title: Determinants of marginal traction alopecia in African girls and women.
abstract: BACKGROUND
  Our recent population studies reported a prevalence of traction alopecia (TA) of 17.1% in African schoolgirls (6-21 years) and of 31.7% in women (18-86 years). More schoolgirls had chemically treated hair than women and disease presence was associated with hairstyles. The aim of this study was to investigate determinants of TA presence and severity in girls and women using data from both studies.
  
  
  METHODS
  Clinical assessment and a Marginal TA Severity score were used for diagnosis and disease severity, respectively. The data used included 574 schoolgirls and 604 women. The first analysis was multiple logistic regression for disease presence. Exploratory associations for disease severity were assessed using the Spearman rank correlation test. Adults were defined as age 18 years or older, irrespective of study.
  
  
  RESULTS
  The odds ratio for TA was higher in adults than in children (<18 years) (1.87 [P < .001, 95% confidence interval 1.28-2.72]) and was higher with braiding-related than chemical-related symptoms. The highest risk of TA, compared with natural hair, occurred when traction was added to relaxed hair (odds ratio 3.47 [P < .001, 95% confidence interval 1.94-6.20]). Only 18.9% of patients with TA had never had symptoms related to hairdressing. TA severity was associated with age group, current hairstyle, and hairdressing symptoms. Participants with severe disease were too few to estimate determinants.
  
  
  CONCLUSIONS
  There is a need for the validation of the Marginal TA Severity score with larger numbers and for future studies to include more participants with severe disease.
  
  
  CONCLUSIONS
  Our findings suggest that avoiding both hairdressing symptoms and the addition of traction, especially to chemically processed hair, may reduce the risk of developing TA.
authors.affiliation: Division of Dermatology, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa. nonhlanhla.khumalo@uct.ac.za
authors.forename: Nonhlanhla P
authors.initials: NP
authors.lastname: Khumalo
authors.forename: Susan
authors.initials: S
authors.lastname: Jessop
authors.forename: Freedom
authors.initials: F
authors.lastname: Gumedze
authors.forename: Rodney
authors.initials: R
authors.lastname: Ehrlich
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000505:Alopecia / Q000145:classification / Q000208:ethnology / Q000209:etiology* / Q000473:pathology; D044383:Black People; D002648:Child; D005260:Female; D018859:Hair Follicle / Q000293:injuries*; D006203:Hair Preparations / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012535:Scalp / Q000473:pathology; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D018709:Statistics, Nonparametric; D013314:Stress, Mechanical
chemical_list: D006203:Hair Preparations