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Last updated October 9, 2019. 3 minute read

Traction alopecia: causes, treatment, and prevention

Traction alopecia is due to repeated and longstanding trauma to hair follicles, usually due to tight hairstyles. When the hair follicles are damaged, this leads to inflammation causing redness and pimples on the scalp. Over time, the inflammation causes hair loss

Dr Chimene Richa Md Written by Chimene Richa, MD
Reviewed by Mike Bohl, MD, MPH

Traction alopecia is a type of hair loss that comes from pulling on the hair repeatedly over a long time. It can affect anyone who wears certain hairstyles, especially if “relaxer” chemical treatments are used at the same time. These “traumatic hairstyles” include tight buns or ponytails, tight braids (such as cornrows or dreadlocks), and the attachment of weaves or hair extensions; they have the highest risk of leading to traction alopecia (Billero, 2018). It can also occur when the same tight headgear is worn repeatedly, often for religious or professional reasons. Traction alopecia happens in one-third of women of African descent who wear these tight hairstyles (Billero, 2018).

Vitals

  • Traction alopecia is a type of hair loss that comes from pulling on the hair repeatedly over a long time.
  • Approximately one-third of women of African descent are affected by traction alopecia.
  • Use of tight hairstyles, like tight ponytails, tight braids, hair extensions, etc. places you at higher risk for getting traction alopecia, especially if used with chemical relaxants.
  • Relieving the traction can reverse the hair loss.

Symptoms of traction alopecia

In traction alopecia, you usually see patches of hair loss in areas of the scalp that are under the most tension; this will depend on the shape of the hairstyle but can be seen at the hairline, above the temples, etc. In the early stages, you may see broken hairs and redness around the hair follicles (cells that produce each hair) located at the base of each hair shaft. As traction alopecia progresses, you can develop inflammation of the hair follicles, also known as folliculitis, leading to pimples on the scalp. As the condition worsens, you may have tenderness, itching, or ulcers on the scalp. In advanced cases, you can develop irreversible scarring of the scalp that leads to decreased hair growth and potentially permanent hair loss in those areas.

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What causes traction alopecia?

Traction alopecia is due to repeated and longstanding trauma to hair follicles, usually due to tight hairstyles. When the hair follicles are damaged, this leads to inflammation causing redness and pimples on the scalp. Over time, the inflammation causes hair loss. The hairstyles with the highest risk of causing traction alopecia are:

  • Tight braiding: these can be sectioned braids, braids with plastic beads attached, or form cornrows
  • Hair extensions or weaves
  • Dreadlocks
  • Tight ponytails or buns, like those worn by ballerinas
  • Turban use: the hair is tied in a tight ponytail and then the head is wrapped tightly with a turban, as is common in the Sikh community

Using chemical “relaxers” with any of these hairstyles increases the risk of traction alopecia because the “relaxed” hair is weaker and more brittle (Billero, 2018).

How to prevent traction alopecia

The best way to prevent traction alopecia is to avoid putting tension on your hair whenever possible. Try to avoid tight hairstyles, or if they cannot be avoided, limit their use and wear your hair loose whenever possible. Change your hairstyles regularly so that the tension is not always on the same part of the scalp. You should limit the use of chemical hair care products and relaxers, especially if you need to wear a tight hairstyle, to help prevent traction alopecia.

Treatment options

If you think you have traction alopecia, see a dermatologist who treats hair loss. Your provider may need additional testing to confirm the diagnosis, such as trichoscopy (examining the hair and scalp under high magnification) or a scalp biopsy (removal of a small piece of scalp tissue for microscopic evaluation) to rule out other conditions that can mimic traction alopecia; these other conditions include:

  • Trichotillomania is an impulse-control disorder where you cannot stop pulling your hair, usually on your scalp, but sometimes from other places on your body. You can see broken hair in the thinning patches.
  • Scarring alopecia is a type of alopecia where inflammation kills the hair follicles, replacing them with scar tissue which leads to baldness; several skin disorders can cause this, including folliculitis and lupus.
  • Alopecia areata is an autoimmune condition where the body attacks its own hair leading to sometimes patchy hair loss (NAAF, n.d).

You can learn more about other causes of alopecia here.

Most cases of traction alopecia can be reversed by removing the source of the traction if they are caught early. Unfortunately, if you wait until it reaches the scarring hair loss stage, treatment may not be successful. During the early folliculitis stages, applying steroid creams can help reduce the inflammation and prevent scarring. There are reports of people having hair regrowth after using topical minoxidil (brand name Rogaine) for several months, but more research is needed in this area. In more advanced stages where you have had scarring and follicle loss, a hair transplant may be an option.

You can learn more about hair loss treatment here.

Can traction alopecia be reversed?

Yes. If you realize you have traction alopecia before scarring sets in, changing your hair care practices and removing the tension from the scalp should allow the hair to regrow naturally again.