Temporal Triangular Alopecia

The primary characteristic of TTA is a well-defined triangular or oval-shaped area of hair loss on the temporal scalp. The hair loss can range in size and shape, but is typically 1-4 cm in diameter. The borders of the hairless area are sharply demarcated, and the skin within the affected area may appear smooth and slightly shiny. Hair growth may be normal in the surrounding scalp, and the hair follicles within the affected area may appear miniaturized, or smaller than normal. In some cases, there may be a single patch of hair loss, while in others, multiple patches may be present.

TTA can be classified into three types based on the age of onset and the pattern of hair loss:

1. Congenital TTA: This is the most common type of TTA, which is present at birth or develops shortly after. It is characterized by a triangular or oval-shaped patch of hair loss on one or both sides of the temporal scalp. The patch may increase in size over time, but typically stabilizes by puberty.
2. Acquired TTA: This type of TTA develops later in life, typically in early childhood or early adulthood. The hair loss pattern is similar to congenital TTA, but the patch may be more irregular in shape and may not be as sharply demarcated.
3. Progressive TTA: This type of TTA is characterized by a progressive hair loss pattern that begins in childhood and continues into adulthood. The hair loss is not limited to the temporal scalp, but can also affect the frontal or occipital scalp. The affected areas may become completely bald or have sparse hair growth.

Causes

The causes of TTA are not fully understood, but several potential factors have been identified. Here, we will discuss the 20 known causes of temporal triangular alopecia and their details.

1. Genetics: TTA may be inherited from one or both parents. In some cases, a genetic mutation may cause TTA.
2. Hormones: Hormonal imbalances, particularly changes in androgen levels, have been implicated in TTA.
3. Trauma: Physical injury to the scalp, such as a cut or burn, may damage hair follicles and cause TTA.
4. Infection: Some infections, such as scalp ringworm or folliculitis, may lead to hair loss and TTA.
5. Autoimmune disorders: Autoimmune disorders, such as lupus, may cause hair loss and TTA.
6. Skin conditions: Certain skin conditions, such as lichen planus, may lead to hair loss and TTA.
7. Nutritional deficiencies: Deficiencies in certain vitamins and minerals, such as vitamin D or zinc, may contribute to TTA.
8. Medications: Some medications, such as chemotherapy drugs, may cause hair loss and TTA.
9. Radiation therapy: Radiation therapy used to treat cancer may lead to hair loss and TTA.
10. Chemical exposure: Exposure to certain chemicals, such as those found in hair dyes or relaxers, may damage hair follicles and cause TTA.
11. Hair pulling disorder: Trichotillomania, a hair pulling disorder, may cause TTA in some cases.
12. Pressure or friction: Constant pressure or friction on the scalp, such as from wearing tight hats or headbands, may contribute to TTA.
13. Scalp psoriasis: Scalp psoriasis, a chronic skin condition, may cause hair loss and TTA.
14. Alopecia areata: Alopecia areata, an autoimmune disorder that causes patchy hair loss, may lead to TTA.
15. Ectodermal dysplasia: Ectodermal dysplasia, a genetic disorder that affects the development of skin, hair, and teeth, may cause TTA.
16. Neurofibromatosis type 1: Neurofibromatosis type 1, a genetic disorder that causes tumors to grow on nerves, may lead to TTA.
17. Down syndrome: Down syndrome, a genetic disorder that causes developmental and intellectual delays, may lead to TTA.
18. Epidermolysis bullosa: Epidermolysis bullosa, a group of genetic disorders that cause the skin to blister and tear easily, may cause TTA.
19. Hypothyroidism: Hypothyroidism, a condition in which the thyroid gland does not produce enough hormones, may cause hair loss and TTA.
20. Cushing’s syndrome: Cushing’s syndrome, a hormonal disorder that results from high levels of cortisol in the body, may lead to TTA.

In temporal triangular alopecia is a rare form of hair loss that can have many causes. Some of the potential causes include genetics, hormonal imbalances, trauma, infections, autoimmune disorders, skin conditions, nutritional deficiencies, medications, radiation therapy, chemical exposure, hair-pulling disorder, pressure or friction, scalp psoriasis, alopecia areata, ectodermal dysplasia, neurofibromatosis type 1, Down syndrome, epidermolysis bullosa, hypothyroidism,

Symptoms

Most common symptoms of temporal triangular alopecia, along with details on the condition.

1. Oval or triangular-shaped patch of hair loss: The most common symptom of temporal triangular alopecia is a patch of hair loss in an oval or triangular shape on one or both sides of the scalp. The patch is usually located on the frontotemporal region of the scalp.
2. Sparse or thinning hair: Hair within the patch of hair loss may appear sparse or thin, with a decreased number of hair follicles in the affected area.
3. Absence of hair follicles: In some cases, there may be a complete absence of hair follicles within the patch of hair loss.
4. Uneven hairline: The hairline may appear uneven due to the patch of hair loss.
5. Unilateral or bilateral: Temporal triangular alopecia can occur unilaterally (on one side of the scalp) or bilaterally (on both sides of the scalp).
6. Hair loss in childhood: Temporal triangular alopecia is usually present at birth or develops during childhood.
7. Slow progression: The hair loss associated with temporal triangular alopecia is usually slow and gradual, and may not become noticeable until later in childhood or adolescence.
8. Asymptomatic: The condition is usually asymptomatic and does not cause any itching, pain or discomfort.
9. Normal hair growth elsewhere: Hair growth is normal in areas of the scalp not affected by the patch of hair loss.
10. No scarring: Unlike other forms of hair loss, temporal triangular alopecia does not cause scarring.
11. No inflammation: There is usually no inflammation associated with the patch of hair loss.
12. No scaling: There is usually no scaling or flaking of the skin within the patch of hair loss.
13. No signs of infection: There are usually no signs of infection such as redness, swelling or pus within the patch of hair loss.
14. No hormonal changes: Unlike other forms of hair loss, temporal triangular alopecia is not associated with hormonal changes.
15. No autoimmune disorders: Temporal triangular alopecia is not associated with autoimmune disorders such as alopecia areata.
16. No systemic diseases: Temporal triangular alopecia is not associated with any systemic diseases.
17. No genetic syndromes: Temporal triangular alopecia is not associated with any genetic syndromes.
18. No nutritional deficiencies: Temporal triangular alopecia is not associated with any nutritional deficiencies.
19. No medications: Temporal triangular alopecia is not associated with any medications.
20. No trauma: Temporal triangular alopecia is not caused by trauma or injury to the scalp.

Diagnosis

Diagnosis of TTA requires a thorough clinical evaluation and a combination of diagnostic tests. Here is a list of 20 diagnosis and tests for temporal triangular alopecia, along with an explanation of each test:

1. Physical examination: The diagnosis of TTA starts with a physical examination of the affected area of the scalp. The triangular-shaped bald patch with vellus hair is the most significant finding on examination.
2. Family history: The family history of TTA should be explored as it is known to have a genetic predisposition.
3. Clinical history: The clinical history of the patient, including the age of onset, duration, and progression of the hair loss, and any associated symptoms, should be evaluated.
4. Trichoscopy: Trichoscopy is a non-invasive technique that allows examination of the hair and scalp using a special dermoscope. In TTA, trichoscopy may reveal reduced density, short, and thin vellus hair.
5. Dermoscopy: Dermoscopy is a magnifying tool that allows for a more detailed examination of the scalp and hair. In TTA, dermoscopy may reveal reduced density, short, and thin vellus hair.
6. Biopsy: A skin biopsy may be performed to confirm the diagnosis of TTA. The biopsy involves taking a small sample of skin from the affected area of the scalp for examination under a microscope. The biopsy may reveal hair follicles with a decreased number of hair shafts or an absence of hair shafts.
7. Hair pull test: A hair pull test involves gently pulling on several hairs from the affected area of the scalp to determine the amount of hair loss. In TTA, the hair pull test may reveal a positive result, indicating that hair is easily pulled out of the scalp.
8. Blood tests: Blood tests may be performed to evaluate hormonal imbalances or autoimmune conditions that may contribute to hair loss.
9. Genetic testing: Genetic testing may be performed to identify any genetic mutations associated with TTA.
10. Scalp biopsy with immunohistochemistry: This test involves a biopsy of the affected area of the scalp and an immunohistochemical evaluation of the hair follicles. This test can help confirm the diagnosis of TTA by showing a decrease in hair follicle size.
11. Microscopic evaluation of the hair shaft: Microscopic examination of the hair shaft can help identify any structural abnormalities that may contribute to hair loss.
12. Scalp biopsy with electron microscopy: This test involves a scalp biopsy with electron microscopy to examine the hair follicles for structural abnormalities that may contribute to hair loss.
13. Hair analysis: Hair analysis involves examining the hair for any abnormalities or deficiencies that may contribute to hair loss.
14. Scalp biopsy with culture and sensitivity: This test involves a biopsy of the affected area of the scalp and a culture and sensitivity test to identify any bacterial or fungal infections that may contribute to hair loss.
15. Patch testing: Patch testing involves applying small amounts of various substances to the skin to determine if an allergic reaction is contributing to hair loss.
16. Hormonal evaluation: Hormonal evaluation involves testing for hormonal imbalances that may contribute to hair loss.
17. Thyroid function tests: Thyroid function tests may be performed to evaluate the function of the thyroid gland, which can contribute to hair loss if not functioning properly.

Treatment

The treatment options for TTA depend on the severity of the condition, the age of the patient, and the cause of the hair loss. Here are 20 common treatments for TTA:

1. Topical Minoxidil: Topical Minoxidil is a medication that is applied to the scalp to promote hair growth. It is available over-the-counter and by prescription. Minoxidil increases blood flow to the scalp and stimulates hair follicles.
2. Topical Steroids: Topical steroids are medications that are applied to the scalp to reduce inflammation and promote hair growth. They are available by prescription only.
3. Oral Steroids: Oral steroids are medications that are taken orally to reduce inflammation and promote hair growth. They are available by prescription only.
4. Oral Minoxidil: Oral Minoxidil is a medication that is taken orally to promote hair growth. It is available by prescription only.
5. Platelet-Rich Plasma (PRP) Therapy: PRP therapy is a procedure in which a patient’s own blood is drawn, processed to concentrate the platelets, and then injected into the scalp to stimulate hair growth.
6. Hair Transplant Surgery: Hair transplant surgery is a procedure in which hair follicles are taken from the back or sides of the scalp and transplanted to the affected areas.
7. Scalp Reduction Surgery: Scalp reduction surgery is a procedure in which the affected area of the scalp is removed and the surrounding skin is stretched to cover the area.
8. Scalp Flap Surgery: Scalp flap surgery is a procedure in which a flap of skin is taken from an area of the scalp with hair and transplanted to the affected area.
9. Scalp Micropigmentation: Scalp micro pigmentation is a cosmetic tattooing procedure in which tiny dots are tattooed onto the scalp to give the appearance of hair follicles.
10. Hairpieces and Wigs: Hairpieces and wigs are non-surgical options for covering up hair loss. They come in a variety of styles, colors, and materials.
11. Hair Fibers: Hair fibers are small fibers that are applied to the scalp to give the appearance of thicker hair.
12. Hair Thickening Shampoos and Conditioners: Hair thickening shampoos and conditioners are products that are designed to make hair appear thicker and fuller.
13. Laser Therapy: Laser therapy is a non-invasive procedure in which low-level laser light is applied to the scalp to promote hair growth.
14. Ultraviolet (UV) Light Therapy: UV light therapy is a procedure in which UV light is applied to the scalp to promote hair growth.
15. Zinc Supplements: Zinc supplements are taken orally to promote hair growth. Zinc is an essential mineral for hair health.
16. Biotin Supplements: Biotin supplements are taken orally to promote hair growth. Biotin is a B vitamin that is essential for hair health.
17. Iron Supplements: Iron supplements are taken orally to promote hair growth. Iron is an essential mineral for hair health.
18. Vitamin D Supplements: Vitamin D supplements are taken orally to promote hair growth. Vitamin D is essential for hair health.
19. Omega-3 Fatty Acid Supplements: Omega-3 fatty acid supplements are taken orally to promote hair growth. Omega-3 fatty acids are essential for hair health.
20. Hair fiber powders: Hair fiber powders are cosmetic products that can be sprinkled onto the affected area to temporarily camouflage the bald patch.
21. Camouflage makeup: Similarly, camouflage makeup can be used to conceal the bald patch.
22. Hair growth supplements: There are a variety of hair growth supplements on the market that claim to promote hair growth. However, the efficacy of these supplements is not well-established.
23. Herbal remedies: Some herbal remedies, such as saw palmetto and ginseng, are thought to promote hair growth. However, there is limited scientific evidence to support their use.
24. Scalp reduction: In this surgical procedure, the bald patch is removed and the scalp is tightened, reducing the appearance of the bald area. This procedure is typically reserved for cases where hair transplant surgery is not a viable option.
25. Scalp expansion: This procedure involves placing a silicone balloon under the scalp and gradually inflating it over time. The resulting stretch in the scalp can allow for additional hair growth in the affected area.
26. Topical immunotherapy: This treatment involves applying a chemical (typically diphencyprone) to the affected area, which can stimulate hair growth by triggering an immune response.