Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Apr 1;15(2):4578.
doi: 10.5826/dpc.1502a4578.

Dermoscopy of Traction Alopecia in Black Scalp Patients: Insights from a Literature Review

Thiago Vilas Boas  1 , Rita Fernanda Cortez de Almeida  1 , Violeta Duarte Tortelly  1 , Michela Starace  2 , Daniel Fernandes Melo  1
Affiliations
Review

Dermoscopy of Traction Alopecia in Black Scalp Patients: Insights from a Literature Review

Thiago Vilas Boas et al. Dermatol Pract Concept. .

Abstract

Introduction: Traction alopecia (TA) is a form of hair loss from excessive tension due to specific hairstyling practices. It disproportionately affects black women, including children.

Objective: Our study aimed to review the trichoscopy of TA.

Methods: A literature search was performed in the scientific database PubMed for articles published between 1958 and 2023, using the terms "traction alopecia," "black scalp," "trichoscopy," and "dermoscopy."

Results: The most frequent findings were vellus hair, hair casts, black dots, broken hairs, and white dots. Reduction in hair density, hair diameter variability, empty follicle openings, and vellus hairs may appear early or later during the disease course.

Conclusions: Trichoscopy is a crucial diagnostic tool if associated with a suggestive clinical history. Despite non-specific, its common clinical findings offer relevant information about the disease's progress.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: None.

Figures

Figure 1
Figure 1
Clinical presentation of traction alopecia patients with different hair styles.
Figure 2
Figure 2
Trichoscopy of acute TA. Black dots (black arrows), broken hairs (green arrow), perifollicular scales (red asterisks), hair cast (yellow asterisk), pinpoint white dots (green bracket), absence of follicular opening (blue rectangle), perifollicular erythema (black circle), short hairs (blue asterisks), and pili torti (yellow braces).
Figure 3
Figure 3
Trichoscopy of acute TA. Hair casts (yellow asterisk), perifollicular scales (red asterisks), empty follicle unit (green bracket), perifollicular erythema (red circle), short hairs (blue asterisks), and pili torti (yellow braces).
Figure 4
Figure 4
Trichoscopy of chronic TA. Pili torti (yellow braces), yellow dots (green arrows), peripilar scales (red arrow), thin arborizing vessel (orange circle), and decreased hair density.
Figure 5
Figure 5
Trichoscopy of chronic AT. Pinpoint white dots (red arrow), white patch (yellow arrow), vellus hair (orange circle), preserved honeycomb pigmented network (blue box), and marked reduction in terminal hairs.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Mayo TT, Callender VD. The art of prevention: It’s too tight-loosen up and let your hair down. Int J Womens Dermatol. 2021;7(2):174–179. doi: 10.1016/j.ijwd.2021.01.019. - DOI - PMC - PubMed
    1. Slepyan AH. Traction alopecia. AMA Arch Derm. 1958;78(3):395–398. doi: 10.1001/archderm.1958.01560090111025. - DOI - PubMed
    1. Samrao A, McMichael A, Mirmirani P. Nocturnal traction: Techniques used for hair style maintenance while sleeping may be a risk factor for traction alopecia. Skin Appendage Disord. 2021;7(3):220–223. doi: 10.1159/000513088. - DOI - PMC - PubMed
    1. Haskin A, Aguh C. All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA) J Am Acad Dermatol. 2016;75(3):606–611. doi: 10.1016/j.jaad.2016.02.1162. - DOI - PubMed
    1. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Determinants of marginal traction alopecia in African girls and women. J Am Acad Dermatol. 2008;59(3):432–438. doi: 10.1016/j.jaad.2008.05.036. - DOI - PubMed

LinkOut - more resources