Traction Alopecia: Causes, Stages & Treatment Options

Alopecia is a term used often to describe hair loss, affecting millions of men and women worldwide. Traction alopecia (TA) is a common form of alopecia that can affect both men and women. This type of hair loss is characterised by balding caused by repeatedly pulling on your hair, usually as a result of wearing tight hairstyles.

In this article, we’ll be discussing what traction alopecia is, how you can spot the earliest symptoms, and what the most appropriate treatment options are.

What is traction alopecia?

Traction alopecia is a type of hair loss that is caused by tension when hair is repeatedly pulled on. The condition was first identified in the early 1900s, typically with women who frequently wore their hair in tight ponytails which led to hair loss. Women who wore their hair in styles that caused a lot of tension would often experience hair loss, particularly around their hairline. More recently, men wearing on-trend man buns and top knots can lose hair to TA.

Traction alopecia can be caused by a range of hairstyles, but it’s normally tightly slicked-back or braided hairstyles which cause the most tension and create a continuous pulling force [1].

Unlike other forms of hair loss, which can be caused by age, genetics, or hormones, TA can be relatively easy to treat. If you catch it early enough, you may find all you need to do is stop wearing your hair in these hairstyles.

Who can get traction alopecia?

Traction alopecia is caused by the damage inflicted on your hair follicles that prevents them from being able to grow. The people who are at most risk of developing TA are those who:

• Regularly wear their hair in tight styles like buns and ponytails
• Style their hair in braids, dreadlocks, cornrows, or other protective styles
• Use hairpieces (including wigs and extensions) that pull on the hair
• Have very long, thick hair that can put pressure on the scalp when worn down
• Use harsh chemicals when styling their hair

Like central centrifugal cicatricial alopecia, a type of scarring alopecia, traction alopecia mainly affects women of African descent. One study suggests it affects up to a third [2]. But it can also happen to anyone, regardless of their ethnicity. It’s also more likely to affect people as they get older, as traction alopecia normally occurs after an extended period of time where hair is constantly pulled.

Symptoms of traction alopecia

The most obvious sign that you’re experiencing traction alopecia is that you’ll notice your hair starting to fall out beyond the usual 50-100 hairs that the average person loses every day [3].

Normally, those who experience TA will see hair loss beginning around the front and sides of their scalp. These are the areas that are under the most pressure from tight hairstyles and increased tension.

Unlike other types of alopecia, hair loss caused as a result of traction alopecia often appears symmetrical. The hair loss occurs in a typical pattern, rather than affecting random areas across your head. When TA affects the temples and forehead, it’s known as marginal traction alopecia. Patchy traction alopecia refers to hair loss in other areas across the scalp.

For example, if you are a gymnast that wears their hair slicked back every day for training, you will probably start to experience symmetrical hair loss around the hair line where your hair is pulled back into a ponytail or bun. You may also see hair thinning on one side of the head if your hair style pulls on one side more than the other.

Alongside the hair loss, you may also start to notice small skin-coloured or white bumps around the hair follicles in areas where hair loss is present. These marks are an indicator of the stress you’re putting your scalp under. You may also see red skin, scaling, itching, cylindrical hair casts, and folliculitis in addition to hair loss.

Broken hairs and black dots on the scalp associated with traction alopecia

Traction folliculitis

As soon as you spot the earliest symptoms of TA, it’s important to do what you can to prevent it getting any worse. In some cases of this condition, the hair follicles can become so damaged that they are unable to produce new hair, causing sustained, noticeable balding in certain areas of the scalp.

Traction alopecia patient photos

Early stages of TA

Patient with marginal traction alopecia

Patient with patchy TA

Frontal balding — frontal traction alopecia

What are the different stages?

Traction alopecia often occurs in stages. The earlier you recognise the symptoms, the more likely you are to prevent long lasting side effects.

Early stage TA will normally present itself as thinning hair, with patches of non-scarring hair loss. You may also see broken hairs and pustules in the areas where the scalp is experiencing the most tension.

At this point, you should undo or loosen the styles you wear. If you don’t address the early signs of traction alopecia, the condition may start to progress into it’s later stages, which can then be harder to treat.

These later stages of traction alopecia normally progresses into irreversible scarring around the areas where hair has fallen out or come under stress. Some patients who have late stage TA may also experience itching, tenderness and headaches [2].

How to prevent traction alopecia

If you’re worried about developing traction alopecia, there are plenty of things that you can do to prevent it.

Because the condition is caused by the way you style your hair, all you need to do is change your hair styling routine to reduce the stress and tension on your scalp. To prevent TA, consider the following changes:

• Use the lowest setting possible when using heated tools to style your hair
• If you’re wearing wigs, use a satin wig cap that won’t pull on your hair
• Don’t sleep in rollers
• Avoid using chemical processed products in your hair like relaxers
• Don’t use rubber bands when tying your hair up in a bun or ponytail
• Only wear weaves or extensions for a short period of time and take breaks inbetween
• If you’re wearing your hair in braids or dreadlocks, wear thicker braids that don’t pull as much on your hair
• Don’t wear the same hairstyle for long periods of time. Try to switch things up to limit the amount of stress placed on your hair follicles and scalp.

Can you treat traction alopecia?

Although there are easy ways to prevent traction alopecia, or reverse some of the effects if you aren’t experiencing the later stages of the condition, there are also different treatment options that you can choose.

Traction alopecia can cause skin issues. If you experience scaling or flaking on your scalp, it’s best to start by speaking to your dermatologist.

To address your hair loss, speak to a trichologist. They can examine your scalp to diagnose the TA and discover the extent to which your hair has been affected. They may also take a sample of tissue to see if there are any underlying causes of hair loss.

In most cases, the best way to treat TA is simply by switching up your hairstyle. If you start wearing your hair down more, you may notice that the signs of TA disappear.

If you find that your scalp gets sore or hurts in certain hairstyles, it’s an easy sign that the hairstyle is far too tight and may eventually lead to TA. Remove your braids, use hair elastics that are more gentle on your hair, minimise the use of heat, or even just cut your hair if you’re worried about the symptoms of TA.

If your symptoms are severe, your GP may be able to prescribe you antibiotics, topical steroids, or antifungal shampoo. These treatments are prescribed when there is evidence of infection or inflammation alongside traction alopecia.

It can take several months to a year to see healthy hair regrowth after your traction alopecia treatment. Be patient, and treat your hair kindly — don’t resort to old habits because you’re not seeing immediate changes.

Other ways to treat hair loss

Hair loss affects a lot of people. But it can be a real knock to your confidence if you start to notice thinning or bald patches.
If you’ve lost some of your hair because of traction alopecia and it’s not growing back, there are other hair loss treatments that you can look into.

Minoxidil is a popular hair loss treatment that can be used by both men and women to stimulate hair growth. It’s a topical solution that is applied twice daily, and has some promising studies that prove its efficacy. It may even help in cases of advanced traction alopecia [2].

In more extreme cases, where you have larger bald patches, or your hairline has receded significantly due to traction alopecia, you may also think about whether a hair transplant is right for you. Afro hair transplants are popular with those of African descent who have traction alopecia.

To find out more about hair transplants and how it can help you with hair loss, book a no-obligation consultation meeting with one of our experts at Wimpole Clinic today.

Sources:

1. Traction Alopecia
2. Traction alopecia: the root of the problem
3. Do you have hair loss or hair shedding?