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Traction Alopecia– Causes, Treatments And Prevention

traction alopecia

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Hair loss can be really distressing especially when you know that your hairstyle is largely responsible for that. If you have suffered from unusual hair loss due to excessive pulling of the hair, then you are not alone. This form of acquired hair loss condition is medically termed as Traction Alopecia. It was first described in 1907 in some subjects from Greenland who developed hair loss due to tight ponytails.

What Is Traction Alopecia?

Traction Alopecia is a form of hair loss that occurs due to increased tension in the hair follicle resulting from unusual pulling of hair. Traction Alopecia is usually contributed due to distinctive hairstyles such as wearing tight ponytails, buns, tight braids, dreadlocks. The prolonged wearing of such hairstyles put a lot of pressure on the hair shaft and hair follicle resulting in gradual hair loss.

Traction alopecia can affect adults as well as children. People with long hair have also shown the prevalence of traction alopecia due to the repetitive tension caused by the weight of hair. The chances of traction alopecia increase with age as hair follicles start getting weaker and more prone to hair loss.

What Are The Histological Findings In Traction Alopecia?

The historical findings were compiled by taking the skin biopsy from an area of a patient with traction alopecia and useful findings were made on the basis of the stage of progression –

Early Stages Of Traction Alopecia Showed The Presence Of
o Trichomalacia or thinned out hair
o Preserved sebaceous glands
o Normal number of telogen follicle
o Increased number of catagen and telogen hairs

Later Stages Of Traction Alopecia Showed The Presence Of
o Fine and short hair or vellus hair development
o Reduction in sebaceous glands and terminal hairs which were replaced by fibrotic fibrous tracts or scars
o Mild to absent inflammation

Also Read: What Are The Early Signs And Symptoms Of Hair Loss?

What Are The Classifications Of Traction Alopecia?

Traction alopecia can be classified on the basis of the severity of the condition and extent of hair loss. There are two different ways to classify traction alopecia –

Acute Traction Alopecia

Acute Traction Alopecia occurs when the hair gets pulled out suddenly after a traumatic injury such as in case of a motor vehicle accident. It produces similar symptoms to hair pulling disorder or traction alopecia.

Chronic Traction Alopecia

Chronic Traction Alopecia is caused due to repetitive tension on hair follicles due to certain hairstyles such as tight braiding, cornrows, tight ponytails or wearing elastic hair ties. Chronic Traction Alopecia is synonymous with common traction alopecia. It can be further classified as Reversible and Irreversible traction alopecia on the basis of damage caused by hair styling.

Reversible Traction Alopecia occurs when only few hair follicles get affected and they quickly rebound into the catagen or telogen phase after some time. Irreversible traction alopecia occurs when even more number of hair follicles get affected causing irreversible hair loss and scarring of hair follicles.

baldness hair loss calculator

What Are The Signs And Symptoms Of Traction Alopecia?

Apart from unusual hair loss, traction alopecia shows many other symptoms to help us understand the causes of hair loss better. The following symptoms that appear due to possible damage of hair follicles and inflammation are –

• Thinning of hair
• Multiple broken hair
• Itching on the scalp
Bald patches
• Inflammation or redness of the scalp
• Formation of red bumps or scaling on the scalp
• Hair loss especially at the front or crown area
• Widening of hair partition
• Discomfort on the scalp from sweating
• Constant headaches
• Appearance of blisters or folliculitis or pustules

What Are The Causes Of Traction Alopecia?

Traction alopecia is caused due to the repetitive tension or pressure on the hair follicles that result in loss of hair. Here are the most common causes of traction alopecia –

• Tight hairstyles such as braids, ponytails, cornrows, dreadlocks, weaves, man buns etc. which exert a force on the hair follicle and pull them out.
• Twisting hair manually or in certain hairstyles such as twist buns for a prolonged time period
• Excessive use of hair styling creams or chemical treatments such as permanent hair straightening
• Frequent use of hair styling tools such as rollers overnight
• The habit of pulling out hair while stressed
• Tight helmets, wearing headgears or caps that may cause traction
• Wearing tight elastic hair ties or hair clips that apply pressure on the scalp
• Use of hot combs for styling
• Frequent use of hair extensions.

Also Read: What Are The Causes Of Hair Loss In Men & Women?

Who Can Get Affected By Traction Alopecia?

Traction alopecia can affect men and women of all races. Certain races especially Africans are more prone to getting traction alopecia. The epidemiological studies have shown that traction alopecia is more prevalent in the people of African descent because of their traditions of putting hair in dreadlocks or braids.

Other cultures that experience traction alopecia in India include Sikh men and women who wear their hair in tight knots underneath the turban. In addition, gymnasts, military personnel, Caucasian ballerina wearing a tight bun for years are more prone to developing traction alopecia.

Is Traction Alopecia Permanent?

Traction alopecia is temporary but may lead to permanent hair loss if it is undetected or not treated properly. The early stages of traction alopecia can be reversed by reducing the stress on hair. It can be done by changing habits of hair styling. But if the condition has progressed to chronic traction alopecia leading to permanent damage of hair follicles, then it cannot be reversed.

What Are The Treatments For Traction Alopecia?

It is best to visit your nearest dermatologist as soon as you start experiencing unusual hair loss to get a timely and dedicated treatment. The dermatologist can assess your condition and then advise you with the right treatment option. The early diagnosis is helpful in treating traction alopecia completely unless the chronic damage to the hair follicles has happened. In the case of permanent hair loss, advanced treatment options such as hair transplant are recommended that show promising results.

Most popular treatment options for traction alopecia are –

Antibiotics – Antibiotics are prescribed by the dermatologist to prevent infection caused by mild to moderate level of traction alopecia.

Medication – Medications in the form of pills, tablets, medicated shampoos and creams are prescribed by the dermatologist to treat the early signs of traction alopecia. Finasteride and Spironolactone are two popular medicines to reduce hair loss. Apart from that, medicated shampoos can help reduce scalp infection and inflammation.

Steroids – The dermatologist may suggest intralesional or topical steroid treatment depending upon the nature of hair loss. Steroids are injected directly into the scalp to strengthen hair follicles. They are also helpful in healing any inflammation or redness of the scalp. Some steroids can immediately boost hair growth.

Biotin supplementsBiotin supplements are prescribed to treat traction alopecia that resulted in hair folliculitis. Besides that, the dermatologist can also prescribe oral antibiotics to be taken along with the supplements and heal the damaged follicles faster.

Topical treatments – Minoxidil is the only topical alopecia cure approved by the US FDA and prescribed by the dermatologists to treat hair loss caused by traction alopecia. It comes in foam or solution form and is easily available in the market. Some 2 to 5% concentration of Minoxidil solution is considered safe to be applied directly to the scalp although it should be prescribed by the dermatologist upon a thorough examination. Minoxidil should be applied only on the places where hair growth is scarce or else it can cause hair growth in unwanted areas such as the forehead or sides of the cheeks. It is available in the market under the brand name Rogaine.

PRP TherapyPlatelet Rich Plasma therapy is an advanced technique that uses the patient’s own blood platelets for hair regrowth. The blood plasma extracted from the patient is activated and injected into the patient’s scalp to stimulate dormant hair follicles. The activated plasma is rich in growth factors that help in growing new hair naturally by activating the dormant hair follicles. PRP therapy shows a high rate of success and faster improvements.

Also Read: PRP Vs Other Treatments For Hair Fall – Which Is Better?

Laser therapy – Laser therapy uses laser light energy to stimulate hair follicles for new hair growth. It has shown promising results making in no downtime making it a preferred option for treating hair loss. The light beam of certain defined frequency is targeted on the affected area of the scalp and improve blood supply and circulation for new hair growth.

Hair Transplantation – If the damage to the hair follicle is permanent and irreversible, then hair transplant is the only viable option. It is an invasive procedure done under stringent conditions by an experienced dermatologist and works best against signs of permanent traction alopecia or when it is too late. The grafting of hair follicles is done in areas where hair thinning or bald patches are prevalent. Also, it is helpful for people having visible scarring due to traction alopecia.

The treatment is completely safe as healthy hair follicles are taken from the donor and harvested using strip harvesting or punch harvesting methods. It is then grafted carefully to the bald patches on the scalp to trigger new hair growth.

How To Prevent Traction Alopecia?

If you have started seeing the early traction alopecia signs or symptoms, it is important to start following good hair styling habits that can prevent further damage to the hair follicles. Some common practices to prevent traction alopecia are –

• Change your hair styling habits and wear low to moderate risk hairstyles such as loose ponytails, loose braids, wigs with satin or cotton wig caps etc. Leave your hair down instead of high and avoid making a tight or twisted bun.

• Try to change your hairstyle frequently, for instance, keep changing the location of the bun or ponytail.

• Avoid using heat rollers or other such accessories that can put pressure on the hair follicle

• Wear loose braids especially around the hairline

• Never sleep in rollers especially never wear them overnight if needed wrap or curl your hair

• Do not use tight elastic rubber ties or rubber bands

• Avoid using hair extensions that can take a toll on the hair root. If needed, get them from an experienced beautician while taking care of your natural hair

• Do not comb your hair when they are wet

• Use a satin or silk pillowcase instead of a cotton one

• Avoid using heat-based hair appliances such as hair straightener, blow dryers, curling iron etc. at high temperatures. Use them in moderation if needed.

• Use right wigs by ensuring that it is made up of skin-friendly material such as satin or cotton to minimize friction on the scalp.


Can Traction Alopecia Be Reversed?

Yes, traction alopecia can be reversed. In case of early stages of traction alopecia, one can reverse it by changing hair styling techniques. Also, one can consult the dermatologist who generally prescribes the first line of treatment that includes biotin supplements, oral antibiotics or topical creams and gels to reverse hair loss caused by traction alopecia.

How Long Does It Take Traction Alopecia To Grow Back?

Traction alopecia gets reversed within 6 months if proper treatment procedure is followed. In most cases, it takes 4 to 6 months whereas in severe cases, it may take up to 1 year to completely heal the damaged hair follicles and regrow hair.

How Do I Know If I Have Traction Alopecia?

If you being to experience unusual hair loss every day which is more than normal due to suspected hair styling then it is a sure sign of traction alopecia. Also, if you notice hair loss in evident amounts coupled with inflammation of the scalp, blisters, redness of scalp, itching or physical tension then it may also indicate traction alopecia.

What Are The Clinical Features Of Traction Alopecia?

The clinical features of traction alopecia include – itchiness or redness of the scalp, inflammation, blistering, folliculitis, infection of the scalp, soreness, bumps on the scalp, scaling, headache etc.

Does PRP Treatment Work For Traction Alopecia?

PRP is one of the best treatments that work for traction alopecia without any side effects. It can help you reverse hair loss effectively without causing any evident damage to the body or the scalp. The procedure is completely safe and non-invasive making it the safest and the most advanced procedure for treating hair loss due to traction alopecia. Also, the treatment is affordable as it will help you recover from this condition in a long run.

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About The Author

Minu Manisha Babel

Minu Manisha Babel

An MBA by chance, a trainer by passion, a psychologist by interest and a voracious reader by parentage. I enjoy traveling, public speaking, exploring and writing on topics relevant to our health and well-being.

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