Expert stresses prevention of traction alopecia in children.

MIAMI BEACH -- Physicians can prevent traction alopecia in children through early intervention, according to an ethnic skin care specialist.

Although physicians can treat inflammation with topical steroids, the clinical focus should be counseling patients and parents about prevention of future damage. "I would like to see an increase in education to primary care providers to catch it before it starts," said Dr. Heather Woolery-Lloyd, director of ethnic skin care in the department of dermatology at the University of Miami. "They should emphasize avoidance of tight hairstyles."

She said that she would also like to see a direct-to-consumer advertising campaign geared to the black community emphasizing that traction alopecia is preventable.

"Kids are more likely to achieve regrowth if you stop the tight hairstyle technique. The prognosis is better if it is caught earlier," said Dr. Woolery-Lloyd at the annual Masters of Pediatrics conference sponsored by the University of Miami.

Although there are no differences in the keratin or amino acid composition among the hair of Asian, white, or black patients, the physical properties of a black patient's hair might explain why traction alopecia is one of the conditions of more concern to children with skin of color. A black patient's hair is more elliptical and flattened on cross section, compared with an Asian or white patient's hair. Most naturally shed hairs of a black patient feature a frayed tip (J. Am. Acad. Dermatol. 2000;43:814-20). Researchers observed more longitudinal splitting, fissures, and breaking of black patients' hair shafts in this study. Other investigators found decreased tensile strength, resistance to breakage, and hair density, compared with the hair of white and Asian patients (Arch. Dermatol. 1999;135:656-8).

A black patient's hair also features fewer elastic fibers to anchor the hair follicles to the dermis, said Dr. Woolery-Lloyd. This is part of the traction alopecia etiology. A tight hairstyle is the other main cause of traction alopecia.

Black children with multitufted braids, for example, are at higher risk, particularly if the braids or multiple ponytails are pulled too tightly. Cornrows are another hairstyle that is more common among black children. Again, traction alopecia can result if these braids along the scalp are pulled too tightly, Dr. Woolery-Lloyd said. The prevalence of traction alopecia is increasing among blackboys, she added, with the increasing popularity of cornrows.

Chemical relaxers might also increase risk of traction alopecia, according to a South African study of 1,024 school boys and girls (Br. J. Dermatol. 2007;157:106-10). The researchers found a higher prevalence of traction alopecia in children with chemically relaxed hair, compared with the group with untreated hair.

Patients present with hair loss on the frontal or temporal scalp with a rim of short hairs at the hairline. Some patients "with very, very tight hairstyles" also have pustules from inflammation along the hairline, Dr. Woolery-Lloyd said.

Although her presentation addressed traction alopecia in pediatric patients, in the future she would like to see researchers assess the viability of hair transplants in adults with traction alopecia, Dr. Woolery-Lloyd said in a follow-up interview.

BY DAMIAN McNAMARA

Miami Bureau