Congenital Triangular Alopecia

Abstract

Congenital triangular alopecia (CTA) also known as temporal triangular alopecia is a benign noncicatricial pattern of hair loss. It typically affects the frontotemporal region and rarely involves the temporoparietal or occipital scalp. It is a nonprogressive disorder that presents as a triangular, oval or lancet-shaped patch of alopecia. CTA can manifest at birth or develop later in life. The exact etiology of this condition remains unknown. Rarely, it may be associated with other disorders such as Down's syndrome and phakomatosis pigmentovascularis. The diagnosis is based on its distinct clinical appearance. Histologically, hair follicles are miniaturized and replaced by sparse vellus hair follicles. Tricoscopy using a polarized light handheld dermatoscope can be a useful diagnostic tool. CTA is often asymptomatic and remains unchanged throughout the life. No treatment is required. Surgical intervention with follicular unit hair transplantation can provide a satisfactory cosmetic result. In this paper, we have identified 126 cases of CTA in the published literature cited on PubMed between 1905 and 2015. From the available evidence, 79% of patients with CTA presented with unilateral hair loss, 18.5% with bilateral involvement and rarely, with occipital alopecia (2.5%). There was no gender predilection. These figures are entirely consistent with previously published data. Physicians should remember to consider CTA as a potential diagnosis in any patient presenting with a nonscarring alopecia in order to avoid unnecessary investigations and treatments.

Keywords: Congenital triangular alopecia; non-scarring alopecia; temporal alopecia.

Figure 1

Congenital triangular alopecia affecting the frontotemporal regions bilaterally in an 8-year-old girl (left frontotemporal hair loss shown in this photograph) (This photograph is original courtesy of Dr. Paul Yesudian)

Figure 2

Congenital triangular alopecia affecting the frontotemporal regions bilaterally in an 8-year-old girl (right frontotemporal hair loss shown in this photograph) (This photograph is original courtesy of Dr. Paul Yesudian)

Figure 3

Triangular patch of hair loss over the left frontotemporal region; normal terminal or vellus hairs may be noted within the affected patch (This photograph is original courtesy of Dr. Paul Yesudian)