SKIN January 2023 Volume 7 Issue 1 (c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 638 SHORT COMMUNICATION Traction Alopecia in the Beard Jayvon McKinley1 and Mindy Kresch-Vatch2 1Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 2 New York Medical College, Valhalla, NY Traction Alopecia (TA) is a type of hair loss that results from recurring pulling on hair follicles. Hairstyles such as dreadlocks and ponytails are believed to increase the risk of developing TA. Due to its potential to be misdiagnosed as frontal fibrosing alopecia (FFA), alopecia areata, or patchy central centrifugal cicatricial alopecia (CCCA), histopathology can help discriminate TA from these other diagnoses.1 Early stages are distinguished by an elevated proportion of catagen and telogen hair follicles, whereas the later stages have a reduction in the terminal follicle count.2 Without timely intervention, chronic TA could develop into scarring alopecia that may be unaffected by treatments. To avoid this irreversible course, it is crucial to focus on early prevention and therapeutic options. To date, most cases have been reported in the scalps of African American women.3 Here we present a unique case of TA to the frontal chin area of a Hasidic Jewish male. A 27-year-old male with a history of eczema presented to our dermatology clinic for hair loss to the submental region of his beard (Figure 1). Hair loss first started one year ago and has gradually progressed since onset. He admits to frequent hair pulling, twisting, and braiding his beard. Patient reports pruritus but denies any other localized symptoms. He denied any known allergies, systemic symptoms, or current medications. Physical examination revealed a large patch of hair loss at the submental and frontal chin area. There was evidence of scarring at the frontal chin. Patient was diagnosed with traction alopecia and advised to stop braiding his beard. Figure 1. Traction alopecia in the beard. Three months post clinic visit, patient has noticed significant improvement in pruritus. INTRODUCTION CASE REPORT SKIN January 2023 Volume 7 Issue 1 (c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 639 He has ceased all twisting or pulling to the area. Although he reports minimal hair regrowth so far, there has been no further loss of hair to the chin area. No medications or other treatments were used. Patient will continue to minimize repetitive and extended tension to his hair. TA is a type of hair loss that, if left untreated, can result in permanent scarring alopecia – another indication that early diagnosis is critical. Although most cases have been reported in African Americans, it is believed that hair care practices are the cause of TA rather than hair type. This case report supports this pathophysiological argument by presenting a Hasidic Jewish male with TA to his chin area. Prior literature has shown encouraging results of TA with Triamcinolone Acetonide, Gashee lotion (a topical botanical formulation), 2% topical minoxidil, and oral minoxidil with fluocinonide 0.05% topical solution.3-6 In light of these promising therapeutic options, a large randomized, double-blind, placebo-controlled study is warranted to further evaluate the efficacy of these case-by-case situations. Until there is additional data published regarding treatment options for TA, prevention and patient education remain the most important recourse. Conflict of Interest Disclosures: None Funding: None Corresponding Author: Jayvon McKinley Icahn School of Medicine at Mount Sinai Department of Dermatology 5 E 98th St. 5th Floor New York, NY 10029 Email: Jayvonbmckinley@gmail.com References: 1. Billero V, Miteva M. Traction alopecia: the root of the problem. Clin Cosmet Investig Dermatol. 2018 Apr 6;11:149-159. doi: 10.2147/CCID.S137296. PMID: 29670386; PMCID: PMC5896661. 2. Pulickal JK, Kaliyadan F. Traction Alopecia. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470434/ 3. Uwakwe LN, De Souza B, Tovar-Garza A, McMichael AJ. Intralesional Triamcinolone Acetonide in the Treatment of Traction Alopecia. J Drugs Dermatol. 2020 Feb 1;19(2):128-130. doi: 10.36849/JDD.2020.4635. PMID: 32129955. 4. Umar S, Carter MJ. A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases. Case Rep Dermatol Med. 2021 Feb 4;2021:6659943. doi: 10.1155/2021/6659943. PMID: 33614172; PMCID: PMC7878086. 5. Khumalo NP, Ngwanya RM. Traction alopecia: 2% topical minoxidil shows promise. Report of two cases. J Eur Acad Dermatol Venereol. 2007;21(3):433- 434. 6. Kim SR, Craiglow BG. Treatment of traction alopecia with oral minoxidil. JAAD Case Rep. 2022 Apr 1;23:112-113. doi: 10.1016/j.jdcr.2022.03.023. PMID: 35495975; PMCID: PMC9039860. DISCUSSION