Trichoscopic evaluation of non-marginal traction alopecia: A case series

Here, we report ten cases of non-marginal traction alopecia.All female patients presented with asymptomatic focal hair loss on the scalp.A patch of hair loss in the middle of the scalp and otherwise very long, normal-looking hair was seen on examination.e patch was irregular, linear, variable in length, and extended from the frontal line to the vertex through the middle of the scalp.No other patches of hair loss were observed on the scalp or any other body part.On further inquiry, patients denied any history of pulling their hair, tying their hair tightly, or using any hot combs, relaxers, tight extensions, or weaves.On trichoscopy, flambeau sign (multiple linear white tracks at the base of the shaft of the terminal hair posterior to the formed fringe), empty hair follicles, hair shafts of different diameters, single follicular units, and peripilar cylindrical cast areas were seen [Table 1] [Figures 1 and2].Scalp biopsy for histopathology was suggestive of traction alopecia [Figures 3a andb].Eight of ten patients provided consent for scalp biopsy.e most prevalent histological findings were catagen/ telogen follicles, empty hair follicles, sebaceous gland preservation, minor perifollicular fibrosis, and mild perifollicular inflammatory infiltration.ese findings confirmed our diagnosis of nonmarginal traction alopecia.ey were advised to cut their hair to a shorter length and apply a topical 2% minoxidil solution twice a day, which improved their alopecia within a few months.Traction alopecia is a type of patchy alopecia that occurs as a result of chronic tensile forces on the hair.It results from prolonged traction on the scalp due to physical pressure, due to different hairstyles such as tight braids, tight ponytails, cornrows, dreadlocks, or due to hair treatment with rollers or extensions. [1]Traction alopecia is of two types: Marginal and non-marginal. [2]arginal traction alopecia is the more frequent type, typically involving the frontoparietal scalp, while non-marginal traction alopecia can affect any part of the scalp. [2]Recently, it has been noted that non-marginal traction alopecia can be caused by the excessive weight of very long, nonmanipulated hair.Alejandro et al., called this type of non-marginal traction alopecia Rapunzel alopecia. [1]action alopecia often produces a recognizable pattern of hair loss, typically presenting as marginal alopecia, but it can involve any area of the scalp, depending on the hairstyling practice undertaken.Marginal traction alopecia affects patients whose hair is drawn firmly back.e "fringe sign" is characteristic of this type of alopecia -the hair along the frontal hairline is retained.Still, it is attenuated or finer in caliber, and the area of alopecia is present behind this "fringe". [1,2]Non-marginal traction can involve any area of the scalp.One such type is chignon www.jsstd.