Traction alopecia is a rare type of hair loss that is caused by hairstyles that pull on the hair roots. As the cause is mechanical, anyone can get traction alopecia, and it’s also easy to prevent. Traction alopecia is very often concentrated on certain demographics, such as women of African descent or Sikh men due to the constant tension exerted on the hair follicles.
Traction Alopecia and its Causes
Traction alopecia is a type of hair loss that is caused by a consistent pulling force on the hair. Unlike many forms of hair loss which are primarily the result of genetic or autoimmune factors, traction alopecia has a mechanical cause and is, therefore, preventable. By removing the tension on the hair, the problem can be prevented entirely.
Common culprits include:
- Ponytails or pigtails
- Weaves and wigs
- Use of hairpieces, hairpins, headbands
- Tight headgear used consistently (such as cyclists)
- Repeated use of hair rollers
In theory, almost anything that can cause a consistent pulling at the hair has the potential to lead to traction alopecia. However, not all hairstyles or activities are equally common or risky. Ponytails and pigtails, for example, are extremely common hairstyles in the West as well as in Asia but these hairstyles seldom lead to traction alopecia. This is because these hairstyles are often loosened from time to time. Braids, on the other hand, are common culprits of traction alopecia as they seldom get loosened. They are common in African and Caribbean cultures, and traction alopecia is often found concentrated within this community. Wherever braids and dreadlocks are prevalent, traction alopecia is also very common.
In many cultures, both men and women have various braids that often have cultural significance. Hair can have religious components as well. In the Sikh male population, traction alopecia is also more prevalent due to the turban pulling at the hair follicles. In one population study from South Africa, up to 32% of women had traction alopecia, while young children aged 6-15 had a prevalence rate of 8.6% – 21.7%.
The symptoms of traction alopecia vary based on the exact cause of the traction. Common signs of traction alopecia include:
- Asymmetrical hair thickness
- Redness or pain in the scalp area
- Itchy scalp after wearing braids or a weave
- Scalp sensitivity after undoing a hairstyle/relief after untying hair
- Headache resulting from too tight a hairstyle
- Acne caused by tension to the hair follicles
For braids, it usually starts at the temple area, below the ears. The pattern of damage often follows the braids in the form of folliculitis, and loss of hair density, and broken hairs. As the alopecia progresses, it can result in a complete loss of hair that leads to scars. Hair at the margin of the scalp is put under friction and tension. Receding hairline is the start. Tight braiding in cornrows can lead to marginal or central alopecia with widening part lines. Twisting hair into a bun on the top of the head can produce horseshoe-shaped hair loss. Rough brushing or even massaging the scalp too vigorously can cause widespread hair loss. Different pulling hairstyles will result in various types of geometrical formation. It’s thought that the constant traction from the hair will damage the hair follicle over time. Traction alopecia can start out as a reversible condition, but eventually will cause permanent scarring.
Prevention and Treatment
Prevention should first and foremost be the priority. Traction alopecia is preventable, and educating parents will be a very effective intervention as this condition often starts at a very young age. As hair follicles are more vulnerable during childhood, the early signs of alopecia in children are often the result of tight hairstyles. Prevention is always better than treatment, but it’s especially true with traction alopecia. Very simple interventions such as loosening the braid (or any other hairstyle that tends to pull) so that it isn’t so tight can minimize traction alopecia. In many cases, simply loosening the braid or other hair pulling style, or taking time off of it periodically will allow the hair to recover. Patients who show signs of damage may also want to stay away from other types of hair manipulation that can damage the follicles such as heating curlers, chemicals, or excessive brushing.
While prevention is the most important factor, if there is damage to the hair, treatment will be necessary. The earlier that traction alopecia is identified and treated, the better the results will be. Traction alopecia progresses in stages. At the early stages, the hair is still largely intact and at this stage, the damage is minimal. At this stage, simple lifestyle changes such as avoidance of heat (especially curlers), and exposure to chemicals will likely reverse the damage. As the condition progresses, the terminal hairs may drop out. If the area is inflamed, red, or scaled, topical steroids can help reduce these symptoms. Sometimes antibiotics may be prescribed for a short time, primarily for their anti-inflammatory effects. In the late stages, the hair follicle is replaced with a fibrous tract. If the alopecia is severe, intralesional steroids may be prescribed. There are also other interventions such as hair transplantation that can help.