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Disclosures: The authors report no relevant financial disclosures.


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Most patients received who counseling for traction alopecia had improved outcomes at follow-up, according to a research letter published in the Journal of the American Academy of Dermatology.

“Traction alopecia (TA) is a condition that primarily affects women and children of color and can significantly reduce quality of life,” Gabriella Santa Lucia, MD, MSCR, of the Medical University of South Carolina, and colleagues wrote. “Hairstyle modification through counseling remains the cornerstone of prevention.”

To examine the clinical management and outcomes of TA, Santa Lucia and colleagues conducted a retrospective review of patients diagnosed with TA alone or TA in combination with androgenetic alopecia (AGA).

The researchers identified 167 patients, 11 of whom had concurrent AGA. Most of the patients were black women and had a history of tight braid use. Additionally, most patients exhibited frontotemporal distribution of hair loss.

While most patients received therapeutic counseling and were prescribed adjunctive pharmacotherapy, approximately two-thirds of patients did not return for follow-up. Of those who did return, 78% were lost to follow-up within the first 6 months.

Among the patients with follow-up, 96.3% had stabilized or improved disease.

Santa Lucia and colleagues highlighted health care gaps they identified during the study.

“The frequent diagnostic delay observed in our study underscores the need to increase recognition of TA in children as well as adults and expedite referral of affected individuals to a dermatologist,” they wrote. “Patient education may also encourage earlier visits to the dermatologist when the disease is still reversible, and therapy is more likely to be beneficial.”

They continued that the number of patients with brief or no follow-up may be linked to limited clinician understanding pertaining to disease, cultural norms, societal expectations and economic limitations.

“Practitioners must appreciate the personal value of hairstyles and provide detailed recommendations for low-risk alternatives,” the researchers concluded. “Culturally sensitive practices may lead to sustained, positive outcomes.”

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