Nurse's cap alopecia

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.

Traction alopecia: the root of the problem

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.

Evaluation of clinical signs and early and late trichoscopy findings in traction alopecia patients with Fitzpatrick skin type II and III: a single-center, clinical study

BACKGROUND

Traction alopecia refers to (often permanent) hair loss caused by prolonged physical damage. No study has yet described the unique trichoscopic findings of the condition. We describe the trichoscopic findings of traction alopecia and its relationships with the duration of traction.

METHODS

We studied 25 patients who were clinically diagnosed with traction alopecia. The patients were divided into two groups in terms of traction duration. Trichoscopy was performed at a minimum of two scalp locations in each patient.

RESULTS

Reduction in hair density, hair diameter diversity, empty follicles, and vellus hairs were observed in all patients. In addition, the following were observed: loss of follicular openings in 19 (76%) patients, yellow dots and broken hairs in 17 (68%), black dots in 12 (48%), hair casts in 7 (28%), circular hairs in 5 (20%), and arborizing red lines in 3 (12%). The trichoscopic findings varied with the duration of traction.

CONCLUSIONS

Traction alopecia is a chronic condition that is difficult to treat. Trichoscopy can be used for diagnosis. Our study is the first to identify the early and late trichoscopic features of traction alopecia. The limitation of the study is the lack of histologic diagnosis.

Traction alopecia: how to translate study data for public education--closing the KAP gap?

Traction alopecia (TA) affects up to 32% of women and 22% of high school girls with Afro-textured hair but can start in the preschool years. Traction induces inflammation and follicle damage. The risk of TA increases with symptomatic traction and combined hairstyles. To influence the practice of hairdressers and at risk individuals and help narrow the knowledge, attitudes, and practices (KAP) gap, scientific data should be translated into simple messages like "tolerate pain from a hairstyle and risk hair loss" and "no braids or weaves on relaxed hair". With appropriate education and public awareness, TA could potentially be eradicated.

Cicatricial marginal alopecia: is it all traction?

BACKGROUND

In a specialized hair loss clinic, a group of patients was identified with focal or complete hair loss at the scalp periphery, with a normal scalp surface. Biopsy revealed complete loss of individual hair follicles, indicative of scarring alopecia. Not all patients had a history supportive of a diagnosis of traction alopecia.

OBJECTIVES

To identify and characterize further patients with scarring alopecia of the scalp margin using a retrospective review.

METHODS

All biopsies of scarring alopecia carried out by a single clinician between 1 January 1999 and 29 September 2006 were reviewed. Patients in whom the hair loss was located at the periphery of the scalp were selected for retrospective chart review.

RESULTS

A total of 15 patients met the study criteria, which included histological scarring alopecia and hair loss of the scalp margin. Six of the patients gave a history of relaxing or straightening their hair. Six denied hair care practices sufficient to cause traction alopecia. In three patients, the hair care history was unknown. Occipital hair loss was a common clinical finding, mimicking alopecia areata. The presence of scarring was often subtle histologically.

CONCLUSIONS

A group of patients with moderate to severe cicatricial alopecia of the scalp margin is described. The presence of scarring is difficult to diagnose both clinically and histologically. The lack of a history of severe traction or harsh styling practices in half the patients casts doubt on whether or not traction is the only pathogenic factor.

Clinical relevance of hair microscopy in alopecia

Hair microscopy can clarify the cause of hair loss in a range of diagnoses. Most of these are associated with hair breakage, the rest are related to lack of growth. Hair breakage may be due to excessive trauma or underlying susceptibility, where structural clues may be present. Lack of growth reflects follicular dynamics and represents the central mechanism of most common causes of alopecia. In such conditions, microscopy only reveals nonspecific confirmation of short anagen. Although this may assist clinical diagnosis, microscopy in alopecia only allows exclusion of diagnoses related to hair breakage. Confidence in the outcome of hair microscopy is based on the size of the sample of hairs, the length of the hair, the characteristics of the observations and the experience of the person undertaking the microscopy.