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August 16, 2010

Traction Alopecia in a Ballerina: Clinicopathologic Features

Author Affiliations

Author Affiliations: Departments of Dermatology, University of California, San Francisco (Drs Samrao, Zedek, and Price), and Eastern Virginia Medical School, Norfolk (Dr Chen).

Arch Dermatol. 2010;146(8):918-935. doi:10.1001/archdermatol.2010.183

A 17-year-old white woman was seen in 2002 with a 2-year history of symmetrical hair thinning above both ears and thick hair density over the rest of her scalp. Follicular markings were normal. At another institution, scalp biopsy specimens were interpreted to indicate cicatricial alopecia.

The patient was a serious ballet student who wore her hair in a tight bun for every dance lesson, 4 times a week, for 13 years. Her father twisted her thick, heavy, long hair 2 to 3 times to form the tight bun, which was uncomfortable and painful. Reexamination of the scalp biopsy specimens showed a mild nonspecific perivascular and perifollicular lymphocytic infiltrate and retained sebaceous glands. Correlation of the clinical history, examination findings, and pathology findings led to our diagnosis of early traction alopecia (TA). She was advised to refrain from wearing her hair in a tight bun. This resulted in stabilization of hair loss at 1-year follow-up (Figure 1A).