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Traction Alopecia- What You Need To Know

    Traction alopecia is a form of hair loss caused by consistent strong pulling of the hair when styling and grooming resulting in trauma to the hair roots and consequently hair loss. This blog aims to take you through everything you need to know about traction alopecia, including its symptoms, causes, treatment and prevention tips.

    What is traction alopecia?

    Traction alopecia is a type of hair loss that occurs as a result of a continuous pulling force on the roots of the hair. This pulling force usually comes from wearing your hair in tight braids, bun, or ponytails. It most commonly occurs in women of African descent who have a tightly styled their curly hair.

    According to a review published in John Hopkins Medicine, which evaluated up to 19 scientific researches, there is a strong association between certain scalp-pulling hairstyles (mainly common among African-Americans) and the development of traction alopecia. In fact, it found that an estimated one-third of African-American women suffer from traction alopecia. This means it is the leading cause of hair loss among this group of women.

    Braids and weaves can cause traction alopecia

    Traction alopecia doesn’t only affect African- American women but can in fact affect anyone. If you engage in any habit that can creates a repeated pulling force on your hair, then traction alopecia can also affect you. Some of these habits include always wearing tight headbands in the same position, everyday, and pulling the hair back tightly into ponytails.

    The good thing is that the hair loss caused by traction alopecia is preventable if you stop styling your hair in a way that exerts a force on the hair root. For patients who have lost hair due to traction alopecia the hair loss is often permanent and will require hair transplant surgery to restore fullness.

    As mentioned earlier, traction alopecia is most commonly associated with Afro-Caribbean hairstyles like tight braids. The hair loss is usually visible in the hairline, temporal and preauricular regions of the scalp. It also occurs just above the ears and other parts of the scalp, depending on the hairstyles most commonly used.

    Symptoms of traction alopecia

    Hair loss in the hairline, temples and around the ears are the most common symptoms of traction alopecia. However, during the early stages of traction alopecia, there are some signs that you can spot. Depending on the hairstyle you most commonly use, you might begin to see signs like little bumps on your scalp, along with broken hairs that precedes hair loss. Usually, the front and sides of the scalp are where the hair loss occurs the most. Other symptoms might include:

    • Folliculitis; which is a common condition that’s characterised by the inflammation or infection of the hair follicles
    • Redness of the scalp
    • Bumps
    • Itching scalp
    • Pus-filled blisters that are usually painful
    • Soreness of the scalp
    • Hair casts; which are elongated, thin, and whitish cylindrical keratinous structures that encircle or ensheath the hair shaft.

    Traction alopecia is different from most other forms of hair loss. In other forms, hair loss occurs all over the scalp in patches, while in traction alopecia, it affects only the hair that’s continuously experiencing a pulling force. The most common areas are:

    • Hairline
    • Temples
    • Around the ears
    • Nape of the neck

    Causes of traction alopecia

    As mentioned earlier, you can get affected by traction alopecia when you wear hairstyles or engage in habits that can create a pulling force on your hair. When this pulling force or tension occur continuously, it loosens the hair shaft’s position in its follicle eventually leading to hair loss.

    Some of the most common causes of traction alopecia include:

    • Wearing tight braids, dreadlocks, or cornrows
    • Using hair extensions or weaves
    • Hair twisting and styling into Turbans for those who following Sikhism
    • Using hair rollers, especially when they stay put for a long period of time
    • Hair pulling styles like buns or tight ponytails
    Tightly styling your hair exerts a force on the hair root causing hair loss in the form of traction alopecia

    Treatment of traction alopecia

    To treat traction alopecia, doctors first look at factors like how long the condition has been present for, and whether there is a permanent hair loss or not. Based on these initial assessments, the treatment of traction alopecia is classified into three stages: the prevention stage, early traction alopecia stage, and longstanding traction alopecia stage.

    • In the prevention stage, behavioural modifications can be suggested such as altering hair grooming and styling practices. This can prevent traction alopecia altogether.
    • In early traction alopecia stage, the hair follicles are still largely undisturbed. So, treatment in this stage involves the doctors talking one through all the various behavioural modifications that can reduce hair pulling. This includes the use of hairstyles that can reduce tightness of the braid, complete avoidance of chemicals and heat, not brushing the affected areas of the scalp, and the use of topical or injected corticosteroids once there are signs of inflammation, which usually show up in the forms of scaling or tenderness of the scalp.
    • In the longstanding traction alopecia stage there is permanent hair loss and hair transplant surgery is the most common method to treat the condition

    Prevention of traction alopecia

    Once you begin to notice some of the earliest signs of traction alopecia like small bumps on your scalp, or short broken hairs around your forehead, then you ought to take measures to prevent further hair loss.

    The following tips might be found very helpful in preventing traction alopecia:

    • Avoid hairstyles that can cause a pulling force on your hair such as braids, ponytails, and dreadlocks. Even if you have to wear these kind of hairstyles, make sure you wear them loosely.
    • Explore the possibility of changing your hairstyles every now and then. By alternating between hairstyles, you reduce the repeated forceful pulling of hair in a specific region of your scalp. If you wear braids 1 week, you might want to consider wearing your hair down the following week.
    • Avoid sleeping in rollers or wearing wigs that can continuously pull on your scalp.
    • Avoid the use of strong chemicals on your hair. Chemicals can easily damage your hair, cause it to break off easily, and make it more susceptible to traction alopecia.
    • Give your hair a break from repeated styling. Consider taking breaks after using a pulling hairstyle. This can allow your hair strands to rest and recover from the tension
    • You should also avoid heat, and harsh hair relaxers.
    • If you enjoy plaiting braids, try as much as possible to go for thicker ones.  Thick braids don’t pull hair as much as the thin ones.


    Traction alopecia is hair loss that occurs as a result of the continuous pulling force exerted upon the hair roots by certain hairstyles like braids, buns, and ponytails. It causes hair loss usually on the front and sides of the scalp. When noticed early, traction alopecia is preventable. However, when left unnoticed, it can lead to permanent hair loss.

    Certain behavioural changes can be adopted to fight traction alopecia. These changes include hairstyles modifications, and avoiding the use of damaging chemicals on the hair. That being said, when the condition reaches a chronic stage, hair transplant becomes the best option to treat the condition



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