13. Friction Injuries to the Hair
This chapter on sports-related traumatic conditions focuses on frictional effects on the hair. Skin almost always is the only interface between athletes and their equipment, competitor, or environment. The hair plays the primary interface role in only a few scenarios. In these situations, the hair may bear the brunt of intense friction. Skin can accommodate these frictional forces over time (i.e., by adapting with calluses). Hair is much more fragile and has no ability to adjust; it simply falls out. Thus, frictional forces from all varieties of athletic activity result in the common endpoint of alopecia.
Aquaslide Alopecia Epidemiology
Whereas epidemiologic studies of skin infections at water parks exist, none has examined the incidence of alopecia caused by waterslide friction.
Only one report of alopecia from a day at the water park is reported in the literature (Adams, 2001). This condition is the direct result of repeated friction between the waterslide and the hair. To increase the speed down the slide, enthusiasts arch their backs, hold their hands on their stomach, and tense their legs so that only a small portion of the back of the head and the outside edges of the legs touch the slide. In this position, very small areas receive all the friction.
Clinical Presentation
On examination, well-defined, symmetrical, round, nonscarring, alopecic patches are observed over the posterolateral aspects of both legs (Figure 13-1).
Theoretically, alopecic areas also can occur on the posterior scalp, although this has not been observed.
Diagnosis
Without taking a proper history, the clinician may confuse these round patches for alopecia areata. No exclamation point hairs are seen, which sets this condition apart from alopecia areata.
Figure 13-1. Round alopecic patches that could be mistaken for alopecia areata actually are the result of friction from a waterslide.
Treatment
The water enthusiast should be reassured that the hair will regrow and will be back to normal length within 1 to 2 months (depending on the original length of the leg hair).
Prevention
If speed is the goal for the water park visitor, then the practice of limiting the amount of direct connection to the slide will always produce, over several 242 Sports Dermatology
downhill trips, enough friction to cause alopecia. If the hair loss is disturbing, then they should be encouraged to allow as much as their posterior body to touch the slide to distribute the frictional forces and to slow their descent speed. In this way, no alopecia will occur.
Balance Beam Alopecia Epidemiology
No studies have systematically reviewed patterned hair loss in gymnastics;
however, this condition has been observed on multiple occasions (Adams, 2001;
Ely, 1978).
Clinical Presentation
A patterned thinning alopecia develops from the centrofrontal scalp to the occiput due to tremendous frictional forces between the balance beam and the gymnast’s hair during head stands and rollovers.
Diagnosis
The first time this condition was reported, the clinician believed the patterned alopecia was the result of tension from the athlete’s hairstyle. This condition underscores the importance of relating skin and hair abnormalities to an athlete’s activity.
Treatment
No treatment is necessary. The hair loss will decrease as the gymnast decreases use of the beam. Acutely, this is not a scarring process, so all the hair should return. Scalp hair grows quite slowly and may take many months to attain the pre-alopecia length.
Prevention
There is no satisfactory preventative action.
13. Friction Injuries to the Hair 243
Jogger’s Alopecia Epidemiology
There has been one case report of jogger’s alopecia (Copperman, 1978).
Clinical Presentation
A female jogger developed linear, transverse, nonscarring alopecia due to the daily friction of a very heavy, tight-banded, wide headphone worn upon her scalp.
Diagnosis
Any pattern (especially unusual) should prompt the clinician to search for a connection to the athlete’s environment and activities.
Treatment
Discontinuation of the heavy Walkman is curative (see Prevention).
Prevention
In the age of iPods and very small, compact, athletic radios, this condition likely will not be a problem.
Bibliography
Adams BB. Water-slide alopecia. Cutis 2001;67:399–400.
Copperman SM. Two new cause of alopecia. JAMA 1984;252:3367.
Ely PH. Balance beam alopecia. Arch Dermatol 1978;114:968.
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