[2][3] Diagnosis is clinical and treatment directed at cessation of the chronic traction, while cosmeses, with surgical restoration is reserved for severe cases with scarring fibrosis.
It is commonly seen with certain hair styles like a particularly tight ponytail, pigtails, braid or braiding pattern that pulls the hairline forcefully towards the vertex of the scalp,[4][5] and has been reported more often in African American women (as some wear their hair tightly pulled back), sometimes causing scarring.
The former involves creating a braid around the head below the existing hairline, to which an extended-wear hairpiece, or wig, is attached.
[10] A condition known as CCCA (central cicatricial centrifugal alopecia), seen almost exclusively in African American women, can cause extensive hair loss.
Management includes cessation of the chronic traction, cosmeses, with surgical restoration reserved for more severe cases with scarring fibrosis.