Frictional alopecia explained

Frictional alopecia is the loss of hair that is caused by rubbing of the hair, follicles, or skin around the follicle.^[1] The most typical example of this is the loss of ankle hair among people who wear socks constantly for years.^[2] The hair may not grow back even years after the source of friction has ended.

Signs and symptoms

Frictional alopecia causes hair loss secondary to frequent rubbing of the hair.^[3]

Causes

Frictional alopecia is a non-scarring alopecia that may result from something rubbing against the hairs or from a self-inflicted tic disorder.^[3]

Friction alopecia, when self-inflicting, is called trichoteiromania, a psychiatric condition marked by obsessive hair rubbing.^[4]

Friction alopecia can be brought on by something rubbing against hairs repeatedly. It has been reported in the distribution of socks and shoes on the lower extremities of men,^[5] on the back of the lower extremities from water slides,^[6] in gymnasts performing head stands and rollovers on the balance beam,^[7] and in a jogger with a tight-banded headphone on her scalp.^[8]

When no frictional etiology can be identified, associations with peripheral nerve disease, thyroid dysfunction, and androgenetic alopecia have been proposed.^{[9] [10]}

Diagnosis

Histology reveals no abnormal alterations.^[11] Alopecia areata is a significant differential diagnosis. It is possible to distinguish between the two entities using dermoscopy.^[12]

Treatment

Reassurance and avoiding the trigger factor are part of the treatment for frictional alopecia.^[12]

Further reading

• Verma . Shyam . Jakhar . Deepak . Post Herpetic Itch Leading to Frictional Alopecia of Eyebrow and Scalp-A Hitherto Undescribed Phenomenon . Indian Dermatology Online Journal . 2024 . Wolters Kluwer -- Medknow Publications . 15 . 1 . 86–88 . 38282999 . 10.4103/idoj.idoj_25_23 . free . 10810396 . none.
• Hsieh . Chang-Yu . Tsai . Tsen-Fang . Friction-Induced Skin Disorders—A Review . Dermatitis . 34 . 4 . 2023-08-01 . 1710-3568 . 10.1097/DER.0000000000000934 . 278–286 . 35951433 . 251494692 . none.

Notes and References

1. Web site: What Causes Hair to Fall Off Your Legs?. Matt. Olberding. livestrong.com.
2. Frictional (Sock) Alopecia of the Legs: Trichoscopy as an Aid. Deepak. Jakhar. Ishmeet. Kaur. 2 October 2018. International Journal of Trichology. 10. 3. 129–130. 10.4103/ijt.ijt_96_17. 30034193. 6029005 . free .
3. Fowler . Emilie . Tosti . Antonella . A Case of Friction Alopecia in a Healthy 15-Year-Old Girl . Skin Appendage Disorders . 5 . 2 . 2019 . 2296-9195 . 30815442 . 6388551 . 10.1159/000490712 . 97–99.
4. Banky . Jeremy P . Sheridan . Adam T . Dawber . Rodney PR . Weathering of hair in trichoteiromania . Australasian Journal of Dermatology . Wiley . 45 . 3 . 2004-07-13 . 0004-8380 . 10.1111/j.1440-0960.2004.00087.x . 186–188. 15250901 . 38743534 .
5. Zhao . Johnny . Cohen . Philip R . Frictional alopecia of the distal legs: case series and review . Dermatology Online Journal . August 2016 . 22 . 6 . 13030 . 10.5070/D3228032179 . 27617943.
6. Adams . B B . Water-slide alopecia . Cutis . May 2001 . 67 . 5 . 399–400 . 11381856.
7. Ely . P. Haines . Balance Beam Alopecia . Archives of Dermatology . 114 . 6 . 1978-06-01 . 0003-987X . 10.1001/archderm.1978.01640180098043 . 968. 666348 .
8. Copperman . Stuart M. . Two New Causes of Alopecia . JAMA: The Journal of the American Medical Association . 252 . 24 . 1984-12-28 . 0098-7484 . 10.1001/jama.1984.03350240017021 . 3367. 6502902 .
9. Harries . MatthewJ . Siah . TeeWei . Anterolateral leg alopecia: Common but commonly ignored . International Journal of Trichology . Medknow . 6 . 2 . 2014 . 75–76 . 0974-7753 . 10.4103/0974-7753.138595 . free . 25191043 . 4154156 .
10. Srinivas . SahanaM . Sacchidanand . S . Jagannathan . Balaji . Anterolateral leg alopecia . International Journal of Trichology . Medknow . 8 . 1 . 2016 . 49–50 . 0974-7753 . 10.4103/0974-7753.179402 . free . 27127383 . 4830179 .
11. Sharquie . Khalifa E. . Al-Rawi . Jamal R . Al-Janabi . Hassan A . Frictional Hair Loss in Iraqi Patients . The Journal of Dermatology . Wiley . 29 . 7 . 2002 . 0385-2407 . 10.1111/j.1346-8138.2002.tb00297.x . 419–422. 12184639 . 37002393 .
12. Jakhar . Deepak . Kaur . Ishmeet . Frictional (Sock) alopecia of the legs: Trichoscopy as an aid . International Journal of Trichology . Medknow . 10 . 3 . 2018 . 129–130 . 0974-7753 . 10.4103/ijt.ijt_96_17 . free . 30034193 . 6029005 .