Room for Growth — Donovan Hair Clinic

Authors from the Department of Dermatology and Dermatologic Surgery and the Department of Pediatrics Medical University of South Carolina, Charleston, South Carolina performed a retrospective chart review in patients with a clinical diagnosis of traction alopecia to better understand how these patients were cared for.

They identified  167 patients over the period April 2012 to September 2020. Most patients were female and Black.. The mean age at diagnosis was 31.5 (median, 31; range, 1.3-84), and approximately 33.5% of patients were in the pediatric age range. 

Most patients (53.3 %) had a history of tight braid use. Weaves were noted in 7.2 %.  In terms of sites, 52.7 % had frontal loss, 47.3 % had temporal loss, 2.4 % parietal and 13.2 % had occipital loss

Among patients with a known prediagnostic disease duration, 36.4 % presented within 1 years 51.4 % presented more than 1 year after onset and 12.1 % more than 5 years

In terms of treatment, 63% were given treatment and 36.5 % were not. Of those who were given treatment, 66 % were prescribed topical steroids, topical minoxidil was given to 34 %, steroid injections to 6.6 % and PRP to 0.9 %.

 In terms of follow up appointments, the majority of patients did not have follow up. Of 167 patients, 67.7 % did not return and 32.3 % did return. Of the patients that did return back for follow up, 70% had follow up for less than 6 months, and 11 % had 6-12 months of follow up and 18.5 % had more than 1 year.


Of 52 patients who did have documented follow up, 63 % improved, 33.3 stabilized and only 3.3 % worsened.


 Comments and Key Points

This paper highlights several key points in my view


1)  Traction alopecia has a fairly high chance of improvement if we can get patients connected with therapy. 63 % of patients in this study improved. Of course this study did not set out to determine in detail if improvements are significant and meaningful to all but nevertheless the main message is clear. Traction alopecia can improve.

2)    Most patients are not given a chance to come back to clinic. Traction alopecia requires proper counseling and education and then dedicated follow up to ensure improvement. This is an area for improvement. We ideally need to provide education and strategies for patients and then see them back to ensure that patients and families find our recommendations easy to carry out.

3)    We are probably not treating traction alopecia as aggressively as we could be. With 34 % minoxidil and 7 % steroid injections we probably have room for improvement.  Of course 33 % of patients here were pediatric patients so it may be that we are more conservative in pediatric patients. Nevertheless, it’s likely we underuse strategies to get hair growing like steroid injections, topical minoxidil and oral minoxidil

4)    Early diagnosis is key and we still have a majority of patients presenting after 1 year of hair loss.


Lucia GS et al. Traction alopecia: Neglected in women and children of color. J Am Acad Dermatol. 2022 May 28;

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