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

Clinical Pearls and Promising Therapies

Abstract

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.