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A 38-year-old woman was found to have hair thinning on the anterior scalp. She had long thick heavy hair that she always styled in a bun on the top of her head. She was concerned about the slow, steady loss of hair that she was experiencing. Figure 188-1 shows the appearance of the thinned hair as a result of chronic traction. A 4-mm punch biopsy was performed to confirm the clinical impression and the histology was supportive of this diagnosis.
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Traction alopecia is hair loss caused by damage to the dermal papilla and hair follicle by constant pulling or tension over a long period. It often occurs in persons who wear tight braids, especially “cornrows” that lead to high tension, pulling, and breakage of hair. Trichotillomania (Greek for “hair-pulling madness”) is a traction alopecia related to a compulsive disorder caused when patients pull on and pluck hairs, often creating bizarre patterns of hair loss.
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- The prevalence of traction alopecia (Figures 188-1 and 188-2) is unknown and varies by cultural hairstyle practices. It is most commonly seen in females and children.1
- The prevalence of trichotillomania (Figures 188-3, 188-4, 188-5, and 188-6) is also difficult to determine, but is estimated to be approximately 1.5% of males and 3.4% of females in the United States. The mean age of onset of trichotillomania is 8 years in boys and 12 years in girls, and it is the most common cause of childhood alopecia.2
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