title: The "Fringe Sign" - A useful clinical finding in traction alopecia of the marginal hair line.
abstract: BACKGROUND
  Traction alopecia is hair loss caused by prolonged or repetitive tension on the hair. Diagnostic challenges are encountered when the clinical suspicion is not high and when a history of traction is remote or not obtained. We have made the observation that the presence of retained hairs along the frontal and/or temporal rim, which we termed the "fringe sign," is a finding seen in both early and late traction alopecia, and may be a useful clinical marker of the condition.
  
  
  METHODS
  This was a retrospective single-center review to determine the frequency of the fringe sign in patients with traction alopecia.
  
  
  RESULTS
  Over a 3.5-year period the diagnosis of traction alopecia was made in 41 women. Twelve of the 41 patients were Hispanic (29%). Thirty-five (85%) of all women and 100 percent of women who had traction involving the marginal hairline had the fringe sign. Fourteen biopsies (58%) were available for review. Histopathologic findings included retained sebaceous glands (100%), an increase in vellus-sized hairs (50%), a decrease in terminal hairs (100%), fibrotic fibrous tracts (100%), and sparse lymphocytic inflammation (57%).
  
  
  CONCLUSIONS
  The fringe sign is a sensitive and specific clinical feature of traction alopecia when it involves the marginal hairline.
authors.affiliation: Department of Dermatology, University of California, San Francisco, California, USA.
authors.forename: Aman
authors.initials: A
authors.lastname: Samrao
authors.forename: Vera H
authors.initials: VH
authors.lastname: Price
authors.forename: Daniel
authors.initials: D
authors.lastname: Zedek
authors.forename: Paradi
authors.initials: P
authors.lastname: Mirmirani
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000505:Alopecia / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D001505:Beauty Culture; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006184:Habits; D006197:Hair / Q000473:pathology*; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D055815:Young Adult