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Traction alopecia: Symptoms and prevention

Traction alopecia is hair loss caused by tightly pulled hairstyles. Caught early, it is fully reversible and the hair can regrow. Over time, however, hair follicles can become irreversibly damaged so that the hair does not regrow.

This article provides the key information about causes, treatment, and prevention of traction alopecia.

What is traction alopecia?

Woman experiencing hair loss and alopecia.
Traction alopecia is caused by the hair being pulled in a certain way repeatedly.

Traction alopecia is hair loss caused by the hair being pulled in the same way for a long time.

Traction alopecia can happen to anyone who wears their hair pulled back tightly, whether in braids, dreadlocks, or a ponytail. It can also occur when tight headwear is used in the same way every day.

Repeated strain on the hair follicles can pull out strands of hair and even damage the follicles. This causes redness, itching, and even pus-producing ulcers or infections.

Signs of traction alopecia include:

  • a receding hairline typically around the forehead, temples, or nape
  • small pimples appear on the scalp or at the base of braids
  • redness, itching, and ulcers on the scalp
  • the hair parting widens
  • patches of thin or broken hair in places where the hair has been under strain
  • patches of shiny, scarred skin in more advanced cases

Occasionally wearing tight hairstyles is not a problem, and some daily hair loss is normal. According to the American Academy of Dermatology, humans lose between 50 and 100 hairs every day, which are usually replaced by new hair growth.

Traction alopecia is not a medical concern, but it can have adverse psychological effects.

This form of hair loss is different from others, such as alopecia areata, alopecia universalis, and male or female pattern baldness, which are caused by genetic or immune factors.

A related condition called central centrifugal cicatricial alopecia CCCA can also occur when hair loss starts on the crown and moves outwards. This type of alopecia is likely to cause scarring on the scalp.

Causes

Man wearing cycling helmet outdoors.
Wearing sports helmets or headbands every day may cause traction alopecia.

Traction alopecia is made more likely by certain hairstyles and professions.

Here is a list of possible causes of traction alopecia:

  • Certain hairstyles, including dreadlocks, braids, cornrows, and tight ponytails.
  • Hair extensions or weaves. Extensions are glued or tightly tied to the base of the hair, which may cause tension at the hair roots.
  • Headwear, such as sports helmets or tight elastic headbands, may cause the hair to thin where the headwear makes contact with the hair.
  • Hair accessories, including hair slides or grips that are worn in the same way every day.
  • Very long hair can be heavy, pulling on the hair follicles. Very long or tightly tied beards can also result in traction alopecia.
  • Hair relaxers and other chemical treatments. These change the structure of the hair shaft in a way that makes hair loss more likely.
  • Using extensions and relaxers together. According to one study, this was the most significant risk factor for traction alopecia.

A study in the British Journal of Dermatology found traction alopecia in 31.7 percent of African women with relaxed or permed hair.

Traction alopecia is common among ballet dancers and other sports professionals who wear tight buns or ponytails for long periods of time.

Children and adults are both affected, but it is more common in older people because hair follicles naturally weaken over time.

Traction alopecia can also occur in pets. Leaving hair clips in a dog s fur for too long or allowing the fur to form dreadlocks can strain the follicles to cause painful pulling and hair loss.

Treatment

Treatment can be as simple as changing hairstyle techniques. Here are some steps to treat this condition:

  • Avoid tight hairstyles if possible. If a person s religion or profession require tight hairstyles, they should tie their hair as loosely as possible and wear their hair loose or down whenever possible.
  • Avoid or limit chemicals, including relaxers. Avoid putting relaxer onto already relaxed hair.
  • Change hairstyles every few weeks to prevent strain on one area of the scalp.
  • Try hair growth products. Around 40 percent of people using a minoxidil product regrow some hair after 3 to 6 months. The United States Food and Drug Administration FDA have approved Rogaine, but people should not use it if their scalp is red or inflamed.
  • Use anti-inflammatories. Steroid creams can reduce swelling on the scalp caused by traction alopecia.

If the hair still does not regrow after a few months, the hair follicles may be damaged. If there is substantial scarring, the hair may not be able to grow back.

Consult a doctor or dermatologist to find out the best course of treatment. In severe cases, hair transplants or camouflage techniques are an option.

Prevention

Women braiding hair and testing out different hairstyles.
Changing hairstyles frequently and wearing loose braids may help to prevent traction alopecia.

These tips will help prevent traction alopecia:

  • loosen or change any hairstyle that is painful
  • change hairstyles every few weeks
  • wear thick, loose braids instead of small, tight braids
  • choose fabric hair ties instead of elastics
  • keep the hair loose as often possible

It is vital to keep hair healthy by getting enough protein and iron, which are essential for hair growth. Good sources of iron include beans, nuts, brown rice, meat, and leafy vegetables, such as spinach.

Outlook

Traction alopecia is fully reversible in the earlier stages. In most cases, recognizing the problem and avoiding tight hairstyles will result in a full restoration of the hair.

In the later stages, follicles may become damaged and the hair may not re-grow. In these cases, a person may wish to ask a healthcare professional about hair transplants.

When a person is concerned about hair loss, they should speak to a doctor or dermatologist. A professional can work out the cause of hair loss and suggest the best course of treatment.