title: Cicatricial marginal alopecia: is it all traction?
abstract: BACKGROUND
  In a specialized hair loss clinic, a group of patients was identified with focal or complete hair loss at the scalp periphery, with a normal scalp surface. Biopsy revealed complete loss of individual hair follicles, indicative of scarring alopecia. Not all patients had a history supportive of a diagnosis of traction alopecia.
  
  
  OBJECTIVE
  To identify and characterize further patients with scarring alopecia of the scalp margin using a retrospective review.
  
  
  METHODS
  All biopsies of scarring alopecia carried out by a single clinician between 1 January 1999 and 29 September 2006 were reviewed. Patients in whom the hair loss was located at the periphery of the scalp were selected for retrospective chart review.
  
  
  RESULTS
  A total of 15 patients met the study criteria, which included histological scarring alopecia and hair loss of the scalp margin. Six of the patients gave a history of relaxing or straightening their hair. Six denied hair care practices sufficient to cause traction alopecia. In three patients, the hair care history was unknown. Occipital hair loss was a common clinical finding, mimicking alopecia areata. The presence of scarring was often subtle histologically.
  
  
  CONCLUSIONS
  A group of patients with moderate to severe cicatricial alopecia of the scalp margin is described. The presence of scarring is difficult to diagnose both clinically and histologically. The lack of a history of severe traction or harsh styling practices in half the patients casts doubt on whether or not traction is the only pathogenic factor.
authors.affiliation: Department of Dermatology, Boston University School of Medicine, 609 Albany Street, Boston, MA 02118, USA. lynngold@bu.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000505:Alopecia / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D001706:Biopsy; D002921:Cicatrix / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D018859:Hair Follicle / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D012189:Retrospective Studies; D012535:Scalp / Q000187:drug effects / Q000473:pathology*; D013256:Steroids / Q000627:therapeutic use; D014143:Traction / Q000009:adverse effects; D055815:Young Adult
chemical_list: D013256:Steroids