What Is Traction Alopecia?

Traction alopecia is hair loss caused by steady pulling from tight hairstyles. Alopecia is the medical term for hair loss. Pulling hair back into ponytails, braids, or other hairstyles can damage the hair follicles and cause hairs to fall out of your head. Hair loss can have emotional impacts and affect your quality of life.

The rates of traction alopecia have not been well researched. This type of hair loss has been described in people of all races. However, it appears more common in females than males and frequently occurs in people of African descent.

This article discusses traction alopecia symptoms, causes, diagnosis, treatment, and how to cope.

Traction Alopecia Symptoms

With traction alopecia, hair loss occurs most often along the edges of the hair. The areas where the hair is pulled tightest generally have the most significant hair loss. Tightly pulled hairstyles seem to be the main cause of traction alopecia.

A receding hairline is the most common way traction alopecia occurs. When hair is divided into sections for braids or other hairstyles, hair loss can happen along the edges of the sections.

Early signs of traction alopecia involve redness around the hair follicles (perifollicular erythema). The hair follicles then become inflamed or infected (folliculitis), and pustules and papules (a red bumpy rash) may occur.

Some scientists report that naturally curly hair, especially hair of people of African descent, is at a higher risk of being damaged by the pulling forces of tight hairstyles. This is because the naturally irregular and asymmetrical shape of the hair is believed to have more points of weakness and potential damage than straight hair.

Causes

High tension, tightly pulled back hairstyles can cause traction alopecia. Tenting, skin on the scalp pulling upward toward the braid or ponytail, is a risk factor for traction alopecia. Common hairstyles that may cause hair loss include:

• Sectioned braids
• Braids with beads
• Cornrows
• Dreadlocks
• Hair weaves
• Ponytails
• Turbans
• Buns
• Nurse's cap

Chemical relaxers or straighteners may increase the risk of developing traction alopecia. The chemical process may weaken the hair and make it more susceptible to the forces used to create hairstyles. Overall, relaxer use is a risk factor for traction alopecia.

Diagnosis

Trichoscopy allows your healthcare provider to look closely at your scalp and hair with a device called a dermatoscope. This tool magnifies the skin's surface on your head and allows your healthcare provider a close-up look at the hair growth patterns and any changes to your scalp.

Broken hair of varying lengths and empty hair follicles (where the hairs have been pulled out) may be seen. Because there are different kinds and causes of alopecia, a skilled healthcare provider must carefully inspect your hair loss.

Other changes can occur in areas where too much pulling has damaged the hairs and follicles. Hair may be thinner, or peach fuzz (vellus hairs) may develop in the areas of hair loss from traction.

Treatment

Prevention of hair loss is the best treatment. Choosing looser hairstyles, avoiding tight hairstyles after using relaxers and chemical treatments, and avoiding heat treatments can help to prevent damage to the hair and follicles.

Scalp redness and inflammation may benefit from steroids and antibiotics. They may be taken orally or put directly on the affected skin areas (topically), depending on the prescription from your healthcare provider.

Rogaine (minoxidil) may have some benefits in helping hair regrow. Be sure to discuss any treatments with your healthcare provider before starting them.

If you notice changes related to your hairstyle, early intervention is important. Limiting damage to hair follicles can prevent scarring and permanent hair loss. Once scarring has occurred, the hair loss is no longer potentially reversible. However, hair transplants are sometimes helpful in returning hair growth to areas where the original follicles have scarred.

Coping

Hairstyles can be part of social, cultural, and religious practices. Hair is an important part of identity and self-presentation for many people. Hair loss has been found to increase rates of anxiety and depression.

Children and adolescents may be at higher risk than adults for developing traction alopecia. Educating caregivers and hairdressers has been recommended as a tool for choosing styles that help preserve hair.

Hair loss can also affect personal emotions about appearance. Interestingly, an individual's sense of hair loss and the effects of alopecia do not always match the degree of hair loss a healthcare provider may diagnose. Your sense of the severity of hair loss impacts your perception of your quality of life.

Prevention

Hair loss prevention is possible, especially if caught in the early stages. Treatments are available to help with damage and potentially re-grow hair. Wigs, hair pieces, and extensions should be avoided while allowing hair to heal.

Summary

Tightly pulled hairstyles most often cause traction alopecia. Over time, chronic pulling damages the hair and the follicles. Skin pulling and pimples around the base of the hair can be early warning signs of damage. Loosening ponytails, braids, and buns may help prevent permanent damage. If you have already lost some hair, especially around the edges of your face, be sure to see a healthcare provider.

A Word From Verywell

Hair loss can be an emotionally challenging issue to face. Hair can be very important in your appearance and sense of self. Typically, traction alopecia is not due to a serious medical condition. There are ways to reverse traction alopecia, especially if it is found early. If you notice breakage or hair loss and have worn tightly pulled-back hairstyles, reach out to your healthcare provider as soon as possible to restore your hair growth.