"Chignon alopecia": a distinctive type of nonmarginal traction alopecia

Localized occipital alopecia may result from traction of the hair necessary to form and maintain a bun (chignon) in the occipital region. Marginal alopecia in the patient whose hair is drawn firmly back is more familiar, although traction may lead to loss of hair at any site of the scalp depending on the hairdressing techniques used. Three women were seen with localized alopecia of the occipital scalp associated with the wearing of a chignon. They had previously been uniformly misdiagnosed as having alopecia areata. "Chignon alopecia" should be ruled out when the diagnosis of persistent alopecia areata at the level of the lambda is considered. A distinctive histopathologic finding is perifollicular fibrosis extending into the subcutaneous fat. Traumatic alopecia is classified with respect to the type of trauma, localization, and pattern within the hairy scalp.