Traction Alopecia in a 35-Year-Old Woman: Combination Oral Therapy for Hair Regrowth

Case Overview

A 35-year-old woman presented to our Houston dermatology clinic with a long-standing history of focal hair loss. The patient noted gradual thinning over several years, primarily affecting the temporal regions of the scalp.

She had previously used topical Rogaine (minoxidil) and spironolactone with minimal improvement. Her goal was to explore more effective, evidence-based treatments for her ongoing hair loss.

Clinical Findings

A detailed scalp examination revealed localized thinning along the frontal and temporal hairline, consistent with traction alopecia (L65.8).
There was mild perifollicular scarring and decreased follicular density but no inflammation or erythema.

The rest of the scalp appeared normal, and there were no signs of diffuse androgenetic alopecia. The patient was otherwise healthy, well-nourished, and in no acute distress.

Diagnosis

• Traction Alopecia – focal scarring alopecia from chronic mechanical stress

• History of androgenetic predisposition (given prior use of minoxidil and spironolactone)

Discussion and Counseling

We discussed the pathophysiology of traction alopecia, emphasizing that chronic pulling or tight hairstyles cause permanent follicular damage over time.
While regrowth may be limited in scarred areas, early intervention can help preserve remaining follicles and stimulate regrowth where viable follicles persist.

The patient was counseled extensively regarding treatment expectations, risks, and the importance of discontinuing tight hairstyles to prevent further damage.

Treatment Plan

1. Oral Minoxidil

The patient was prescribed oral minoxidil 2.5 mg daily (starting with half a tablet for the first month).
This low-dose systemic therapy can improve hair density in both scarring and non-scarring alopecias by enhancing blood flow to the follicles and prolonging the hair growth phase.

Counseling Highlights:

• Initial shedding during the first 8–10 weeks is normal.

• Potential side effects include ankle swelling, lightheadedness, or increased body hair growth.

• Patients should discontinue use and contact the office if experiencing chest pain, shortness of breath, or fluid retention.

2. Oral Finasteride

Given the patient’s IUD use and lack of pregnancy plans, finasteride 5 mg daily was also initiated.
Finasteride works by reducing DHT levels, which helps prevent further miniaturization of remaining hair follicles.

Counseling Highlights:

• Potential side effects include low libido, breast tenderness, and mood changes.

• Medication should not be handled by women who are pregnant or may become pregnant due to risk of fetal harm.

3. Additional Options Discussed

We discussed several other therapies to support follicular recovery:

• Platelet-Rich Plasma (PRP) Injections:
  Involves injecting concentrated growth factors from the patient’s own blood to stimulate regrowth in viable follicles.

• Topical and Oral Minoxidil Combinations:
  May enhance outcomes when used concurrently.

• Low-Level Laser Therapy (LLLT):
  Devices such as laser combs or helmets can complement medical therapy by stimulating follicular activity.

• Hair Restoration Surgery:
  Considered for advanced cases once active hair loss is stabilized.

The patient opted to proceed with oral combination therapy and monitor for regrowth before considering procedural options.

Follow-Up

The patient was scheduled for a 6-month follow-up to evaluate progress and treatment tolerance.
If regrowth is limited, adjunctive procedures like PRP therapy may be added to enhance outcomes.

Discussion

This case demonstrates a modern, comprehensive approach to traction alopecia in women, combining oral minoxidil and finasteride for enhanced regrowth potential.

While traction alopecia is often partially permanent due to scarring, early and consistent intervention with systemic treatments can reactivate dormant follicles, improve scalp density, and prevent further progression.

At Reena Jogi MD Dermatology, patients benefit from individualized treatment plans that integrate medical, procedural, and lifestyle interventions for optimal results.

Key Takeaways

• Traction alopecia results from chronic tension on the hair and can cause scarring and permanent follicle loss.

• Oral minoxidil and finasteride may restore density in areas with surviving follicles.

• Avoiding tight hairstyles is essential to prevent further damage.

• Procedures like PRP can complement oral therapy for enhanced outcomes.

About Our Clinic

At Reena Jogi MD Dermatology, we provide advanced diagnostic and treatment options for all types of hair loss, including traction alopecia, androgenetic alopecia, and scarring alopecias.

Our team serves patients throughout Houston and Katy, Texas, offering both medical and procedural therapies such as oral treatments, PRP injections, Alma TED, and personalized hair restoration plans.