Alopecia is a general term for hair loss. Traction Alopecia is one of the most common types of hair loss caused by constant pulling “traction”. The pulling is usually on some hairs more than others leading to the development of bald patches. Often, this type of alopecia is due to the hairs being pulled repeatedly by tight hairstyles. Traction alopecia is a different condition to the one when people have the desire to actively pull their own hair known as Trichotillomania.
Traction alopecia can get better when it has only been present for a few weeks or months if the tension applied to the hair is stopped. However, if there is long-term and repetitive pulling on the hair it can lead to permanent hair loss due to damage to the hair follicles, which produce hair.
What causes traction alopecia?
The commonest cause of traction alopecia is tight hairstyles. The pattern of the hair loss will depend on the type of hairstyle and where the tension is highest. Usually it is the longer hairs at the edge of the scalp that are pulled the most.
As only longer hairs are tied up, smaller finer hairs escape being pulled and can be still be seen in the balding patches. Hairstyles often associated with traction alopecia are tight ponytails, causing hair loss at the front and side margins of the scalp, tight buns causing hair loss at the sides and back of the scalp, as well as attachment of weaves or hair extensions. Braids such as cornrows and dreadlocks are also common causes of traction alopecia with hair loss being seen between the braids.
The risk of traction alopecia is further increased if these hairstyles are combined with various chemicals used on the hair such as chemical relaxers to straighten hair. Hair clips and tight head scarves have also been associated with traction alopecia. Excessively long hair may contribute to traction alopecia due to the weight of the hair.
Is traction alopecia hereditary?
It is uncertain whether there is a true genetic predisposition to traction alopecia. It is mainly due to hair-styling practices. It can affect people from all ethnic backgrounds. Traction alopecia has been seen in some people with cultural, religious and occupational hairstyles.
Traction alopecia is often seen in women and children who regularly use braids or chemicals to make it easier to manage tightly curled hair. It is possible that tightly curled hair may be more susceptible to breakage and traction alopecia. Traction alopecia of the scalp and beard area has also been noted in some Sikh men.
Hair styles that cause Traction Alopecia:
- Tight ponytails
- Tight Wigs
- Hair Extensions
To stop Traction Alopecia from spreading, avoid the hairstyles that caused it. Once you stop putting pressure on your hair, the hair loss will stop but that doesn’t mean that your hair will automatically grow back. It is likely that you will require treatment to restore hair growth.
What are the symptoms?
Some people may experience itching, soreness or increased flaking of the scalp.
What does traction alopecia look like?
Traction alopecia can occur anywhere on the scalp where there are mechanical forces pulling the hair. Often hair loss is seen at the front, sides or back of the scalp. Smaller hairs within the patch are often unaffected and a rim of slightly longer hairs called the “fringe sign” may be also be seen at the edge of the patch furthest away from the traction.
Within the patches of hair-loss the skin usually looks normal. However, if tight hairstyles are still being used then sometimes redness, spots and white skin flakes attached to the hairs called “hair casts” may be seen at the margins of the bald patches closest to the tension. In longstanding traction alopecia the scalp may appear smooth and shiny, where the hairs have been permanently destroyed.
How is traction alopecia diagnosed?
The diagnosis is usually based on the history and pattern of the hair loss. If the diagnosis is un-clear then a scalp biopsy may be required.
Signs of Permanent Traction Alopecia.
Signs of traction alopecia typically start with excessive hair shedding, soreness or tightness on the scalp – particularly after letting hair down from being tied up or braided. As the condition persists, signs will become more severe such as itchiness and tightness, swelling at the hair follicle, follicular pustules, broken hairs and balding patches.
The hair loss often appears at the hairline and temple region from the excessive pulling and tension. Scarring can also be present and the cessation of hair growth. If you are experiencing these more extreme signs, it is important to see a doctor or hair loss specialist to seek treatment and avoid permanent hair loss. The doctor may do a biopsy to examine medical or topical procedures that may help. If scarring has in fact occurred, there is no topical cream that will generate new hair growth as the follicle has been permanently damaged.
Can it be cured?
Yes, depending on the stage of hair loss, Hair loss treatments are available. If the problem is identified early, then the hair can completely regrow if the tight hairstyles are stopped. However, longstanding traction alopecia can cause permanent destruction of the hair follicle; in this situation the hair loss is permanent.
How can traction alopecia be treated?
Traction alopecia can be treated. Although, how well the hair grows will depend on whether there is any permanent damage to the hair follicle roots.
Stop tight hairstyles: This is the most important step to take to prevent hair loss from worsening or becoming permanent whilst giving the best chance for the hair to recover. Hair regrowth may start around 3 months after discontinuing these hair practices, and once the hair cycle is restored.
Topical Minoxidil solution or foam: Applying 2% or 5% minoxidil solution/foam to the affected areas on the scalp twice daily may stimulate hair growth. Continue treatment until you are happy with the growth and, as long as the traction has been stopped, the minoxidil can be discontinued. Minoxidil is not available on prescription but can be bought over the counter or online. It is expensive and not always effective. Care needs to be taken to apply only to the affected areas. It can sometimes irritate the skin and accidental application to the face may increase facial hair in some women whilst being used.
PRP therapy is a new and innovative hair loss treatment that requires no surgery but can help stimulate hair growth. It requires taking a small blood sample, less than what you’d normally give when donating blood. This blood sample is harvested using the latest, most advanced technology and then injected back into your scalp where hair is thinning. A few short treatment sessions are required but PRP may prevent the need for a hair transplant and there is no aftercare needed for this procedure. PRP treatments tend to be an hour long and patients can go about normal activities immediately after.
How to avoid Traction Alopecia
Don’t wear overly tight hairstyles
Ponytails, braids and cornrows are all common causes of Traction Alopecia. These types of hairstyles apply constant tension to hair which can result in damage over time. By changing your hairstyle to one which is a little more follicle-friendly, or even just being mindful of how tightly you style your hair, you can take a significant step towards preventing hair loss caused by Traction Alopecia.
Don’t use hair extensions
Pulling and tension on the hair can also be caused by excess weight being carried by the hair. Hair extensions add a significant amount of weight to your own hair, which in effect constantly pulls on it, damaging the hair strands and even the follicle. The glue used to bind some hair extensions to natural hair can also result in damage.
Avoid frequently colouring your hair
Regular use of hair colouring treatments can prove damaging for hair. The chemicals and bleaches used in hair dyes drain moisture out of the hair, leaving it dry, brittle and prone to breakage.
Change your styling methods
Heated styling methods such as hair straighteners and curlers can significantly contribute towards Traction Alopecia. The extreme heat that hair is subjected to during such styling methods has a damaging effect, particularly when used frequently.
Go natural, at least sometimes
The best thing you can do to prevent Traction Alopecia from occurring is to wear your hair naturally. If this is not possible or desirable all the time, then you may benefit from at least leaving your hair to its natural devices from time to time. This will give your hair a chance to recover and repair itself