The "Fringe Sign" - A useful clinical finding in traction alopecia of the marginal hair line

Dermatol Online J. 2011 Nov 15;17(11):1.


Introduction: Traction alopecia is hair loss caused by prolonged or repetitive tension on the hair. Diagnostic challenges are encountered when the clinical suspicion is not high and when a history of traction is remote or not obtained. We have made the observation that the presence of retained hairs along the frontal and/or temporal rim, which we termed the "fringe sign," is a finding seen in both early and late traction alopecia, and may be a useful clinical marker of the condition.

Methods: This was a retrospective single-center review to determine the frequency of the fringe sign in patients with traction alopecia.

Results: Over a 3.5-year period the diagnosis of traction alopecia was made in 41 women. Twelve of the 41 patients were Hispanic (29%). Thirty-five (85%) of all women and 100 percent of women who had traction involving the marginal hairline had the fringe sign. Fourteen biopsies (58%) were available for review. Histopathologic findings included retained sebaceous glands (100%), an increase in vellus-sized hairs (50%), a decrease in terminal hairs (100%), fibrotic fibrous tracts (100%), and sparse lymphocytic inflammation (57%).

Conclusions: The fringe sign is a sensitive and specific clinical feature of traction alopecia when it involves the marginal hairline.

MeSH terms

  • Adolescent
  • Adult
  • African Americans
  • Aged
  • Alopecia / diagnosis*
  • Alopecia / etiology
  • Alopecia / pathology
  • Beauty Culture
  • Biopsy
  • Diagnosis, Differential
  • Female
  • Habits
  • Hair / pathology*
  • Hispanic Americans
  • Humans
  • Middle Aged
  • Sensitivity and Specificity
  • Stress, Mechanical*
  • Young Adult