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The Causes and Prevention of Traction Alopecia

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  • Post last modified:September 26, 2023

Hair Health Hotline is your direct access to dermatologists, trichologists, hairstylists, and other beauty professionals. Each story in this series addresses a common concern regarding hair or scalp and provides evidence-based solutions for taking care of your strands.

Styling your hair can enable you to avoid distractions during a workout, express yourself, or safeguard your hair from the elements, but it also has its drawbacks. Firstly, you may have heard of traction alopecia, a type of hair loss that occurs due to excessive tension, typically from hairstyling.

If you have no intention of losing your hair because of your preferred styling practices, you might be curious about which hairstyles can lead to traction alopecia and whether it can be prevented or reversed. Below, Janiene Luke, M.D., F.A.A.D., a dermatologist and residency program director at Loma Linda University Medical Center, shares that information and more.

Q: I’ve come across social media posts discussing hair loss caused by traction alopecia. What kinds of hairstyles typically lead to traction alopecia, and is it possible to avoid it?

A: Traction alopecia is often a result of wearing tightly styled hairstyles for extended periods of time, and taking breaks from these hairstyles or ensuring that they are not excessively tight can help prevent this condition of hair loss,” explains Dr. Luke. However, it’s best to start with the basics and understand this condition.

What is traction alopecia?

“Traction alopecia is a form of hair loss that occurs when there is excessive tension or stress applied to the hair follicle, leading to mechanical damage and subsequent hair loss,” clarifies Dr. Luke. As mentioned earlier, the tension typically arises from styling practices. “Medical professionals commonly observe traction alopecia in Black patients due to prevalent hair care practices in this community,” but it also affects other populations, notes Dr. Luke.

Individuals experiencing traction alopecia typically notice hair loss in a specific area of their scalp, depending on where tension has been applied through hairstyling. “The most common area is the frontal or temporal region of the scalp” (i.e., along the hairline at the front and sides), states Dr. Luke. “Dermatologists observe what is known as the fringe sign, which patients can also look out for. This refers to the presence of short hairs that cannot be incorporated into the hairstyle, and there is a zone of hair loss between these short hairs and the rest of the scalp hair. While hair loss primarily affects the front and sides of the scalp, it often extends to the back of the scalp, especially when tight ponytails are the cause.

How do you develop traction alopecia?

Tight hairstyles can potentially result in traction alopecia, particularly if you wear them for extended periods of time. “Traction alopecia occurs when there is consistent stress or tension on the hair follicle,” explains Dr. Luke. “There is ample evidence that frequently sporting a tight bun or ponytail can contribute to this condition, but certain other hairstyles pose a higher risk. Braids or dreadlocks, in particular, can generate continuous tension, especially if they are tightly done from the start.”

Furthermore, “dreadlocks are another hairstyle with a heightened risk, especially because they are a more permanent style and as the dreadlocks grow, they become heavier,” adds Dr. Luke. “So it’s not only the tension applied to the follicle but also the added weight that makes it a riskier style.”

Dr. Luke also points out that wearing hair extensions can also lead to traction alopecia. The weight of the extensions can cause tension, and in the case of sew-in extensions, tightly braiding the hair to install them adds additional tension.

What are the most effective methods for treating and preventing traction alopecia?

If you enjoy wearing hairstyles that may contribute to traction alopecia, taking breaks from these styles can help reduce the risk of developing the condition, advises Dr. Luke. “There is always an inherent risk, but I recommend periods of rest where you either avoid that particular style or opt for styles that pose a lower risk. So you could wear your hair naturally or use a wig that isn’t too tight or secured with glue.”

It’s also important to remove a style promptly if it feels too tight. “You can determine whether a style is too tight based on the presence of pain,” says Dr. Luke. “Redness in the area where the hair has been braided or even folliculitis, which is inflammation or small pus-filled bumps around the hair follicle, are also indicators. Sometimes, the tightness of the style can even cause the skin to tense up.”

If you suspect you already have traction alopecia, it is best to take action as soon as possible. “In the early stages, traction alopecia is potentially reversible, meaning it hasn’t caused permanent damage to the hair follicles. However, if the style continues to be used or if it is excessively tight, it can lead to a permanent form of hair loss,” explains Dr. Luke. Early intervention involves doctors injecting an anti-inflammatory medication to stimulate hair follicles and reverse traction alopecia. In cases of permanent damage, a hair transplant may be an option.

Various hairstyles, which you may be reluctant to completely give up, can contribute to traction alopecia. However, taking breaks, being vigilant for signs of excessive tightness, and promptly seeking medical attention if you suspect the condition can also be beneficial.

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