A Tale of Two Frontal Alopecias: Traction Alopecia and Frontal Fibrosing Alopecia

Clinical Pearls and Promising Therapies


  • Renée A. Beach, MD, FRCPC
  • Kikachukwu Otiono, BA MD Candidate, Michael G. DeGroote School of Medicine, McMaster University (Class of 2022)


Traction alopecia (TA) is a form of hair loss caused by repetitive tension and pulling of the hair. TA most commonly occurs in women of Afro-Caribbean descent with afro-textured hair due to the higher prevalence of high-tension hairstyles such as braids and weaves. However, it has also been reported in other patient demographics including ballerinas, gymnasts, and patients with certain head coverings. TA typically occurs in a biphasic nature, starting with an early stage that is non-cicatricial (without scarring) which can progress to cicatricial and permanent alopecia with prolonged tension. Conversely, frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris (LPP) that presents as an inflammatory cicatricial alopecia. FFA is clinically characterized by permanent alopecia, an unpredictable clinical course, and a band-like pattern of involvement in the frontal and temporal hairline. FFA mainly affects post-menopausal women as described by Kossard, although there have been cases reported in premenopausal women and in men.

When hair loss involves the frontotemporal region, it can sometimes be difficult to distinguish between TA and FFA. Marginal or frontal hairline TA can especially mimic the band-like pattern of hair loss seen in FFA. As such, delineation of the clinical presentations and distinguishing features of each condition is important.  This paper outlines clinical parameters for each diagnosis to enable accurate diagnosis and therapy. 

Author Biographies

Renée A. Beach, MD, FRCPC

Dr Renée A. Beach is an adjunct Assistant Professor in the University of Toronto’s Faculty of Medicine. She completed her medical training at McMaster University (MD) and dermatology residency at the University of Ottawa. She practices medical and cosmetic dermatology at her recently opened practice DermAtelier on Avenue in Toronto. At Women’s College Hospital, she teaches dermatology residents in the Consultative Hair Loss Clinic.

Kikachukwu Otiono, BA, MD Candidate, Michael G. DeGroote School of Medicine, McMaster University (Class of 2022)

Ms. Kikachukwu Otiono is a 2nd year medical student at the Michael G. DeGroote School of Medicine at McMaster University. She is a native of Ottawa and the Director of Advocacy & Representation for the Black Medical Students’ Association of Canada (BMSAC).


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How to Cite

Beach RA, Otiono K. A Tale of Two Frontal Alopecias: Traction Alopecia and Frontal Fibrosing Alopecia: Clinical Pearls and Promising Therapies. Can Dermatol Today [Internet]. 2020 Nov. 1 [cited 2024 Jun. 22];1(4):30-4. Available from: https://canadiandermatologytoday.com/article/view/1-4-beach-otiono