Chapter 2 65 approaches91 should be customized to each individual person. Traction alopecia: Traction alopecia is hair loss secondary to a tensile force to the scalp hair and most commonly is caused by hair styling applications. Sustained traction leads to conversion of anagen hair into telogen hair and miniaturization of the hair follicles.92 Traction alopecia commonly occurs in African or Caribbean women and children, and is often precipitated by hair styling trends such as braiding, pony tails, overnight use of a brush roller, and wearing chignons and wigs. Typical presentation of traction alopecia is marginal alopecia with hair loss at hair margins behind the frontal hairline or along the temporoparietal margin. Depending on the cause of traction, any scalp area can be involved.93 Eliminating the source of traction returns hair growth to normal, but prolonged traction may result in permanent alopecia. Topical use of 2% minoxidil helps with hair re=growth. Tinea capitis: Tinea capitis is caused by dermatophyte infection of the hair follicles, which results in breakage of the HS. It mostly affects children, but in some geographic regions postmenopausal women account for the majority of the cases.94 Accompanying symptoms other than hair loss may include pruritus, scaling, pustules, inflamed papules, or black dots (Figure 14). Kerion is the most severe form of tinea capitis and presents as an inflamed and bulging mass on the scalp. There is geographic variation in the distribution of causative fungi. Pets can be an infectious source. Tinea Figure 14. Tinea capitis with pustules, crusts, inflamed skin and broken hair shafts