Hair extensions: a concerning cause of hair disorders

Considerations and recommendations on camouflage in alopecia in Black women

Alopecia is among the leading dermatological concerns affecting Black women. For many women, hair is a central component of identity and self-expression, the loss of which can have significant psychosocial effects. Hair camouflage is often utilized to minimize the visibility of hair loss, provide aesthetic benefits, and improve quality of life. The versatility and affordability of hair camouflage allows patients with alopecia to conceal hair loss, increasing self-confidence, and decreasing social stigma. However, hair camouflage practices often involve adhesives, chemicals, and/or high-tension braiding, all of which can exacerbate alopecia. Accordingly, special considerations should be made to protect patients' natural hair from damage while using these styling practices. A better understanding of best practices for some of the most widely used camouflage options-wigs, extensions, topical hair fibers, and micropigmentation-can help clinicians establish rapport with Black women and optimize individually-tailored therapeutic plans during active treatment and end-stage hair loss.

The histopathologic diagnosis of traction alopecia: An evidence-based model

BACKGROUND

Traction alopecia (TA) is common, but histopathologic criteria for TA have not been objectively defined.

OBJECTIVE

Determine whether the pauci-follicular unit (PFU) can be used as a diagnostic criterion for TA. Compared to a normal follicular unit (NFU), the PFU is a noninflamed follicular unit with an intact sebaceous gland but fewer than 2 follicles.

METHODS

A retrospective review of 25 cases of TA and 25 cases of "normal scalp" was performed. Data included all follicles (by size and phase), sebaceous glands, and total follicular units.

RESULTS

Comparing data (traction vs normal), we found a significantly higher number of PFUs in cases of TA (median 6 vs 0, P < .001), which can be used as a helpful and easily recognizable diagnostic tool in diagnosing cases of TA.

LIMITATIONS

Comparison to other forms of alopecia was not performed.

CONCLUSIONS

The number of PFUs in an alopecia biopsy can be used to establish the diagnosis of TA.

Postpartum Telogen Effluvium Unmasking Traction Alopecia

<b><i>Introduction:</i></b> Telogen effluvium (TE) is a type of diffuse hair shedding that occurs 2–3 months after an exposure or trigger. The excessive hair loss may “unmask” underlying hair loss disorders such as female pattern hair loss. <b><i>Case Presentation:</i></b> This is a case series of 3 patients with postpartum TE in which an underlying traction alopecia (TA) was revealed. <b><i>Conclusion:</i></b> TE can unmask underlying TA. Awareness of this phenomenon is critical to appropriate diagnosis and treatment.

Patient satisfaction and adverse effects following the use of topical hair fiber fillers

Introduction:

Alopecia (hair loss) commonly affects patients and can severely affect one's confidence and self-esteem. In addition to medical therapy, hair filler fibers can improve the gross appearance of thinning hair in a targeted manner by making hair appear fuller and thicker. The objective of this study is to assess patient use, satisfaction, and adverse effects following the application of a commercially available hair fiber filler product.

Materials and Methods:

This cross-sectional study was conducted at an academic tertiary dermatology center. Alopecia patients were supplied a keratin hair fiber filler, which best matched their natural hair color. Following 90 days of application, patients were asked to complete questionnaires to assess patient satisfaction and record patient-reported adverse events.

Results:

Twenty women and 20 men with hair loss participated. Patients reported improved hair volume and increased perceptions of confidence and attractiveness after applying fiber. Most subjects (92.5%) reported a high level of satisfaction with the fiber's ability to match hair color and provide sufficient coverage. No serious adverse effects were reported.

Conclusion:

Alopecia has a negative impact on quality of life and several psychological domains. Topical hair filler fiber can serve as an effective and safe camouflage for patients with alopecia with high user satisfaction.

Synthetic hair extensions causing irritant contact dermatitis in patients with a history of atopy: A report of 10 cases

BACKGROUND

We present a case series of 10, atopic, African women who developed irritant contact dermatitis (ICD) from synthetic hair extensions.

METHODS

Ten consecutive African female patients who presented with a pruritic cutaneous eruption on the neck over a period of 2 years are described. Patients underwent skin patch testing using both standard and hair commercial patch test panels and samples of their own hair extensions. Hair care products were not tested.

RESULTS

All 10 patients used synthetic hair extensions. A strong history of atopy was documented for all the patients and examination was significant for eczematous, lichenified plaques at the location of contact with the free end of the hair extension. Patch test results yielded no relevant reactivity and a diagnosis of ICD was made for all patients. The lesions resolved completely on removal of the hair extensions and the use of topical steroids and emollients, dependent on eczema severity.

CONCLUSIONS

Artificial hair extensions should be considered as a potential irritant, resulting in ICD. Patients with a history of atopy are at risk of developing ICD from synthetic hair extensions.

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.

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.

Hair camouflage: A comprehensive review

Hair is venerated, cherished, and desired in societies throughout the world. Both women and men express their individual identities through their hairstyles. Healthy hair contributes to successful social assimilation, employment, and overall quality of life. Therefore, hair loss can have detrimental effects on almost every aspect of a person’s life. In this review, we discuss the myriad of options that aid in concealing and camouflaging hair loss to facilitate a healthier-appearing scalp. Camouflage options for patients who suffer from hair loss include full or partial wigs, hair extensions, concealing powders and sprays, surgical tattoos, and hair transplants. We describe these modalities in detail and discuss their respective advantages and disadvantages.

Hair camouflage: A comprehensive review

Hair is venerated, cherished, and desired in societies throughout the world. Both women and men express their individual identities through their hairstyles. Healthy hair contributes to successful social assimilation, employment, and overall quality of life. Therefore, hair loss can have detrimental effects on almost every aspect of a person’s life. In this review, we discuss the myriad of options that aid in concealing and camouflaging hair loss to facilitate a healthier-appearing scalp. Camouflage options for patients who suffer from hair loss include full or partial wigs, hair extensions, concealing powders and sprays, surgical tattoos, and hair transplants. We describe these modalities in detail and discuss their respective advantages and disadvantages.

Full-thickness Scalp Injury Due to Hair Braiding and Weave

Full-thickness scalp necrosis secondary to hair weave placement is a rare but serious complication of a common hairstyle. The defects can be large and may necessitate complex reconstruction with hair-bearing tissue. We report on the case of a young woman with extensive scalp loss following tight spiral braiding. The case description illustrates this relatively unknown complication, its treatment, and possible preventative measures.

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.

Role of trichoscopy in children's scalp and hair disorders

Hair and scalp disorders in children may originate from the hair itself, scalp skin, or infectious causes and be congenital or acquired. The most common sign is alopecia, frequently brought on by tinea capitis, patchy alopecia areata, or trichotillomania. Sometimes less frequent and clinically more elusive conditions such as initial androgenetic alopecia, congenital triangular alopecia, or alopecia areata incognita may be responsible for hair loss. The noninvasive technique known as trichoscopy is being used more frequently, aiding in the prompt differential diagnosis and follow-up of many of these diseases, oftentimes providing further examination before a treatment decision is made. This review of trichoscopy of the main scalp and hair disorders afflicting children and adolescents discusses the most important dermoscopic criteria and the usefulness of this technique.

Dermoscopy in the diagnosis of hair and scalp disorders

Dermoscopy is a non-invasive, in vivo technique that has been recently utilized for the diagnosis and management of hair and scalp disorders. In the last few years many studies have been published in this field; this review will describe the dermoscopic patterns observed in the most common hair and scalp disorders and discuss their diagnostic relevance.

Frontal Fibrosing Alopecia: Role of Dermoscopy in Differential Diagnosis

Frontal fibrosing alopecia (FFA) is more common in postmenopausal women, but it can occur in younger women. Some authors consider FFA to be a distinct frontal variant of lichen planopilaris. From a clinical point of view, this relatively uncommon condition is characterized by progressive frontotemporal recession due to inflammatory destruction of hair follicles. Dermoscopy can be very useful, as the differential diagnosis between traction alopecia, alopecia areata, FFA and cicatricial marginal alopecia may be difficult. It is not clear whether or not treatment alters the natural history of the disease - the disease stabilized with time in most of the patients with or without continuing treatment. Here we report a case of a 50-year-old woman with FFA and discuss the relevance of dermoscopy in the differential diagnosis of this disease.