Factors associated with traction alopecia in women living in Yaoundé (Cameroon).

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 < 0.001). CONCLUSION: Age and some haircare practices are associated to TA occurrence in our context. Women therefore need to be educated on these various factors that could be able to cause, worsen or prevent TA.

Marginal Traction Alopecia: Hair Care Practices, Severity Score and Trichoscopic Features in Lagos, Nigeria.

BACKGROUND: Marginal traction alopecia (MTA) is commonly observed in adult females. Studies of prevalence, severity, trichoscopy and severity scoring are few. OBJECTIVE: The aim of this study was to determine the community prevalence, pattern, severity score and trichoscopy features of MTA amongst adult Nigerian females. Patient and method: This was a cross-sectional descriptive study of a cohort of 207 adult females in a community in Lagos, Nigeria. The participants were clinically evaluated for MTA. Sociodemographic, clinical and trichoscopy data was documented. Severity score was documented using the MTA severity score. Data was analyzed using SPSS version 22. RESULTS: The mean age of participants was 43±12.8 years and the prevalence of MTA was 76.3%. Marginal traction alopecia was frontoccipital in 65.2%. The MTA score was 1-3 in 22.2%, 4-6 in 29.7% and ≥6 in 48.1%. Fringe sign was observed in 30.4%, folliculitis in 9.5% and 13.9% had tight weaves. Trichoscopic features included preserved honeycomb pigment, preserved white dot architecture, varying hair length and single hairs from hair follicles. CONCLUSION: Marginal traction alopecia is common in Nigerian women. It is mostly severe, severity is not significantly associated with haircare practices and it is represented by common trichoscopy features. Appropriate awareness and education of females on hair styles can mitigate this hair loss.

CONTEXTE: L'alopécie de traction marginale (ATM) est couramment observée chez les femmes adultes. Les études de la prévalence, de la gravité, de la trichoscopie et de la notation de la gravité sont peu nombreuses. OBJECTIF: L'objectif de cette étude était de déterminer la prévalence, le modèle, le score de gravité et le score de gravité de la communautaire, le modèle, le score de gravité et les caractéristiques trichoscopiques de l'ATM chez les femmes adultes nigérianes. PATIENTE ET MÉTHODE: Il s'agissait d'une étude descriptive transversale d'une cohorte de 207 femmes adultes dans une communauté de Lagos, au Nigeria. Les participantes ont été évaluées cliniquement pour l'HTA. Les données socio-démographiques, cliniques et trichoscopiques ont été documentées. Le score de sévérité a été documenté en utilisant le score de gravité de l'ATM. Les données ont été analysées en utilisant. RÉSULTATS: L'âge moyen des participants était de 43±12,8 ans et la prévalence de l'ATM était de 76,3 % prévalence de l'AEM était de 76,3%. L'alopécie marginale de traction était frontoccipital dans 65,2 % des cas. Le score de l'ATM était de 1-3 dans 22,2%, 4-6 dans 29,7%. et ≥6 dans 48,1 %. Le signe de la frange a été observé dans 30,4%, la folliculite dans 9,5 % et 13,9 % présentaient des tissages serrés. Les caractéristiques trichoscopiques comprenaient pigment en nid d'abeille préservé, architecture de points blancs préservée, une longueur de cheveux variable et des poils isolés des follicules pileux. CONCLUSION: L'alopécie marginale de traction est fréquente chez les femmes nigérianes. Elle est le plus souvent sévère, sa sévérité n'est pas significativement associée aux pratiques de soins capillaires et elle est représentée par des caractéristiques trichoscopiques communes.Une sensibilisation et une éducation appropriées des femmes en matière de coiffure peuvent atténuer cette perte de cheveux. MOTS CLÉS: Alopécie marginale de traction, Pratiques de soins capillaires, Caractéristiques trichoscopiques, Évaluation de la gravité de l'alopécie de traction marginale.

Acute onset traction-associated ulceration and alopecia.

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.

Review of traction alopecia in the pediatric patient: Diagnosis, prevention, and management.

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.

Tips for addressing common conditions affecting pediatric and adolescent patients with skin of color.

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.

Bibbidi bobbidi bald: Two "hairowing" tales of Princess Package hairstyles.

We present cases of localized alopecia on the vertex scalp of two girls after elaborate professional hairstyling marketed as the "Princess Package" at a major U.S. theme park. Localized alopecia followed pain, erythema, and delayed crusting due to necrosis of the scalp. The majority of the affected alopecic areas had evidence of regrowth at interval follow-up, but small areas of scarring alopecia remained. We propose that these cases represent a type of alopecia caused by a combination of pressure ischemia and acute traction alopecia.

All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA).

Prevalent among black women, traction alopecia (TA) is a type of hair loss that is often attributed to certain hairstyling practices. Although some of the hair care techniques common in the black community can promote ease of everyday hairstyling for black women, many of these practices have been implicated as risk factors for TA. Because of the limited literature on black hairstyling methods, hair loss in this patient population can present a diagnostic and therapeutic challenge for dermatologists. By increasing the knowledge and understanding of these practices and their risk of causing TA, clinicians can better manage this condition and stop the progression of hair loss before it becomes permanent. This information can be used to develop individualized recommendations for safer styling alternatives and improve patient education by identifying high-risk hairstyling habits. This review stratifies these hair care and styling practices into high-, moderate-, and low-risk categories, in addition to outlining a diagnostic approach for TA and detailed guidelines for conservative management.

Hair loss in patients with skin of color.

Hair loss in skin of color patients can vary from the very simplest of diagnoses to a unique diagnostic challenge requiring extensive knowledge of historical symptoms, haircare practices, and previous treatments. There are several disorders in the literature that are noted to be more common in patients of African descent as compared to Caucasian populations. These disorders include central centrifugal cicatricial alopecia, dissecting cellulitis, discoid lesions of lupus erythematosus, traction alopecia, seborrheic dermatitis, and hair breakage. While there is no definitive prevalence data for the various forms of hair loss in the skin of color population, it is clear that these disorders are a concern for many patients in this population along with common hair loss concerns, such as telogen effluvium and pattern hair loss. A careful detailed clinical examination, history, and potential histopathology will guide the clinician to appropriate management. Hair disorders in skin of color patients may present unique challenges to the clinician, and knowledge of accurate clinical presentation and treatment approaches is essential to providing quality care.

Histologic features of alopecias-part I: nonscarring alopecias.

The diagnosis of disorders of the hair and scalp can generally be made on clinical grounds, but clinical signs are not always diagnostic and in some cases more invasive techniques, such as a biopsy, may be necessary. This 2-part article is a detailed review of the histologic features of the main types of alopecia based on the traditional classification of these disorders into 2 major groups: scarring and nonscarring alopecias. Scarring alopecias are disorders in which the hair follicle is replaced by fibrous scar tissue, a process that leads to permanent hair loss. In nonscarring alopecias, the follicles are preserved and hair growth can resume when the cause of the problem is eliminated. In the first part of this review, we describe the histologic features of the main forms of nonscarring alopecia. Since a close clinical-pathological correlation is essential for making a correct histologic diagnosis of alopecia, we also include a brief description of the clinical features of the principal forms of this disorder.

Postpartum Telogen Effluvium Unmasking Additional Latent Hair Loss Disorders.

Obejctive: 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 difference 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.

Updates on disorders in curly hair.

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.

Elastin staining patterns in primary cicatricial alopecia.

BACKGROUND: Most biopsy specimens of cicatricial (scarring) alopecia can be readily subclassified as lymphocytic versus neutrophilic, but specific diagnosis remains difficult, particularly when a late stage of the disease is sampled. OBJECTIVE: We sought to document patterns of scarring highlighted by elastic tissue staining in primary cicatricial alopecia. METHODS: We documented Verhoeff elastic van Gieson staining patterns in 58 routinely embedded (vertical) biopsy specimens of cicatricial alopecia. Patterns of fibrosis included perifollicular (wedge-shaped vs broad tree trunk-shaped) and diffuse. The patterns were compared against the diagnosis obtained by independent expert clinical review, including central centrifugal cicatricial alopecia (CCCA), lichen planopilaris, traction alopecia, frontal fibrosing alopecia, discoid lupus erythematosus, and tufted folliculitis. RESULTS: Wedge-shaped perifollicular fibrosis was seen in lichen planopilaris but also in CCCA. Broad tree trunk-shaped perifollicular fibrosis was most commonly encountered in CCCA. LIMITATIONS: The retrospective nature of the study precluded temporal staging of the disease process. CONCLUSIONS: Patterns of fibrosis highlighted by elastin staining in primary cicatricial alopecia appear to be disease specific. Superficial wedge-shaped perifollicular fibrosis is associated with but may not be specific for lichen planopilaris. Broad tree trunk-like perifollicular fibrosis is specific for CCCA but not present in many cases. Elastin staining represents a useful ancillary study for the evaluation of late-stage scarring alopecia in routinely oriented punch biopsy specimens.

The development of non-scarring alopecia in women who wear the hijab.

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.

Scarring Alopecia.

African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia. Disorders such as central centrifugal cicatricial alopecia, fibrosing alopecia in a pattern distribution, discoid lupus erythematosus, and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans, dissecting cellulitis, and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp.

Knowledge of Traction Alopecia and Hair Care Practices among Adolescents in Keffi, North-Central Nigeria.

Background: Traction alopecia (TA) is the commonest cause of hair loss among women, with a prevalence of 46.2% in Nigeria. Adequate knowledge and good hair care practices can assist in its prevention. Objective: The aim of this study was to determine knowledge of both TA and hair care practices among adolescents in Keffi, Nigeria. Methods: This was a cross-sectional survey conducted among 333 female adolescents in 3 senior secondary schools between November 2019 and February 2020. The participants were randomly selected and interviewed using a questionnaire which sought information about the knowledge of TA and hair care practices. The data were analysed using SPSS 25 statistical software. Results: Overall, the knowledge score was poor in 61.4% of the adolescents. Hair plaiting 86.8% (289/333), use of chemical relaxers 68.8% (229/333), and use of hair covers 88.3% (294/333) were the predominant hair care practices. In total, 90.8% had concurrently relaxed and plaited their hair. Cornrows with own hair were the commonest hair grooming style. The use of hair attachments was believed to be the commonest cause of TA. The use of hijab was the commonest form of hair cover used. Conclusions: The knowledge of TA is poor among female adolescents. A large number engaged in risky hair care practices. Interventions to reduce the knowledge gap will reduce the prevalence of TA. Key Message: The knowledge of traction alopecia is poor among female adolescents in Keffi who engage in traumatic hair practices.

Regenerative medicine strategies for hair growth and regeneration: A narrative review of literature.

Hair loss, or alopecia, is associated with several psychosocial and medical comorbidities, and it remains an economic burden to individuals and the society. Alopecia is attributable to varied mechanisms and features a multifactorial predisposition, and the available conventional medical interventions have several limitations. Thus, several therapeutic strategies for alopecia in regenerative medicine are currently being explored, with increasing evidence suggesting that mesenchymal stem cell (MSC) implantation, MSC-derived secretome treatment, and blood-derived platelet-rich plasma therapies are potential treatment options. In this review, we searched the Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus using various combinations of terms, such as "stem cell," "alopecia," "hair loss," "Androgenetic alopecia," "male-pattern hair loss," "female-pattern hair loss," "regenerative hair growth," "cell therapy," "mesenchymal stem cells," "MSC-derived extracellular vesicles," "MSC-derived exosomes," and "platelet-rich plasma" and summarized the most promising regenerative treatments for alopecia. Moreover, further opportunities of improving efficacy and innovative strategies for promoting clinical application were discussed.

Nocturnal Traction: Techniques Used for Hair Style Maintenance while Sleeping May Be a Risk Factor for Traction Alopecia.

BACKGROUND: Traction alopecia (TA) is a preventable form of hair loss that most commonly affects women. It is the result of chronic use of hairstyles that put tension on hair. Public health efforts to increase awareness of this condition are critical. Early recognition by health care providers, along with counseling and cessation of offending hair care practices can impact severity of hair loss. OBJECTIVES: In a patient with patchy hair loss, having a high index of suspicion for TA and looking for clues in the history and exam, can help establish an accurate diagnosis. METHODS: Patients with afro-textured or curly hair may use various techniques to maintain their hairstyles while sleeping in order to avoid time-consuming and/or expensive hair care. This behavior is not commonly recognized or addressed. RESULTS AND CONCLUSIONS: Increased awareness of "nocturnal traction" and asking patients "How do you wear your hair when you sleep?" may help identify at-risk patients.