cases of frontal fibrosing alopecia presenting
Traction alopecia is a form of alopecia, or gradual hair loss, caused primarily by pulling force being applied to the hair.[1]:761[2]:645 This commonly results from the sufferer frequently wearing their hair in a particularly tight ponytail, pigtails, or braids. It is also seen occasionally in long haired people who use barrettes to keep hair out of their faces. Traction alopecia is recession of the hairline due to chronic traction, or hair pulling, and is characterized by a fringe along the marginal hairline on physical exam.[3][4] Even though this "fringe sign" is considered a useful clinical marker of this condition, cases of frontal fibrosing alopecia presenting with an unusual retention of the hairline (pseudo fringe sign) have been described.[5]It is commonly seen with certain hair styles or braiding patterns that pull the hairline forcefully towards the vertex of the scalp,[6][7] and has been reported more often in African American women (as some wear their hair tightly pulled back), in whom it can cause scarring.[8][9] It has also been seen in female ballerinas,[10] and in cultural traditions where the hair is voluntarily not cut in religious obeisance, the latter caused by progressively increasing weight of the hair itself.[11] Traction alopecia is mechanical in cause, rather than androgenic, and treatment is typically not pharmaceutical.
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