the transient nature of the condition; however, it has the potential to become permanent and cause significant psychosocial distress. Understanding of afro-textured hair and cultural practices, as well as early recognition and treatment, provides an opportunity to prevent permanent traction alopecia and long-term sequelae.

Background Traction alopecia (TA) is common among women of African descent. There is limited information on the etiology and predisposing factors for TA among adolescents in Nigeria. This information is fundamental in changing hair grooming habits, which result in the development of TA in adult women. Objective To determine the prevalence, pattern, trichoscopic features, and risk factors for TA among adolescents in Keffi, Nasarawa State, Nigeria. Patients and methods This was a cross-sectional study among 333 adolescents selected from secondary schools in Keffi. The students were interviewed to determine their hair care practices and symptoms of TA. The participants were examined for the presence of TA, and trichoscopy was done for those with TA. The data were analyzed using SPSS 25 Statistical software. Results The prevalence of TA was 15.1%. The temporal pattern (54.9%) was the commonest pattern. The trichoscopic features were the presence of peripilar casts (45.1%) and perifollicular halos (43.3%). TA was associated with many variables, but the identified risk factors after logistic regression were frequency of relaxing the hair (P=0.022), duration of covering hair (P=0.022), family economic status (P=0.023), and self-reported presence of dandruff (P=0.001). Conclusion TA occurs among adolescents in northern Nigeria. Increased frequency of relaxing the hair increases the risk of having TA, whereas the use of head scarfs reduced the chance of acquiring it. Further studies are required to evaluate the effect of hair covers on TA.

We present a 24-year-old woman that had received a diagnosis of alopecia areata in the past and was treated with topical 19 corticosteroids with little improvement. Instead, the patient exhibited bitemporal alopecia of one year of evolution related to 20 traction alopecia. Traction alopecia is characterized by localized hair loss related to persistent excessive traction. Although it is 21 initially a reversible condition, if this excessive traction is not removed permanent alopecia may develop.

Hairstyles and practices that frequently apply tension to the hair follicle can result in traction alopecia (TA). Many of the hairstyles and hair practices associated with a higher risk of TA begin at a young age, making early intervention and education advantageous in the pediatric population. Recognizing TA at its reversible stage in the pediatric population is critical as early interventions, and counseling will prevent permanent scarring alopecia. While TA can affect any pediatric patient, this review highlights the reported literature on specific populations with a higher reported prevalence of TA. [ABSTRACT FROM AUTHOR]

Traction alopecia (TA) is hair loss caused by prolonged pulling or repetitive tension on scalp hair; it belongs to the biphasic group of primary alopecia. It is non-scarring, typically with preservation of follicular stem cells and the potential for regrowth of early lesions especially if traction hairstyles are stopped. However, the alopecia may become permanent (scarring) and fail to respond to treatment if the traction is excessive and prolonged. Hence, the ability to detect fibrosis early in these lesions could predict patients who respond to treatment. Histopathological diagnosis based on scalp biopsies has been used as a gold standard to delineate various forms of non-scarring alopecia and to differentiate them from scarring ones. However, due to potential discrepant reporting as a result of the type of biopsy, method of sectioning, and site of biopsy, histopathology often tends to be unreliable for the early recognition of fibrosis in TA. In this study, 45 patients were assessed using the marginal TA severity scoring system, and their biopsies (both longitudinal and transverse sections) were systematically assessed by three dermatopathologists, the aim being to correlate histopathological findings with clinical staging. Intraclass correlation coefficients were used to determine the level of agreement between the assessors. We found poor agreement of the identification and grading of perifollicular and interfollicular fibrosis (0.55 [0.23–0.75] and 0.01 [2.20–0.41], respectively), and no correlation could be drawn with the clinical severity score. Better methods of diagnosis are needed for grading and for recognition of early fibrosis in TA.

This article explores the different types of hair loss that black women may experience more than other groups of patients. Properties of African hair and the impact of hair care practices are discussed, as well as factors affecting the presentation of other hair loss conditions. It is important for the aesthetic practitioner to be able to distinguish between the temporary forms of hair loss that they can help to treat and the permanent or scarring forms of hair loss, which need a prompt referral to a dermatologist with a specialist interest in hair. Prompt recognition and referral can help to delay the progression of hair loss. The symptoms and signs that patients and practitioners should be alerted to are explored, as well as the treatments that can help and where referrals may be necessary. Recent developments and gaps in knowledge are summarised. [ABSTRACT FROM AUTHOR]

Victoria Billero, Mariya MitevaDepartment of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USAAbstract: 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. Keywords: hair loss, alopecia, dermoscopy, trichoscopy, traction alopecia, African-American

Background: Since frontal hairline is the most characteristic feature of the face for both men and women, affecting the psychological state of patients, hair loss has been considered to be one of the most prominent esthetic problems. Hair loss either resulting from the androgenetic or nonandrogenetic origin is characterized by changes in the anterior line. Aim: The aim of this study was to evaluate the causes of the frontal hairline recession in Egyptian female patients using trichoscopy and to detect the prevalence of each of those causes in Egyptian females. Patients and Methods: This study was performed on a total of 200 Egyptian female patients aged between 15 and 65 years who complained of frontal hairline recession. All patients were derived from Al‐Zahraa University hospital outpatient clinic over a period from November 2017 to April 2019. We classified them into two groups according to age: Group A: 15‐45 and Group B: 46‐65. After full history taking, general and dermatological examination, photographs of hair recession were taken from both frontal and temporal sides. Then, the trichoscopic examination by noncontact dermoscopy was done photographed and evaluated. Results: The most common cause of the frontal hairline recession in Egyptian female patients was androgenetic alopecia (AGA) (50%). Most of the patients were of old age (58%). The high statistically significant trichoscopic findings in androgenetic alopecia were yellow dots, peripilar sign, hair diameter diversity, and single‐hair pilosebaceous unit (45.0%, 61.0%, 100.0%, and 96.0%), respectively. On the other hand, perifollicular scaling, absence of hair follicles, and lonely hair revealed a high statistically significant presentation (88.9%, 100.0%, and 22.2%), respectively, with frontal fibrosing alopecia, and vellus hair (100.0%) and perifollicular casts (91.8%) with tractional alopecia. Finally, hair broken at different levels (100%), black powder (88.9%), black dots (100.0%), hook hairs (11.1%), i hair (16.7%),V sign (44.4%), flame hairs (33.3%), coiled hair (5.6%), and burnt match stick sign (5.6%) showed a high statistically significance presentation with trichotillomania. Conclusion: The present study supports the trichoscopic criteria for the diagnosis of causes of frontal hairline recession, which provide a noninvasive diagnostic tool compared with histopathological diagnosis. [ABSTRACT FROM AUTHOR]

Hairstyling trends among Black women fluctuate with social, cultural, and environmental pressures. Dermatologists should be aware of current trends and their associated risks in order to provide the best care to this population. In order to summarize the updated trends and associated health risks for the most common hairstyles worn by Black women, a literature review was performed. PubMed and EMBASE were used to identify articles related to hair styling practices, studies on the effects or risks of various styling practices, and magazine articles citing current styling trends among women of African descent. All hairstyles were found to have associated health risks; however, natural styles had the fewest adverse associations of all styles reviewed. Central Centrifugal Cicatricial Alopecia (CCCA) is the most cited hair disorder in this population, possibly linked to both chemical relaxants and traction styles. Additional studies are needed to further establish causality between these styles and CCCA. Additionally, while acceptance of natural hairstyles is on the rise, there is more work to be done throughout society to help protect and encourage women who choose to wear Afrocentric styles. Dermatologists should be well versed in these hairstyles and ready to lend appropriate advice to patients when it is requested.

Traction alopecia is a protracted form of hair loss resulting from persistent tension on the hair follicle. We report a case of a 9‐year‐old African American girl who presented with extensive scalp ulceration and alopecia 11 days after placement of a synthetic hair braid. Over a period of months, with consistent wound care and low‐tension hairstyling, most of the hair regrew. We propose that the ulceration and hair loss in this case represents an acute variant of traction alopecia due to pressure‐induced ischemia and necrosis. [ABSTRACT FROM AUTHOR]

Pediatric and adolesent patients with skin of color are seen by dermatologists for common complaints such as acne, atopic dermatitis, and traction alopecia. Combining the understanding of cultural practices, empathetic patient communication, and social implications is useful in counseling and treating pediatric and adolescent patients with skin of color. [ABSTRACT FROM AUTHOR]

Summary: Cutaneous 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. [ABSTRACT FROM AUTHOR]

Traction alopecia (TA) is hair loss caused by prolonged pulling or repetitive tension on scalp hair; it belongs to the biphasic group of primary alopecia. It is non-scarring, typically with preservation of follicular stem cells and the potential for regrowth of early lesions especially if traction hairstyles are stopped. However, the alopecia may become permanent (scarring) and fail to respond to treatment if the traction is excessive and prolonged. Hence, the ability to detect fibrosis early in these lesions could predict patients who respond to treatment. Histopathological diagnosis based on scalp biopsies has been used as a gold standard to delineate various forms of non-scarring alopecia and to differentiate them from scarring ones. However, due to potential discrepant reporting as a result of the type of biopsy, method of sectioning, and site of biopsy, histopathology often tends to be unreliable for the early recognition of fibrosis in TA. In this study, 45 patients were assessed using the marginal TA severity scoring system, and their biopsies (both longitudinal and transverse sections) were systematically assessed by three dermatopathologists, the aim being to correlate histopathological findings with clinical staging. Intraclass correlation coefficients were used to determine the level of agreement between the assessors. We found poor agreement of the identification and grading of perifollicular and interfollicular fibrosis (0.55 [0.23–0.75] and 0.01 [2.20–0.41], respectively), and no correlation could be drawn with the clinical severity score. Better methods of diagnosis are needed for grading and for recognition of early fibrosis in TA. [ABSTRACT FROM AUTHOR]

Background: Traction alopecia is common and preventable but frequently overlooked disorder. Objective: To evaluate patients with traction alopecia. Patients and Methods: This study was conducted at the Dermatology Center, Medical City, Baghdad, Iraq, during the period from November 2005 to October 2019. Demographic features like age, gender, disease duration and special hair styling practices and accessories were recorded. Clinical patterns were studied. Results: Thirty female patients were included in this study. Their ages ranged from 6 to 47 years with mean age ± SD was 15.63 ± 9.806. Twenty-one (70%) were below the age of 16 years. No patient had tightly curled hair. All cases were asymptomatic apart from hair loss. The fringe sign was observed in 27 (90%) of cases. The response to therapy was poor. Conclusion: Traction alopecia is an important type of pressure-induced hair loss evident in children and adults with or without curly hair due mainly due to cultural hair styling practices with its frequency apparently increasing in recent years. The fringe sign is common and of diagnostic importance. It is a preventable form of hair loss which can be reversed if diagnosed early; otherwise, permanent scarring alopecia results. It represents a pressure phenomenon evident worldwide in both non-Sub-Saharan lineage and Sub-Saharan lineage individuals.

Objective: The aim of this study is to investigate the significance of trichoscopy by videodermoscope in the clinical evaluation of traction alopecia. Material and Methods: Nine patients, who presented with hair shedding and were diagnosed as traction alopecia after clinical and histopathological evaluation, were included. The age, gender, skin phototype, duration of the disease, etiology, presence of fringe sign, location of the alopecia and the distribution were noted. Two different Punch biopsies of 4 mm were performed from the border of alopecic area for vertical and horizontal investigation in all patients. Clinical photos were undertaken with videodermoscope. Trichoscopic photos were held in 30 fold magnification by videodermoscopy which was used to take clinical photos. All clinical and trichoscopic findings were recorded. They were examined in accordance with the checklist which was described by the features of the previous publications. Results: Vellus hairs and hair diameter diversity were detected in all patients. Short vellus hair, yellow dot, absence of follicular openings and pili torti were shown in 55.6% of the patients. Empty follicles, hair casts and veil feature were established in 44.4% of cases. Broken hairs were the most uncommon follicular trichoscopic finding. Whereas epidermal squam and perifollicular erythema (66.7%) were the most common interfollicular trichoscopic findings. Arborizing red lines, dirty dots, pink-white appearance, honeycomb pigment pattern, pinpoint and fibrotic white dots were the other observed interfollicular features in traction alopecia. Conclusion: According to our study, trichoscopic examination held by videodermoscopy is a useful method in the diagnosis of traction alopecia. [ABSTRACT FROM AUTHOR]

A wide prevalence of socio-religious and cultural practices in the Asian subcontinent often leads to multitude of skin diseases which may be missed by the dermatologists because of a lack of awareness. ′Henna′ use causes IgE-mediated hypersensitivity reactions and contact dermatitis. ′Kumkum′ application can result in pigmented contact dermatitis and lichen planus pigmentosus. Sticker ′bindis′ and ′alta′ induce contact leukoderma. Irritant and allergic contact dermatitis occurs after playing with ′Holi′ colors. Threading and drawstring dermatitis lead to koebnerization of pre-existing dermatoses, infections and even squamous cell carcinoma of skin. Mild irritant reactions and contact sensitization occur secondary to balm and hair oil use. ′Mudichood′ represents the comedogenic effect of hair oils combined with occlusion and humidity. Aromatherapy oils can cause contact dermatitis and photosensitive reactions. Heavy metal and steroid toxicity along with severe cutaneous adverse effects like erythroderma can occur as a consequent to the use of alternative medicines. Squamous cell carcinoma due to chronic heat exposure from the heating device "kangri" is seen in Kashmiris. Prayer nodules in Muslims and traction alopecia in Sikhs illustrate how religious practices can negatively affect the skin. With increasing globalization and migration, the practice of indigenous customs and traditions is no longer limited to regional territories, making it imperative for the dermatologists to be acquainted with the cutaneous side effects they can cause.