Traction Alopecia: Causes, Symptoms, Prevention & Treatment

Traction Alopecia is a type of hair loss that occurs due to increased tension on the hair follicles from pulling of hair. Hair done into tight ponytails, dreadlocks or braids put a lot of pressure on the hair shaft as well as the hair follicles. As a result of constant force the hair follicles gets damaged and result in hair loss. Hair loss in Traction Alopecia occurs due to physical factors and is totally different from other hair loss such as alopecia aerata, alopecia totalis or Cicatricial alopecia that mainly occur due to biological or immunological factors. Traction Alopecia can affect adults as well as children. Certain races especially the Africans are more prone to developing Traction Alopecia due to tradition of putting hair into tight braids or dreadlocks. Other cultures or professionals such as Sikhs who twist hair to put it neatly under turbans, ballerina dancers who put hair into tight buns or sport players who wear tight caps or pull their hair into tight ponytails also show high prevalence of Traction Alopecia. The prevalence of Traction Alopecia increases with age as the hair follicles starts getting weaker. This article explains the causes, symptoms, and prevention strategies for hair loss due to Traction Alopecia.

What is Traction Alopecia?

Traction Alopecia occurs from repeated pulling of hair that causes inflammation eventually leading to hair loss. The alopecia or hair loss that occurs in Traction Alopecia can be both the scarring (cicatricial) and non-scarring alopecia depending on whether it is early and reversible or late and permanent. If the early stages of non-scarring alopecia are ignored it can result to scarring alopecia where the hair growth is not possible. Hair loss from Traction Alopecia is more commonly seen on the frontal or temporal scalp as this is the area of scalp that receives maximum tension in tight hairstyles. However, other sites of the scalp can also be affected. Although it is not a health concern, hair loss occurring on most visible parts of scalp such as frontal hairline or crown is very embarrassing. This is the reason Traction Alopecia can cause psychological distress.

What are the causes of Traction Alopecia?

Tight hair styles as well as repeated use of hair tools such as rollers or hot combs are considered as main causes of Traction Alopecia. A constant force on the hair and pulling causes loosening of the hair from the follicles and also damages them. Pulling and tension on hair follicles can also cause redness, itchiness and inflammation on the scalp. Eventually prolonged inflammation and repeated hair tension results gradual hair loss and scarring of the hair follicles. A minor force of traction can produce hair loss without significant scarring, as in hair pulling disorder trichotillomania. However, prolonged and recurrent tension and traction can result in scarring of hair follicles and permanent hair loss.

The common causes of Traction Alopecia include,

  • Tight hair styles such as braids, ponytails, buns, or dreadlocks
  • Repeated use of hot combs or rollers for hair styling
  • Excessive use of hair relaxers or chemicals used to straighten hair
  • Repeated use of heavy hair extensions
  • Twisting hair to put it in tight buns
  • Using tight head covers such as turbans or caps that pull hair

Who can get affected by Traction Alopecia?

Traction Alopecia can affect people of all races. However it is more common among young Sikh men with tight knots beneath their turbans, Caucasian ballerina wearing tight buns for years and hispanic women with tight ponytails. In addition, gymnasts, military personnel and certain professionals who need to wear their hair pulled back regularly may develop Traction Alopecia.

The epidemiological studies have noted that prevalence of Traction Alopecia is more common among women and children of African descent. Studies also suggest that the incidence of Traction Alopecia is more common in women and children than the men of African race. Also, the prevalence increases with increasing age as the hair follicles get weaker and more prone to damage by external pulling or force.

Classification of Traction Alopecia

Traction Alopecia can present as acute or chronic condition. Acute Traction Alopecia is caused after a traumatic injury to the scalp such as motor vehicle accident. In acute Traction Alopecia the hair gets pulled suddenly and produces symptoms similar to hair pulling disorder. Chronic Traction Alopecia is most often caused by repeated tension on hair due to tight braiding or ponytails, cornrows, or wearing elastic hair bands. The chronic Traction Alopecia is commonly referred to simply as Traction Alopecia. The traction and hair loss is especially seen at the margin of the tightly styled hair, over time leading to a widening of the central partition lines eventually causing hair loss.

Traction Alopecia that is caused by pulling of hair due to styling can also be classified as reversible and irreversible Traction Alopecia. In reversible alopecia only few hair follicles get affected. The affected hair follicle remains in anagen or the growing phase for a very short time and convert quickly to catagen or telogen phase. In irreversible Traction Alopecia more number of follicles gets affected severely causing scarring of hair follicles and irreversible hair loss.

Signs & symptoms of Traction Alopecia

Hair loss is the most common symptom of Traction Alopecia. However, due to possible damage to the hair follicles and inflammation, Traction Alopecia shows following symptoms.

  • Multiple broken hair
  • Thinning of hair
  • Hair loss especially at the frontal line and crown
  • Itching on the scalp
  • Formation of red bumps
  • Scaling of scalp skin
  • Widening of hair parting

Can Traction Alopecia be reversed?

The early stages of Traction Alopecia can be reversed by changing habits of hair styling and reducing the stress on hair. As the hair follicles are not damaged severely, it is possible to regrow the hair even if there is some hair loss. However, if the condition has progressed to chronic Traction Alopecia the majority of hair follicles get damaged causing permanent alopecia, which cannot be reversed.

Treatment options of Traction Alopecia

Early diagnosis of Traction Alopecia allows for easy recovery and shows a possibility of hair growth. The simplest treatment in early reversible Traction Alopecia is change in hair styling habits. The inflammation, itching and red bumps on the scalp can be treated with topical antibiotics or topical corticosteroids. In later stages where more follicles are damaged more aggressive treatments such as oral antibiotics, injected corticosteroids or topical minoxidil may be necessary. However, in cases of permanent hair loss that occurs due to scarring of hair follicles, hair transplant surgery is the only option.

In case of secondary infection that causes folliculitis of scalp, oral ant staphylococcal antibiotics many be recommended.

The treatment options for Traction Alopecia are summarised as follows

  • Change in hair styling habits
  • Switching to loose hairstyles
  • Anti-inflammatory agents to reduce redness and itching
  • Antibiotics to reduce infection
  • Surgical hair transplant

How to avoid Traction Alopecia

The most important strategy to avoid Traction Alopecia is to follow good hair styling habits. Given below are some preventive measures to avoid Traction Alopecia.

Avoid tight hairstyles: Pulling of hair due to tight hair styles such as braids, buns, dreadlocks, etc. is the main cause of Traction Alopecia. The first change one must undertake to avoid Traction Alopecia is to change the hairstyle. When it is becomes mandatory to follow a certain hair style, e.g. for sports players, army professional, or for religious reasons, one must try to pull hair as less as possible while putting it into a specific hairstyle.

Avoid excessive use of styling products: Hair relaxers or other chemicals used to either perm, straighten or curl the hair must be kept to minimum. The styling gels or sprays that harden on the hair after drying tend to increase hair tension and increase risk of Traction Alopecia.

Keep trying different hairstyling: Following one hair style for a long time also is a reason for Traction Alopecia. For instance, having a partition in the middle or same side for years, or putting hair into only a specific hairstyle. To avoid putting pressure on the specific section of hair, change your hairstyle every few weeks.

Try hair growth products: Once the Traction Alopecia is diagnosed at an early stage, regrowth of hair is possible. Use the hair growth agents such as minoxidil after consultation with trichologist.

Use right wigs: If you are using hair wigs make sure to choose the one that has a base made up of skin friendly material and causes less friction with the scalp.

Use hair accessories only if needed: Hair extensions that pull your natural hair or wearing accessories like clips or pins at the same hair area can also be reason for increasing hair tension. Make sure to wear hair accessories only when necessary and try to put it in different styles. Also avoid using plastic or elastic bands while tying hair. Try to use ribbon or cotton bands to avoid friction and pulling of hair.

Be careful with use of hot irons: Hot irons, curlers or rollers used too often can be harmful to hair. Expose your hair to hot air through dryers, or hot tools such as iron only for a short time when needed.

Use satin or silk pillow covers: Pillow covers made of smooth materials like satin or silk cause minimum friction and do not pull hair.

Traction Alopecia recovery time

It is possible to recover from Traction Alopecia and have hair regrowth if the alopecia is reversible. The early Traction Alopecia is reversible if hair follicles are affected and the damage is not severe. The hair loss is similar to non-scarring alopecia as seen in hair pulling disorder. With changes in hair styling habits, giving up tight hair styles, and taking hair growth promoting agent such as minoxidil, hair loss in Traction Alopecia can be recovered in 6 to 9 months.

How to reverse Traction Alopecia

Traction Alopecia can be reversed by following given tips

  • Change hairstyle often
  • Wear hair in loose hairstyles such as loose ponytail, loose braids, soft curls, etc.
  • Avoiding use of relaxants and other chemicals on hair
  • Use anti-inflammatory topical agents on scalp

How do I know if I have Traction Alopecia?

To know if you have Traction Alopecia you need to examine your hair and scalp properly. Look for any signs and symptoms of Traction Alopecia as given below.

  • Patches of hair thinning or hair loss
  • Stinging sensation in scalp
  • Red bumps or pimples near hair roots
  • Itching or redness on scalp
  • Loss of frontal hair line
  • Widening of hair partition
  • Broken hair or baby hair bits


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