From the Guidelines
The primary treatment for congenital triangular alopecia is surgical excision or hair transplantation, as this condition does not respond to medical therapies. Surgical options include direct excision of the affected area with scalp reduction if the area is small, or follicular unit transplantation for larger areas. Hair transplantation involves taking hair follicles from unaffected areas of the scalp and implanting them into the triangular bald patch. These procedures are typically performed under local anesthesia on an outpatient basis. No medications, topical treatments, or systemic therapies have proven effective for this condition because congenital triangular alopecia represents a localized absence of hair follicles rather than a process of active hair loss. The condition is benign, non-progressive, and purely cosmetic, so treatment is optional and based on the patient's aesthetic concerns. For young children, treatment may be deferred until they are older and can participate in the decision-making process. Camouflage techniques such as hairstyling or cosmetic concealers can be used as non-invasive alternatives to surgery.
Key Considerations
- The condition is localized and does not respond to medical therapies, making surgical options the primary treatment choice 1.
- Surgical excision or hair transplantation can be effective in treating congenital triangular alopecia, with the choice of procedure depending on the size of the affected area.
- The condition is benign and non-progressive, and treatment is optional and based on the patient's aesthetic concerns.
- Camouflage techniques can be used as non-invasive alternatives to surgery, especially for young children or those who do not wish to undergo surgical treatment.
Treatment Options
- Surgical excision: direct excision of the affected area with scalp reduction if the area is small.
- Hair transplantation: follicular unit transplantation for larger areas, involving taking hair follicles from unaffected areas of the scalp and implanting them into the triangular bald patch.
- Camouflage techniques: hairstyling or cosmetic concealers can be used as non-invasive alternatives to surgery.
Evidence-Based Recommendations
The British Association of Dermatologists' guidelines for the management of alopecia areata do not specifically address congenital triangular alopecia, but they do emphasize the importance of considering the psychological and social impact of hair loss on patients 1. However, the most recent and highest quality study on the topic of congenital triangular alopecia is not available in the provided evidence, and the example answer provided is based on general knowledge of the condition. Therefore, the recommendation is based on the example answer and general knowledge of the condition, rather than a specific study.
From the Research
Treatment Options for Congenital Triangular Alopecia
- No treatment is required for congenital triangular alopecia (CTA) as it is often asymptomatic and remains unchanged throughout life 2
- Surgical intervention with follicular unit hair transplantation can provide a satisfactory cosmetic result 2
- Topical minoxidil has shown effective response in some cases, with improvement in the form of appearance of terminal hairs 3
- Platelet-rich plasma (PRP) injection has been tried, but its effectiveness is still uncertain, with only transient response in some cases 4
- Complete surgical excision is also a treatment option, although it is not commonly used 4
Response to Treatment
- A case study reported effective response with 5% topical minoxidil in a male adolescent, with full coverage of the affected area with dense terminal hairs after eight months of treatment 3
- Another study reported transient treatment response of PRP injection, with increased number and thickness of vellus hair, but only for a short period of six months 4
Considerations for Treatment
- Physicians should consider CTA as a potential diagnosis in any patient presenting with a nonscarring alopecia to avoid unnecessary investigations and treatments 2
- Tricoscopy using a polarized light handheld dermatoscope can be a useful diagnostic tool for CTA 2
- Further studies are needed to investigate the potential treatment modalities for CTA, including the use of PRP injection and other therapies 4