Dr.
Z. is a 30 year-old ophthalmology resident called to duty on the Covid ward of
a large East Coast metropolitan hospital where over a 1000 Covid patients had
been treated to date. In this age of
telemedicine, she wrote me the following:
“Our
community was hit hard by this pandemic, and we continue to help out on the Covid
floors. It’s been a scary and yet rewarding experience!
I want
to ask your opinion regarding a dermatology question! Last night I noticed a
small patch of hair missing. I think it was in the area where I was wearing a
tight hairband while in the hospital about 3 weeks ago. I had the hair band on
for four days. It was so tight that the area would hurt when I took it off at
night after a long shift. I just didn’t want any hair in front of face
on Covid ward. I was wondering if there is anything I need to do about it? Or
just wait for it to grow out. The scalp area looks a little red, here are two
photos.”
While this appears to “pressure alopecia,” I offered to run Dr. Z.’s anamnesis by a colleague with a special interests in disorders of hair. How we practice now is different from a few months back. We will be seeing new variations on a theme such as perhaps, Hairband Pressure Alopecia.
References:
1. Sano
DT, et. al. Headband pressure alopecia: clinical, dermoscopy, and
histopathology findings in four patients. Int J Dermatol. 2018. Feb;57(2):237-239
2. Iwai
T, et. al. Temporary alopecia caused by pressure from a headband used to secure
a reference frame to the head during navigational surgery. Br J Oral Maxillofac
Surg. 2009 Oct;47(7):573-4.
We consulted with a dermatologist nationally recognized specialist interest hair disorders. She responded “I do not have much experience with pressure induced alopecia, likely because the etiology is apparent and it regrows in most cases. The photos do suggest pressure alopecia, although there is a differential for patchy alopecia including alopecia areata and tinea capitis. As you know, the current theory is that it is ischemic in nature. I wonder how tight the headband was! Her area of loss is small and it looks rather non-inflammatory, so one would think prognosis for regrowth would be good. It can take a couple of months to see new sprouting hair shafts. Scarring can occur if the insult is severe or prolonged – this can sometimes result in ulceration which is not present."
We consulted with a dermatologist nationally recognized specialist interest hair disorders. She responded “I do not have much experience with pressure induced alopecia, likely because the etiology is apparent and it regrows in most cases. The photos do suggest pressure alopecia, although there is a differential for patchy alopecia including alopecia areata and tinea capitis. As you know, the current theory is that it is ischemic in nature. I wonder how tight the headband was! Her area of loss is small and it looks rather non-inflammatory, so one would think prognosis for regrowth would be good. It can take a couple of months to see new sprouting hair shafts. Scarring can occur if the insult is severe or prolonged – this can sometimes result in ulceration which is not present."
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