TEMPORAL TRIANGULAR ALOPECIA
By Gary M. White, MD
Temporal triangular alopecia (TTA) is the loss of hair over the frontotemporal scalp.
- Onset is usually in the first two years of life. In one study [JAAD 2016;75;634], more than half of patients were diagnosed at birth. Most lesions were triangular in shape and measured an average of 3.6 cm in length.
- Most cases are unilateral, but bilateral lesions are present in about 20% of cases.
- Adults may be affected [DOJ 22(3)].
- A giant form has been reported (see below).
- Rarely, TTA is part of Gómez-López-Hernández syndrome, a complex of multiple birth defects including craniosynostosis, midfacial hypoplasia, trigeminal anesthesia, cerebellar dysplasia and mental deficiency.
A triangular, oval or lancet-shaped patch of non-scarring alopecia is seen. The affected areas are devoid of terminal hair but do contain vellus hairs. The skin is normal. The condition is asymptomatic and remains stable throughout life. Dermoscopy shows normal follicular openings with vellus hairs surrounded by terminal hairs on the outskirts of the lesion. There is an absence of yellow and/or black dots, brittle hair and ‘exclamation mark’ hairs, helping exclude alopecia areata, trichotillomania, traction alopecia and congenital aplasia cutis.
No treatment is needed nor known. Usually, the surrounding hair may be made to cover the area. Topical minoxidil has been reported. In extreme cases, excision or hair transplant may be done.
Giant TTA. Int J Trichol 2012;4:51-2
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