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Traction Alopecia: When Is It Too Late?
Dr Meena Zareie (GMC)
Medically reviewed by
Dr Meena Zareie (GMC)
Updated on January 19, 2024

A common concern with traction alopecia is that it may be too late to fix any damage. This concern stems from the fact that traction alopecia is a type of scarring alopecia. However, traction alopecia can be reversed.

This article will cover:

  • When it is too late to fix traction alopecia
  • What causes traction alopecia
  • The early signs of traction alopecia
  • How you can reverse damage caused by traction alopecia
Table of Contents

When is it too late to fix traction alopecia?

There is no time frame that determines when treatment for traction alopecia is not possible. Treatment is available for whatever stage you are at, and it is never too late to fix traction alopecia. However, it is preferable that traction alopecia is caught early on, as this will give a better chance of reversing any damage and regrowing healthy hair.

The stages of traction alopecia

There are three stages of traction alopecia that determine the progression of the condition. These include the following:

  1. The stage of prevention
  2. The stage of early traction alopecia
  3. The stage of longstanding traction alopecia [1].

Stage of prevention

The stage of prevention does not yet see any damage done to the hair, which is why education on avoiding traction alopecia is essential at this point.

Early traction alopecia stage

The early stage of traction alopecia can be recognised as patches of non-scarring hair loss, broken hairs, and pustules or folliculitis around the areas where the hairs are experiencing the most pressure or tension.

The early stage of traction alopecia
The early stage of traction alopecia

Longstanding traction alopecia stage

The later stage of traction alopecia, known as longstanding traction alopecia, presents irreversible scarring in the areas where hair has fallen out. Individuals at this stage may also experience tenderness to the scalp and headaches.
Marginal scarring in long standing traction alopecia
Marginal scarring in long-standing traction alopecia
Scarring around the temples due to traction alopecia
Scarring around the temples due to traction alopecia

Managing the stages of traction alopecia

Each stage has different methods of treatment, from early education to prevention, to a hair transplant.

The stage of prevention is a key stage for understanding why traction alopecia can happen and how to prevent it. This is an incredibly important stage due to the ability to prevent the condition from occurring.

Studies suggest that educating younger individuals about how to avoid traction alopecia is essential in preventing the condition [2].

The early stage of traction alopecia is focused on reducing hair tension. This could be through avoidance, or loosening, of tight hairstyles (ex. tight ponytails or braids). At this stage, it may be suggested that heat on the hair, brushing, and chemicals are also avoided. If dyeing your hair is part of your routine, you may want to consider using hair dye without chemicals.

You may also be prescribed corticosteroids for any inflammation that has occurred due to the condition. Read more about steroids and hair loss. This stage is essential in nurturing natural hair regrowth and reversing any damage, so it is important to follow medical advice.

For longstanding traction alopecia, the only effective treatment is surgical. A hair transplant is a good option for hair restoration at this stage, as the hair follicles have likely suffered irreversible damage leading to permanent hair loss and therefore cannot be naturally restored.

What causes traction alopecia?

Traction alopecia is a type of scarring alopecia. The cause of traction alopecia is due to consistent tension on the hair follicles, usually the result of tight or restrictive hairstyles. For example, tight ponytails can cause hair loss as well as styles such as cornrows, braids, and the use of hair extensions which can pull on the hair [2].

Though traction alopecia is a type of scarring alopecia, it is able to be reversed if caught and treated in time [3].

Traction alopecia is seen across all races, though some studies suggest it is more common in women of African descent [4].

Though the use of chemicals, such as hair dye, can contribute to traction alopecia, studies suggest that hairstyles such as tight braids are more likely to cause the condition [5, 6].

What are the early signs of traction alopecia?

There are a few early signs to watch out for that indicate the presence of traction alopecia. If you notice any of these signs, you may want to consult a clinic about reversing and managing early hair loss.

  • A common sign is patches of non-scarring hair loss and thinning hair. Thin or broken hair will appear in and around the area of tension [7].
  • Redness of the scalp.
  • Itching or stinging sensations on the scalp.
  • Pus-filled blisters on the scalp (usually called pustules) which can occur due to an infection and inflammation of the hair follicle.

How can you reverse damage caused by traction alopecia?

For earlier stages, there are a few ways to lessen the effects of traction alopecia, for example, without medical intervention. Treatment for later stages, more advanced stages, the most appropriate treatment will be medical.

Making changes to your hair styling practices

In the early stages of traction alopecia, your hair may benefit from simply lessening tight hairstyles, as well as avoiding heat and chemical use.

This could mean reducing the amount of time you wear a hairstyle or the tightness of the hairstyle, minimising the temperature of any hair devices, or abandoning chemical use. 

Doing this will take the pressure or tension off the scalp and allow the follicles to rest.

Medication to help regrow healthy hair

Some people are prescribed medication to deal with traction alopecia, for example, topical or oral Minoxidil. Medication such as antibiotics and corticosteroids can also be prescribed to combat inflammation or infection.

One study was conducted on a 31-year-old female who had experienced early traction alopecia for several years [8]. The patient had been treated with 5% topical Minoxidil before the examination, but there had been no improvement.

The patient was prescribed 1.25 mg of oral Minoxidil daily along with 0.05% topical , which is a strong topical steroid that treats skin inflammation and irritation, 2-3 times weekly for the first 2 months.

After 6 months of treatment, there was notable hair growth in the area, so the patient’s dose of Minoxidil was increased to 1.25 mg twice daily. After 11 months of treatment, there was continued and significant hair regrowth.

Traction alopecia before and after treatment
Traction alopecia before and after treatment

Surgical treatment

At later stages of traction alopecia, surgical procedures are the most viable option.

A hair transplant is permanent when it comes to hair restoration techniques and is therefore a good option for those experiencing long-standing hair loss due to traction alopecia. The FUT method of hair transplantation has been found to be effective for traction alopecia [1].

Get help with traction alopecia

If you’re experiencing traction alopecia, you should consult a reputable clinician. Women’s hair loss is particularly difficult to diagnose, so it’s important to speak to a professional trichologist to get the right hair loss treatment for women.

Depending on the stage of hair loss, a good clinician can advise on the best course of action. We offer non-surgical treatments like laser hair loss therapy, as well as surgical options such as FUT/Strip hair transplants and one of the few specialists in afro hair transplants.

Our team is also on-hand to diagnose underlying conditions or answer any questions and concerns you may have.

Book your consultation today.

Traction Alopecia: When Is It Too Late?, Wimpole Clinic

Dr Meena Zareie (GMC)
Medically reviewed by Dr Meena Zareie (GMC)Updated on January 19, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
Talk to a specialist ☎ 020 7935 1861.

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