Hair can be pulled out by several procedures intended to beautify, including hot-combing to straighten kinky hair, tight hairstyles such as a pony tail or ‘corn rows’, and using hair rollers too often or too tightly.
The changes are usually seen in girls and young women, particularly those whose hair has always tended to be thin anyway. The pattern of hair loss is determined by the cosmetic procedure in use, hair being lost where there is maximal tug. The term ‘marginal’ alopecia is applied to one common pattern in which hair loss is mainly around the edge of the scalpaat the sides or at the front (Fig. 13.11). The bald areas show short broken hairs, folliculitis and sometimes scarring.
Patients are often slow to accept that they are respons-ible for the hair loss, and notoriously slow to alter their cosmetic practices. Even if they do, regrowth is often disappointingly incomplete.
The pattern of hair loss provides the main clue to the diagnosis and, if the possibility of traction alopecia
is kept in mind, there is usually no difficulty. The absence of exclamation-mark hairs distinguishes it from alopecia areata, and of scaling from tinea capitis.
Patients have to stop doing whatever is causing their hair loss. Rollers that tug can be replaced by those that only heat.