Alopecia in an ophiasis pattern: traction alopecia versus alopecia areata

We present a case series of 3 black women who presented with alopecia along the anterior and posterior hairline on physical examination. The initial clinical suspicion was traction alopecia from tension placed on the hair and traumatic removal of hairweaves. Two cases were supported histologically as traction alopecia, while the remaining case was alopecia areata in an ophiasis pattern. Interestingly, the case of alopecia areata was associated with the mildly traumatic removal of a weave. Traction alopecia may present in an ophiasis pattern from hair care practices. Although clinical history and physical examination may suggest traction alopecia, alopecia areata must be ruled out. The cases of interest are presented in addition to a brief review of hairweaving practices and hairweave removal techniques.