# Hair Transplants In Sikh Males: Traction Allopecia



## spnadmin (May 30, 2010)

*Hair Transplants in Sikh Males: “Traction Allopecia”. 
*
Sikhism is a distinct religion started by Guru Nanak Dev in India.

 The Sikh tenets make it compulsory for the Sikh male to sport 5  symbols of religion on their person, one of which is “Kesh” or long  hair. This long hair is tied rather tightly on the head as a topknot and  held in place by a rubber band. The pull of this firmly tied knot  stretches the most distant hair which in this case is unfortunately the  frontal hair line and also the temporal hairline.

 However, the frontal hair line is devoid of hair  since the hair roots have been permanently scarred consequent to the  constant pull on them since early childhood. This scarring and hair loss  also occurs  below the jaw<sup> </sup>area because also sport a long  beard and knot tied below the jaw.

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 This is a cause of tremendous anguish and concern amongst these young  males with a broken frontal hairline.

 In many cases with this form of hair loss due to traction, called  traction alopecia,  seborrheic dermatitis or psoriasis may  occur together. Treatment of these skin conditions will reduce the  symptoms.

 Treating this traction alopecia in Sikh males can be a difficult process  since they are forbidden to cut their hair short.

What are your views on this topic? Should a Sikh go for such treatment?


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## spnadmin (May 30, 2010)

*Re: Hair Transplants in Sikh Males:  “Traction Allopecia”.*

Related article

*Traction Alopecia*

http://emedicine.medscape.com/article/1073559-overview
*Introduction*

*Background*

 In 1907, the first example of  traction alopecia was reported in girls and women from Greenland who  styled their hair in a ponytail. A similar pattern of hair loss was  later noted in Japanese women who wear a traditional hairdo. In Sikhism,  one of the religions practiced in India, men grow both scalp hair and  beard hair. To keep their hair from falling in front of their face, it  is tightly pulled into a bun. This practice has led to traction alopecia  in Sikh men.<sup>1,2 </sup>The  tight rolling of beard hair into a pocket in the submandibular region  also results in a similar phenomenon. The use of hair extensions, a  common treatment for male or female pattern baldness, is also associated  with a similar type of hair loss.<sup>3</sup>
<sup>
 </sup>
Traction  alopecia is a common cause of hair loss due to pulling forces exerted  on the scalp hair. This excessive tension leads to breakage in the  outermost hairs. This condition is seen in children and adults, but it  most commonly affects African American women. The 2 types of traction  alopecia are marginal and nonmarginal. Unlike trichotillomania,  a psychiatric disorder of compulsive hair pulling that leads to patchy  hair loss, traction alopecia is unintentionally induced by various  hairstyling practices (eg, use of braids, hair rollers, weaves, twists,  locks, or "cornrows"). In the initial stages, this hair loss is  reversible. With prolonged traction, alopecia can be permanent.  Physicians, especially dermatologists, must recognize this condition  early to prevent irreversible hair loss.
*Pathophysiology*

 Typically,  traction alopecia is associated with sustained tension on the scalp  hair. In theory, this phenomenon can also occur on areas of the face  where hair is grown and styled. Traction causes hair to loosen from its  follicular roots; however, hair loss also occurs secondary to follicular  inflammation and atrophy. Hair loss is often symmetric and along the  frontotemporal hairline; occipital scalp involvement is less common.  Vellus hair is usually spared in the affected area.


Traction  alopecia tends to follow a series of progressive events. Initially,  pruritus and perifollicular erythema may be present. These may be  accompanied by hyperkeratosis, creating a seborrheic picture. Pustules  and scales may form. Eventually, an abundance of broken hairs can be  detected. With persistent traction, the follicles atrophy and no longer  produce the typical long and co{censored} hair. Instead, thinner, fine, short  hair is generated.
When tensile forces are chronically present, an  irritant type of folliculitis develops. Follicular scarring and  permanent alopecia may result. In some cases, peripilar hair casts form.  The casts are fine, yellowish white keratin cylinders smaller than 1 cm  in diameter that ensheathe the hair follicle. Often, peripilar hair  casts occur in isolation; however, they have also been known to occur in  association with hyperkeratotic scalp disorders. The hair loss pattern  entirely depends on the specific grooming pattern of each patient.  Marginal and nonmarginal types may be seen.


Alopecia linearis  frontalis, more commonly known as marginal alopecia, is a hair-loss  pattern that usually results from the use of tight curlers, rollers, or  straighteners during childhood. In this condition, the distribution of  hair loss follows a characteristic pattern in the temporal scalp,  starting in the periauricular area and extending forward in a triangular  manner. The involved area is approximately 1-3 cm in width in most  cases. For example, the constant contraction of the muscles used in  facial expression, in addition to the tension caused by braiding, may  partially account for why this pattern is often seen in the temporal  region.


On the other hand, chignon alopecia is a type of  nonmarginal alopecia that is characterized by hair loss in the occipital  scalp region where the bun rests.<sup>4 </sup>This  condition is seen in patients with a long-standing history of pulling  their hair into a bun. The typical patient is a 40-year-old woman who  initially complains of itching and dandruff localized to the occipital  area. Similar to marginal alopecia, perifollicular erythema with  occasional peripilar hair casts can be seen.


The natural history  of chignon alopecia mirrors that of marginal alopecia, with the eventual  formation of pustules and the development of folliculitis. Permanent  alopecia can also result if this condition remains undetected and the  traction continues. Sometimes, the frontomarginal part of the scalp may  also be involved because the longest hair roots originate in this  region, and may be subjected to traction. When an examining physician  notices both chignon alopecia and marginal alopecia, the index of  suspicion should be high, and the diagnosis of chignon alopecia should  be considered.
*Frequency*

*United  States*

 This condition is most  commonly seen in African American population because of the practice of  styling the hair in tight braids or the use of chemical hair  straighteners. An estimated three fourths of African American females  straighten their hair. More recently, female athletes who pull their  hair tightly have been found to develop from this problem. Traction  alopecia is also reported in nurses who secure their nurse's caps to  their scalp with bobby pins.<sup>5,6 </sup>The  exact frequency of traction alopecia in the United States has yet to be  documented.
*International*

 Traction alopecia is  seen worldwide. Its frequency usually depends on cultural customs.  Japanese women who wear a traditional hairdo, Sikh men in India, and  others who wear ponytails are examples of individuals who may be  affected.

Population studies show a prevalence of 17.1% in  African schoolgirls (6-21 y) and of 31.7% in women (18-86 y).<sup>7 </sup>
*Mortality/Morbidity*

 Traction alopecia may lead  to permanent hair loss if it is undetected for a protracted period. For  females especially, this can lead to significant emotional trauma.  Changes in self-perception, including lower self-esteem and social  problems, are frequently reported by women who have traction alopecia.
*Race*

 This condition can be seen most commonly  in African Americans, Japanese women, and Sikh men in India. See  Frequency above.
*Sex*

 Traction alopecia is  more common in women than in men because women are more involved with  hairstyling practices such as braiding or chemical hair straightening,  and they are more likely to use tight curlers and nylon brushes and to  wear chignons.




Women wear ponytails more frequently  than men. Women use chemical straighteners more frequently than men.
Traction  alopecia is becoming more prevalent in men who are concerned about hair  loss because, ironically, it can result from treatments for alopecia  itself (eg, use of hair extensions). In addition, males, especially of  African descent, commonly use cornrows and this, in part, explains the  increased prevalence of traction alopecia in this population.
Traction  alopecia develops in Sikh men because they tightly pull their hair into  a bun and roll their beard hair.
 *Age*

 Traction alopecia  is initially seen in children and young adults.


Traction  alopecia is an uncommon overall cause of hair loss in adults. However,  in the African American population, this entity is a significant cause  of alopecia.
The exact frequency has yet to be documented in  children, young adults, and adults.
 *Clinical*

*History*



Patients  usually complain of itching and dandruff.
Otherwise, no other  complaints are offered.
 *Physical*



Patients  usually have patchy areas of hair loss.
The hair-pulling test  results in the detachment of more than 6 strands.
Closer  inspection of the scalp reveals perifollicular erythema, scales, and  pustules.
Hair loss may be symmetric, and marginal traction  alopecia may be present in the temporal region.
With chignon  alopecia, hair loss may be in the occipital area.
With  cornrowing, the area most commonly affected is that adjacent to the  region that is braided.
In patients who tie their beards into  knots, areas of alopecia can be detected along the sides of the  mandible.
 *Causes*

 Three basic mechanisms  of traction alopecia have been proposed: trichotillomania, telogen  conversion, and overprocessing. In all cases, immediate cessation of the  underlying cause can reverse the alopecia.




In  trichotillomania, patients compulsively pull out their own hair.
Telogen  conversion appears to be the most common cause.
Usually, the  hair follicle can sustain trauma and still remain in the anagen growth  phase.
Excessive traction for prolonged periods (eg, tight  braiding, wearing of ponytails<sup>8 </sup>)  leads to conversion of the anagen phase to the telogen phase.
In  the telogen phase, the hair follicle ceases to grow and alopecia  results.

In overprocessing, chemical treatment of hair  with dyes, bleaches, or straighteners disrupts the keratin structure in  a manner that reduces its tensile strength.
The hair becomes  fragile and is unusually susceptible to breakage.
Normal combing  can lead to the sudden loss of hair en masse.


See also attached for a medical article in pdf format


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## Mai Harinder Kaur (May 31, 2010)

*Re: Hair Transplants in Sikh Males:  “Traction Allopecia”.*

If people are aware of this, it can be easily avoided.  The jurah needs to be firmly tied, but not _that _tight.  I know I never used a rubber band in my sob's hair, always either a hair tie or one of those things with little ***** on them that you can fold around the hair instead of trying to thread all that hair through.  And there is no reason it has to be so tight.  It stays in place perfectly well if tied a bit looser.  But my son and my husband got very upset at losing a single hair to this and consequently didn't do it.  I know that if I ever pulled my son's too tight, I'd hear an indignant, "Mata ji, you're disrespecting my sacred kesh!"  He would be laughing, but he really was half serious.

Yes, it might take a little time and effort, but I have never seen Kaur with this hairline so common in our keshdhari men and boys.  Maybe if keeping kesh were a little less painful, fewer would chose to become monas.


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