Not many people are aware of triangular alopecia. In fact, because of how it looks, it can be very easily confused with more common and popular hair loss types like androgenetic alopecia or traction alopecia. In truth, however, it’s something completely different.
In this guide, you will learn more about the causes, signs, reversibility and solutions of triangular alopecia.
What Is A Triangular Alopecia?
Triangular alopecia, as the name suggests, is a type of patterned hair loss that leaves a non-scarring triangular bald spot on the scalp. But it’s not always strictly a triangle; it can also be somewhat circular or oval or lance-shaped (like the leaf tapering to a pointed apex).
Patel DR, Tandel JJ, Nair PA. Congenital Triangular Alopecia – A Case Report. Int J Trichology. 2020 Mar-Apr;12(2):89-92. doi: 10.4103/ijt.ijt_4_20. Epub 2020 May 5. PMID: 32684683; PMCID: PMC7362965/CC BY-NC-SA 4.0
It’s considered a benign lesion on the scalp and because of how it looks, it can be quite easily confused with other types of alopecia, such as androgenetic alopecia, traction alopecia, alopecia areata, trichotillomania, or even cicatricial (scarring) alopecia. This is, however, a distinctive kind of hair loss.
It has been reported that triangular alopecia has an incidence of 0.11%, but many researchers take issue with this number because of how triangular alopecia has historically been diagnosed. It’s believed to be more common yet widely underreported.
Parents don’t always realise that their children might be born with this condition. Because hair loss in newborns is quite common yet temporary, it’s possible that they try to wait out the bald spot. However, usually, parents end up seeking help after the child turns 2.
Here, it should also be noted that while the bald spot usually appears in the front and temporal regions of the scalp, sometimes, it can also be seen between the temple and crown area or the back of the head.
But when it’s at the front, it can sometimes be hard to distinguish it from the temple peaks of a receding hairline. However, it’s more clearly demarcated when there’s a small fringe of hair around it.
The size of this bald patch is usually around 3-5 cm in size and can be covered by fine vellus hair instead of being entirely bald. It doesn’t always occur in one area on the scalp, less commonly, it can also be “bilateral,” affecting both sides of the scalp.
Another interesting thing about congenital triangular alopecia is that it’s been reported to occur in association with certain health problems, such as:
- Down syndrome
- Woolly hair
- Dandy-Walker malformation
- Leukonychia
- Phakomatosis pigmentovascularis
Can temporal triangular alopecia occur in adults?
Rarely, triangular alopecia develops in adulthood. A case letter titled: “Temporal triangular alopecia acquired in adulthood” described the case of a 25-year-old woman who had a “lancet-shaped” bald patch on the right temporal scalp. However, she developed this triangular hair loss just 3 years ago, when she was 22, with no history of trauma or any habit of wearing tight hairstyles (which can cause traction alopecia)
What Are The Symptoms & Signs Of Triangular Alopecia?
Temporal triangular alopecia is a benign asymptomatic lesion on the scalp. Usually, there are no symptoms accompanying this condition, however, some patients report “dysesthesia” — an abnormal sensation on touching the skin — according to one study.
As far as the signs of congenital triangular alopecia are concerned, one thing that usually distinguishes it from other types of alopecia is the presence of miniaturised hair follicles. As mentioned above, you can find thin and fine vellus hair within such bald patches (although not always).
And while the same happens in pattern baldness or androgenetic alopecia as well, what makes it different is that it doesn’t progress. The size of the triangular patch remains the same, and no new hair grows in it.
What Does The Dermoscopy Of Triangular Alopecia Reveal?
A study published in Skin Research and Technology described the dermatoscopic features of triangular alopecia. A few of them are as follows:
- Normal hair follicle openings with vellus hair there
- Even distribution of vellus hair, but the hairs themselves are of varied lengths
White vellus hair, white spots, “honeycomb pigment pattern,” and “vascular dilation pattern” were also observed in a few patients.
Is Temporal Triangular Alopecia Permanent?
Temporal triangular alopecia is permanent. The condition doesn’t go into remission, resolve on its own, or begin to grow hair once you reach adulthood. The lesion will remain as is. However, your doctor might try to improve growth in the area by prescribing different medications. If that doesn’t work, surgery’s another option.
Does Triangular Alopecia Spread?
One of the unique features of triangular alopecia is that it doesn’t spread. It will retain its original dimensions as you grow older. So you don’t have to worry about it progressing and engulfing other areas of your scalp. It doesn’t get worse.
What Causes Triangular Alopecia?
It’s not known what causes triangular alopecia. However, since it can be a congenital condition – being present from birth – and can be found in families, it’s believed to have a genetic component.
But it should be noted that this isn’t always the case. Triangular alopecia has been reported in individuals who have no family history of this type of hair loss.
Additionally, according to one research, temporal triangular alopecia can also accompany certain syndromes and disorders, such as “Gomez-Lopez-Hernandez Syndrome and Phacomatosis Pigmentovascularis type 2.”
How Do You Fix Triangular Alopecia?
Minoxidil might be prescribed to improve hair growth in the area affected by temporal triangular alopecia.
Sutisna FD, Gondokaryono SP, Dwiyana RF, Effendi RMRA, Tache N, Anandita R. Congenital Triangular Alopecia: A Case of Effective Response with 5% Topical Minoxidil in a Male Adolescent. Clin Cosmet Investig Dermatol. 2024 May 18;17:1147-1151. doi: 10.2147/CCID.S458753. PMID: 38779301; PMCID: PMC11110803/CC BY-NC 3.0
A case report published in the International Journal of Trichology described a patient who grew new vellus hair in their bald spot after 3 months of applying topical minoxidil.
However, there’s no guarantee that a treatment is going to work. In fact, it’s generally considered unnecessary and ineffective.
Alternatively, wigs or hairstyling techniques can also be used to camouflage the bald patch.
Your surgeon might also advise you to take a surgical route, which can involve:
- Cutting out the piece of skin from the scalp or
- Transplanting new hair into the bald spots
You might be familiar with the first option as a scalp reduction or alopecia reduction surgery. In this procedure, once the affected skin is excised, the hair-bearing areas are pulled over it to cover it.
The second option is treating triangular alopecia with a hair transplant surgery. This surgery can also effectively hide your bald spot by simply taking healthy hair from other areas of the scalp and implanting them into the triangular spot(s).
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Frequently Asked Questions
There will be no hair growth from a triangular alopecia patch because this type of hair loss is permanent. In some patients, however, improvement has been seen with minoxidil treatment.
To our knowledge, there is no cure for triangular alopecia. However, there are a few treatment options, such as a hair transplant, scalp reduction surgery and minoxidil.
Dr Cagla
Dr Cagla earned her medical degree at Trakya University’s Faculty of Medicine in Bulgaria and has almost 6 years of hair transplantation experience. She is a specialist in FUE, DHI and Sapphire hair transplants of the scalp, eyebrows and beard and has performed over 6,000 surgeries. Dr Cagla is multilingual, with fluency in English, Bulgarian and Turkish.
