Conflicts of interest None declared.
Cicatricial marginal alopecia: is it all traction?
Article first published online: 22 SEP 2008
© 2008 The Author. Journal Compilation © 2008 British Association of Dermatologists
British Journal of Dermatology
Volume 160, Issue 1, pages 62–68, January 2009
How to Cite
Goldberg, L.J. (2009), Cicatricial marginal alopecia: is it all traction?. British Journal of Dermatology, 160: 62–68. doi: 10.1111/j.1365-2133.2008.08848.x
- Issue published online: 15 DEC 2008
- Article first published online: 22 SEP 2008
- Accepted for publication 24 July 2008
- hair diseases
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.