OSCE — Traction alopecia

Brief (to candidate)

You will assess a patient with a presentation consistent with Traction alopecia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Traction alopecia is a form of mechanical hair loss — and eventually scarring alopecia — caused by sustained or repeated tension on hair roots over weeks, months, or years. It predominantly affects women and girls of African descent (tight braids, cornrows, weaves, extensions, chemical relaxers), Sikh men (turban knot), ballet dancers, athletes, and any patient whose hairstyle, headwear, or occupational load applies chronic traction. Early (reversible) disease: perifollicular erythema, scaling, papules, broken hairs, tenderness, traction folliculitis at the hair margin. Late (irreversible) disease: scarring with loss of follicular ostia, smooth shiny scalp, vellus hairs only, the pathognomon

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]