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Traction Alopecia: Definition, Symptoms, and Prevention Strategies

Traction alopecia is one of the hair loss patterns, also known as central centrifugal cicatricial alopecia. It is caused by the systematic stretching of the hair.

If you consistently pull your hair, this condition can start developing with time. Because of the trauma that the hair follicles go through, a new strand cannot grow back. The main underlying reasons for this condition are tight hairstyles and harsh hair care practices.

Traction alopecia can be detectable only if looked closely in the early stages. If the right treatment is found, traction alopecia is not permanent.

Here are some helpful key points from the article:

  • TRACTION ALOPECIA IS MAINLY CAUSED BY CONSISTENT TENSION ON THE HAIR AND EXCESSIVE HAIR TRACTION.
  • THE CONDITION IS NOT GENETIC.
  • ALOPECIA FROM HAIR PULLING CAN BE REVERSED WITH THE RIGHT TREATMENT.
  • THERE ARE TIPS AND CHANGES YOU CAN MAKE TO PREVENT FURTHER DAMAGE OR RE-HAVING TRACTION ALOPECIA.

 

Let’s get into it.

What Is Traction Alopecia?

This condition, also known as tension alopecia, is directly caused by consistent tension on the hair. In the case of traction alopecia pulling hair out causes hair loss. It is caused by all sorts of mechanical factors, such as excessive, frequent pulling or rubbing. 

Its direct cause is most often wearing hairstyles that pull the scalp and hair roots. It may occur if you sleep with rollers, wear hair extensions, or often style your hair extensively.

traction alopecia

Can Traction Alopecia Be Reversed?

The effects of traction alopecia can be reversed. If you switch to protective styles that are meant to protect natural hair, the condition will not be permanent.

All you need to do is to find the right treatment. When you start wearing looser hairstyles and introduce gentler hair care, your hair may successfully grow back.

Is Traction Alopecia Genetic?

It is unclear whether there are genetic predispositions to traction alopecia. The condition appears due to hair-styling practices and may happen to people from all ethnic backgrounds.

Yet, traction alopecia affects 1/3 of women of African descent. The reasons are, however, related to popular hairstyles and hair styling among women in this ethnic group.

What Happens to Your Hair with Traction Alopecia?

When traction alopecia occurs, your hair anatomy changes in several ways. Here is what exactly happens to your hair structure:

  • Follicular damage: pulling and tension can damage the hair shaft and weaken the connection between the hair follicle and the scalp. This may lead to hair shaft breakage and gradual weakening of the hair follicles.
  • Inflammation: tension and pulling can cause inflammation, which may disrupt the normal hair growth cycle and lead to hair loss.
  • Miniaturization: over time, the hair follicles produce thinner hair prone to breakage and falling out.
  • Scarring: severe damage to the hair and inflammation may result in scarring around the follicles, which makes it difficult for hair to regrow in the affected areas.

What Causes Traction Alopecia?

Tension alopecia is usually a result of the following factors:

  • WEARING HAIRSTYLES THAT INVOLVE TIGHT PULLING
  • THE WEIGHT OF HAIR EXTENSIONS THAT CAN PULL ON THE NATURAL HAIR AND SCALP
  • REGULAR USE OF HAIR ACCESSORIES
  • FREQUENT USE OF HEAT STYLING TOOLS
  • CHEMICAL TREATMENTS
  • IMPROPER AND FORCEFUL COMBING LEADING TO HAIR BREAKAGE
  • INDIVIDUAL HIGH HAIR FRAGILITY

Which Trends Affect Your Hair?

Many trends in hair styling may contribute to traction alopecia, including:

  • DREADLOCKS
  • CORNROWS (CANEROWS)
  • TOPKNOTS
  • HAIR TWISTS

Why Is Traction Alopecia More Common Among Black Women?

Traction alopecia is more common among black women due to cultural and aesthetic factors. Many traditional hairstyles involve tightly braiding, hair weaving, or styling the hair close to the scalp. They can easily cause constant tension in the hair follicles, leading to damage and hair loss.

Tightly coiled or curly texture type of hair is more susceptible to damage from tension and manipulation. The hair’s natural curl pattern can make it more prone to breakage.

When it comes to traction alopecia in black women, they use more hair care products such as gels or adhesives that can contribute to hair damage and follicle inflammation.

What Are The Symptoms by Stages?

It is not easy to detect traction alopecia in the early stages if you do not pay attention. In the later stages, it becomes easier to understand your symptoms. 

Let’s have a closer look at the most common symptoms of the first stage of tension alopecia and the signs of permanent traction alopecia.

First Signs of Traction Alopecia

Traction alopecia’s early-stage symptoms are:

  • SLIGHT HAIR THINNING
  • SCALP IRRITATION, ITCHING OR TINGLING
  • REDNESS OR INFLAMMATION AROUND HAIR FOLLICLES

Keep in mind that recognizing the first symptoms of tension alopecia is crucial before it progresses to the advanced stage.

Signs of Permanent Traction Alopecia

If not properly taken care of, tension alopecia may in time turn into permanent traction alopecia. Here are all the symptoms of late-stage traction alopecia:

  • EXCESSIVE HAIR SHEDDING AND PERMANENT HAIR LOSS
  • INTENSIVE HAIR THINNING IN THE AFFECTED AREA
  • HAIRLINE RECESSION, ESPECIALLY AROUND THE FOREHEAD AND TEMPLES
  • BRITTLE, DRY, AND BROKEN HAIRS
  • ADVANCED INFLAMMATION AND ITCHINESS AROUND THE HAIR FOLLICLES
  • CHANGES IN THE TEXTURE OF THE HAIR
  • VISIBLE PATCHES OF HAIR LOSS
  • BALD SPOTS AND NO HAIR PRODUCTION

 

⚠️ 50-100 strands of hair shedding a day is normal. 

Most Common Spots for Traction Alopecia

Your hair along the front and sides of the scalp is generally affected the most. Yet, there might be also visible hair loss on other areas of your scalp. It can be directly related to your hairstyle, in the case of traction alopecia from wigs.

Traction alopecia may be also visible at the crown of the head in case of tight ponytails, the nape of your neck, or even behind the ears. Balding in the ear area is a result of wearing very tight braids or extensions.

Is Traction Alopecia Different for Males and Females?

In fact yes, there are. Tension alopecia can affect both men and women, but there are some dissimilarities in terms of the causes and symptoms of the condition.

Let’s take a look at traction alopecia male vs traction alopecia female.

Different Causes of Traction Alopecia

Both men and women can experience traction alopecia. The cause is generally the same, yet, there may be variations in the specific hairstyling that can lead to it. Here are some of the different reasons for males and females:

MEN

  • WEARING TIGHT HATS OR CAPS
  • AGGRESSIVE FACIAL HAIR GROOMING
  • USE OF CERTAIN HAIR PRODUCTS, LIKE GELS AND POMADES

WOMEN

  • TIGHT HAIRSTYLES
  • HAIR EXTENSIONS
  • HEAT STYLING

Different Symptoms of Traction Alopecia

Symptoms of traction alopecia in both men and women include hair thinning, hair breakage, and scalp sensitivity. Yet, when it comes to specific effects of this condition for males and females, they can be listed as below:

MEN

  • RECEDING FRONTAL HAIRLINE
  • THINNING CROWN

WOMEN

  • TENSION-RELATED BALD SPOTS
  • WIDENING OF PARTYING
  • BALDNESS AROUND EARS AND NAPE

Can You Regrow Hair from Traction Alopecia?

It is possible to regrow your hair if you have tension alopecia.

If your condition is mild, then hair restoration can definitely be done. All you need to do is to exclude damaging actions and habits from your hair care routine.

Yet, in some more severe cases, hair follicles are damaged and the result is irreversible scarring alopecia. Regrowth may not be possible in such situations. Scar formation does not support hair growth.

How to Treat Traction Alopecia: Is It Possible?

Treating tension alopecia is definitely possible. There are several options available:

  • TOPICAL CREAMS
  • ORAL MEDICATIONS
  • CORTICOSTEROID CREAMS
  • PRP (PLATELET-RICH PLASMA)
  • LOW-LEVEL LASER THERAPY (LLLT)


A dermatologist can suggest
topical treatments to stimulate hair growth. One of the over-the-counter drugs that can help with hair growth is Minoxidil. It increases blood flow to the hair follicles.

A doctor can also recommend oral medicine such as spironolactone. It may help counteract the effects of androgen hormones that contribute to your hair loss.

Another option is a corticosteroid cream or a set of corticosteroid injections that may be used to reduce inflammation and start hair regrowth.

  • Platelet-Rich Plasma (PRP) therapy injects platelet-rich plasma into the scalp, which may stimulate hair follicles.
  • Low-Level Laser Therapy (LLLT) stimulates hair follicles and can also be recommended by your dermatologist.

 

⚠️ CONSULT A DERMATOLOGIST FOR THE BEST TREATMENT OPTION FOR YOU.

Natural Remedies for Traction Alopecia

There are several products for traction alopecia and home-style remedies that can help you cure the condition. Here is the list of what to DO and DO NOT  if you want to avoid, prevent, and cure tension alopecia:

DOs

DON’Ts

Breaks between artificial hair use

Tight hairstyles

Choosing loose hairstyles

Frequent relaxers usage

Scalp massage

Rubber bands usage

Low heat settings on blow dryers

Sleeping in rollers

Change Your Hair Care and Hairstyle Routine

Here’s what you can change for more relaxed hair follicles:

  • AVOID HARSH BRUSHING OR COMBING WHEN YOUR HAIR IS WET
  • GENTLY MASSAGE YOUR SCALP REGULARLY TO IMPROVE BLOOD CIRCULATION
  • TRY A GENTLE, THERAPEUTIC SCALP MASSAGE
  • FOLLOW A BALANCED DIET RICH IN VITAMINS AND MINERALS THAT PROMOTE HAIR HEALTH AND HAIR ELASTICITY
  • USE MILD, SULFATE-FREE SHAMPOOS AND CONDITIONERS
  • LOOK FOR PRODUCTS THAT CONTAIN INGREDIENTS SUCH AS MINOXIDIL, KETOCONAZOLE, OR CAFFEINE

 

⚠️ DO NOT USE ANY PRODUCTS BEFORE CONSULTING YOUR DERMOTOLOGIST.

Can Hair Transplant Help with Traction Alopecia?

In case your hair pulling alopecia turns into its permanent stage, hair transplantation may be a good solution. So far a hair transplant is one of the best ways to treat traction alopecia permanently.

How to Prevent Traction Alopecia

To avoid traction alopecia, you should take care of the condition of your hair and not overdo it with the frequency of care treatments.

You need to give your hair a break from tiring hairstyles that squeeze them too much and also give up frequent sleeping with hair tightly curled on rollers or the frequent use of strongly fastening ornaments.

You should comb your hair gently, and it is best to leave the hair loose at night.

Preferring More Comfortable Hairstyles

To prevent the condition and to treat the negative effects of traction alopecia, choose less hair-damaging styles.

  • Natural, relaxed hair: wash your hair, use a leave-in conditioner, and let your hair air-dry
  • Short haircuts: no tension on the hair roots, can encourage hair regrowth potential, and support the health of your scalp
  • Low and loose buns: less tension on the hair
  • Loose braids: no excessive pull on the hair roots
  • Bangs: cover up areas where hair may be thinning along the hairline, grow the edges back, and protect regrowth underneath
References:

[1] Pulickal JK, Kaliyadan F. Traction Alopecia. 2022 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262008.

[2] Kim SR, Craiglow BG. Treatment of traction alopecia with oral minoxidil. JAAD Case Rep. 2022 Apr 1;23:112-113. doi: 10.1016/j.jdcr.2022.03.023. PMID: 35495975; PMCID: PMC9039860.

[3] Grayson C, McMichael A. 2 – Ethnic differences in hair, Procedures in Cosmetic Dermatology, Elsevier, 2024, Pages 20-30, ISBN 9780323829212.

[4] Traction alopecia: A type of hair loss, The University of Iowa.