What Is Traction Alopecia?
Traction alopecia is a type of hair loss caused by hairstyles or other things that pull on your hair. This is most often due to wearing tight hairstyles, but it can also come from wearing caps or other items too often.
Traction Alopecia Causes
Any hairstyle that pulls on your scalp or hair can cause traction alopecia over time. Common causes include ponytails or certain styles like hair weaves, extensions, cornrows, and braids. Chemical relaxers can cause it, too. Other causes include:
- Dreadlocks
- Frequent use of tight headbands or hats
- Overuse of hair clips or accessories that pull on your hair
- Excessive use of hair ties
- Prolonged use of hair rollers or other hair devices that put continuous pressure on your scalp
Traction Alopecia Risk Factors
While anyone can get traction alopecia, it often shows up if you tend to wear longer hairstyles. Dermatologists tend to see it mostly in African Americans, both male and female. But studies also show it happens in a high number of Sikh males who twist their uncut scalp hair tightly or in their uncut beard below the chin.
Traction Alopecia Symptoms
The symptoms of traction alopecia can mimic those of other conditions, so it’s important to consult your doctor. Signs of alopecia include:
- Itching
- Redness
- Scaling
- Red or white pus-filled bumps on your scalp (called folliculitis or pustules)
- Multiple short broken hairs
- Thinning and hair loss
Traction Alopecia Diagnosis
Diagnosing hair loss is done by a biopsy in most cases. But other signs help doctors figure out whether you have traction alopecia or something else.
In the early stages, you might have:
- Thinned-out hair
- An increase in catagen and telogen hairs (hair with the bulb on the end)
- An increase of telogen follicles (hair that is dormant and does not grow)
- An excess of oil (sebaceous) glands
In later stages, you may see very fine, short hairs, a very oily scalp replaced by scarring, and some scalp inflammation.
Traction Alopecia Treatment
Traction alopecia can be treated. Doctors may turn to various approaches to manage and potentially reverse it and help your scalp heal and hair regrow. The first step is often to stop doing any styles that pull on your hair and scalp – at least temporarily. Your doctor may suggest other treatments, including:
- Diet and nutrition
- Hair growth supplements
- Over-the-counter drugs
- Prescription drugs
- Steroid shots
- Low-level laser therapy
- Platelet-rich plasma therapy
- Hair transplantation
How to Prevent Traction Alopecia
Your best bet is to take steps to prevent traction alopecia since there is no FDA-approved treatment. Here are some things you can try:
- Mix it up: Give your hair a break from tight ponytails, buns, tight updos, cornrows, dreadlocks, and weaves. Consider wearing one style for no more than 3 to 4 months and then changing to something looser. Even sleeping in rollers every night can damage your hair follicles. Unfortunately, damaged follicles can’t regrow hair, so treat them with care.
- Loosen up: Tight styles (especially those that pull from your hairline) can cause alopecia. Loosen your buns, ponytails, and other styles. Ask your braider to braid your hair loosely.
- Bring in the pros: If you use a chemical relaxer on your hair, only work with a trained professional. Anyone else (including you) might leave the relaxer on for too long, which can damage your scalp.
- Do regular hair checkups: Look for signs of thinning or broken hairs around your forehead. Pay attention if you notice your hairline receding (growing farther back) or if there are patches of hair missing, especially where it has been pulled tight.
- Throw in the towel: Change your hairdo right away if you have pain, stinging, or crusts on your scalp. If you notice tenting, a place where your scalp sticks up like a tent, also stop using that hairdo.
Men get traction alopecia, too. Tight styles like buns, dreadlocks, cornrows, and even wearing hats a lot can cause it. One study showed that 2% of African American men who wear dreadlocks or cornrows have traction alopecia.
What to Do When Wearing a Weave
Weave hairstyles – which involve adding synthetic (or human) hair to your own – can cause traction alopecia. They can add thickness and length to your hair. But to prevent them from damaging your hair, dermatologists suggest you wear them for short periods of time. Wearing them longer may allow the pulling to increase your risk.
If a weave causes pain or irritation to your scalp, doctors suggest you remove it right away.
Also, sew-in weaves (braiding natural hair into cornrows and sewing extensions in) seem to be less damaging to your hair than weaves that use bonding glue – which can pull on your hair.
Living With Traction Alopecia
People who live with hair loss – from any cause – may feel many emotions – from anger and embarrassment to loneliness and guilt or self-blame if you feel your actions caused it.
To manage life with this disease, find a support group with others living with traction alopecia. You can find groups online or ask your doctor for help. Some people use social media to find support.
Consider working with a counselor or therapist to help you process the emotions that can come from living with a chronic condition. There are therapists who are trained in treating people with conditions that can be embarrassing or hard to manage due to pain or other symptoms.
Not everyone sees hair loss as a negative. Some people lose their hair and fully embrace it. But for many people – especially women – hair is part of what defines beauty and can be difficult to lose.
Takeaways
Traction alopecia is caused when you wear tight hairstyles for long periods of time.
You can often reverse this by giving your scalp a break from tight hairstyles that pull on your scalp or chemicals that may damage your hair follicles.
Once hair follicles are destroyed, they cannot regrow.
Losing all or some of your hair can affect your self-esteem. Talking to others with alopecia or even a therapist may help.
Traction Alopecia FAQs
Can hair grow back from traction alopecia?
Yes! If caught early enough and tight hairstyles adjusted, traction alopecia can be reversed.
When is it too late to fix traction alopecia?
Long-term damage to your scalp from hairstyles that pull may not respond to treatment and may be permanent.
How can traction alopecia be treated at home?
You can do a lot to address traction alopecia by changing how you style your hair. Give your scalp a break from tight hairstyles like braids, weaves, cornrows, and tight ponytails. Even wearing hats or other headpieces, like motorcycle or bicycle helmets, can lead to hair loss. Habits that improve health overall, like a healthy diet and stress management, can help your hair too!
How do I know if my traction alopecia is permanent?
Continuous pulling of your hair can permanently damage your hair follicles, and your hair may not grow back. Your hair goes through several stages with traction alopecia before permanent hair loss. Talk to your doctor or dermatologist about how to protect your hair.
How can I know if hair follicles are dead?
There are several causes of hair loss – from genetics to certain medications. But the signs of dead hair follicles are similar. First, the hair will no longer grow in that area. Also, the scalp may be smoother or shinier. It’s important to see a doctor to find out if your hair loss is permanent or if treatment may help.
Can biotin help with traction alopecia?
Sort of. Biotin is a B vitamin responsible for giving some power to hair, skin, and nails. Studies show it cannot necessarily regrow hair, but it can stop or slow down hair loss and maintain existing growth. Biotin is generally safe for most people to try. Some foods have biotin also, like beef liver, eggs, salmon, pork chops, sweet potatoes, almonds and broccoli.
What is stage 1 traction alopecia?
Early stages of traction alopecia include thinning hair, an increase in hair that sheds with bulbs on the end, and a normal amount of oil glands. Later stages have shorter, broken hair pieces, a dryer scalp, and some inflammation. If traction alopecia is untreated, hair loss can be permanent.
How can I thicken my hair after traction alopecia?
Strengthening your hair involves an inside/out approach. Keep your hair follicles strong by eating a healthy, well-balanced diet and reducing stress. See a dermatologist if you notice any changes to your hair or scalp. Ask them about medications and procedures like biotin or laser therapy to thicken your hair.
Can kids get traction alopecia?
Just as with adults, little ones can get traction alopecia, too. Tight hairstyles like braids, ponytails, cornrows, or buns can cause hair loss around the edges, fronts, sides, and back.
Wearing caps and certain types of bonnets that constantly rub the scalp can lead to some hair loss. This can get better if kids wear looser hairstyles and give their hair a break from things that may rub too often.
What are some alternative styles to tightly styled braids?
You can wear a twisted chignon, two-strand twists, crochet locs, knotless braids, clip-in extensions, and braided ponytails. Contact a hair stylist – including one trained in natural hairstyles – for options.
Can a dermatologist fix traction alopecia?
A dermatologist can help manage and, in some cases, reverse traction alopecia. They focus on relieving tension on the hair follicles, treating inflammation or scarring, and encouraging hair regrowth.
Treatments may include topical or injected steroids to reduce inflammation, antifungals or antibiotics for infections, biotin supplements to support hair health, and minoxidil to stimulate hair regrowth. Hair replacement or transplant surgery may also be recommended in severe cases if needed.
Dermatologists can offer a range of treatments for traction alopecia, so it's important to consult with them for a tailored approach based on individual needs and how severe the condition is.
