BH24 Traction alopecia in women: an under-recognized cause of hair loss

Abstract Alopecia ranks among the most common clinical conditions encountered by dermatologists. Affected women especially often experience great psychoemotional stress leading to a reduction in quality of life. We conducted a prospective epidemiological study over 77 weeks from 1 August 2022 to 23 January 2024 in a tertiary hospital outpatient dermatology department. Our primary aim was to evaluate the aetiology of hair loss in adult female patients in our centre. Female patients aged > 21 years were consented for recruitment after a formal diagnosis of alopecia. In total 38 patients were recruited. One-half of patients (19 of 38, 50%) had multiple aetiologies attributed to their hair loss. History and clinical examination, including use of trichoscopy, were used to ascertain the aetiology of alopecia. We found that the most common cause of alopecia was female pattern hair loss (71%, n = 27), followed by traction alopecia (34%, n = 13) and alopecia areata (21%, n = 8). Indian patients were over-represented, comprising 21% of patients with alopecia in this study despite making up only 7% of the local population. Interestingly, traction alopecia was a cause of alopecia in 80% of the Indian patients in the study group. The mechanism of traction alopecia was either hair tying or clipping. Seborrhoeic dermatitis (21%) and eczema (16%) were commonly seen in the study group, higher than expected for the local population. This study found traction alopecia to be the second most common cause of alopecia in our cohort. Raising awareness and education on methods of hair care to prevent traction alopecia are important, as it is potentially treatable if detected early. We have also identified possible risk factors for alopecia, such as hair practices common to Indian ethnicity, and coexisting conditions such as seborrhoeic dermatitis and eczema. Identifying patient groups at higher risk of alopecia in this study will help with early detection and institution of preventive and treatment strategies for alopecia.