Frictional alopecia

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Frictional alopecia is hair loss caused by repeated rubbing of the hair, follicles, or skin around the follicles. It is non-scarring, meaning the skin doesn’t form permanent scars. A common example is loss of ankle hair in people who wear socks or tight footwear for long periods. Hair may not grow back for years after the rubbing stops.

Causes include ongoing rubbing against the skin or a self-inflicted habit called trichoteiromania (compulsive hair rubbing). Frictional alopecia has been seen in several situations: along the lower legs under socks or shoes, the back of the legs from water slides, gymnasts’ heads during headstands or rolls, and joggers with tight headphones pressing on the scalp.

If no rubbing source is found, some doctors think there may be associations with nerve problems, thyroid disease, or androgenetic alopecia, but these links aren’t certain. Under the microscope, the hair follicles look normal. Alopecia areata is another common cause of hair loss and can look similar, but dermoscopy (a special skin exam) can help distinguish them.

The main treatment is reassurance and removing the source of friction.