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Understanding Traction Alopecia: Causes, Symptoms, and Solutions

Traction alopecia (hair loss)

Understanding Traction Alopecia: Causes, Symptoms, and Solutions

Traction alopecia is a form of hair loss triggered by repeated pulling or tension on hair follicles, often linked to specific hairstyles that exert consistent stress on the scalp. Early recognition and intervention can prevent permanent damage and promote hair regrowth.

Causes of Traction Alopecia

Traction alopecia results from prolonged or repetitive tension on the hair, commonly caused by:

  • Tight Hairstyles: Ponytails, buns, dreadlocks, braids, or cornrows, especially when styled tightly or worn for extended periods.
  • Hair Extensions and Weaves: Excessive weight or overly tight application can strain hair follicles.
  • Tight Headwear: Frequent use of helmets, headbands, or hats that apply consistent pressure.
  • Chemical Treatments: Chemically relaxed or treated hair is more prone to breakage under tension.
  • Sleeping in Rollers: Prolonged tension from rollers or tight curlers during sleep.

Symptoms to Watch For

Early detection is critical. Look for these signs:

  • Scalp discomfort, including pain, itching, or tenderness during or after styling.
  • Redness or small bumps (folliculitis) around hair follicles in areas of tension.
  • Hair breakage or thinning, often along the hairline (frontal, temporal, or preauricular regions) or between braids.
  • The “fringe sign,” where short, fine hairs remain in balding areas, too short to be pulled by tight styles.
  • Hair casts (white or brown cylindrical flakes) around the hair shaft.
  • In advanced cases, smooth, shiny scalp areas may indicate permanent follicle damage and scarring.
Traction alopecia (hair loss)
Traction alopecia (hair loss)

Diagnosis

A dermatologist can diagnose traction alopecia through:

  • Clinical Examination: Assessing the scalp and reviewing hairstyling habits.
  • Trichoscopy: A microscopic scalp examination to evaluate hair follicles.
  • Scalp Biopsy: Rarely needed to confirm the diagnosis or rule out other hair loss causes.

Prevention and Treatment

Traction alopecia is often preventable and reversible if addressed early. Here’s how to protect your hair and promote recovery:

Prevention Tips

  • Choose Looser Hairstyles: Avoid tight ponytails, buns, braids, or cornrows.
  • Vary Your Style: Rotate hairstyles to reduce repetitive tension and give your scalp breaks.
  • Limit Extensions and Weaves: Use lightweight options and remove them periodically to let hair rest.
  • Be Gentle: Minimize heat styling and chemical treatments, which weaken hair.
  • Use Gentle Products: Opt for mild hair products and brush or comb carefully, starting from the ends.
  • Avoid Sleeping in Rollers: Choose loose or no curlers for overnight styling.
  • Opt for Thicker Braids or Locs: Thinner styles increase tension on follicles.
  • Listen to Your Scalp: Pain or discomfort signals potential damage—adjust the style immediately.

Treatment Options

  • Stop the Cause: Cease tight hairstyles to allow hair regrowth in early cases.
  • Hair Transplant Surgery: For permanent follicle damage, transplants may restore hair in severe cases. However, may have to take drugs for a period of time. Whether someone needs to take drugs after a hair transplant depends on the individual case, type of transplant, underlying hair loss condition, and the doctor’s recommendation. Therefore, find out the full details before you pursue any of the methods.
  • Herbal Hair Growth Formula: A natural remedy can support hair health and growth. Try this herbal blend:
    • Rosemary Oil (2 tbsp): Stimulates scalp circulation and promotes hair growth.
    • Castor Oil (2 tbsp): Nourishes follicles and strengthens hair.
    • Lavender Essential Oil (5-10 drops): Soothes the scalp and supports hair health.
    • Chamomile Extract (1 tbsp): Calms scalp irritation and strengthens hair follicles.
    • Carrier Oil (e.g., Coconut or Jojoba, 4 tbsp): Dilutes essential oils for safe application.
    • Instructions: Mix ingredients in a small bottle. Apply a few drops to affected scalp areas, massage gently for 5-10 minutes, and leave on for at least 30 minutes or overnight before rinsing. Use 2-3 times per week. Perform a patch test to check for allergic reactions, and consult a dermatologist before starting.
Traction alopecia (hair loss)
Traction alopecia (hair loss)

Take Action Early

Combining early intervention, gentle hair care, and natural remedies like the herbal formula above maximises the chance of full regrowth and prevents irreversible damage. Prioritise scalp health and adopt gentler styling habits for lasting results.

References

– Skin of Color Society. (n.d.). Traction Alopecia. Retrieved from https://skinofcolorsociety.org/discover-patients-public/patient-education/traction-alopecia
– DermNet NZ. (n.d.). Traction alopecia. Retrieved from https://dermnetnz.org/topics/traction-alopecia
– StatPearls [Internet]. (2025, May 4). Traction Alopecia. National Center for Biotechnology Information (NCBI) Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470434/
– Billero, V., & Miteva, M. (2018). Traction alopecia: the root of the problem. Clinical, Cosmetic and Investigational Dermatology, 11, 149–159. https://doi.org/10.2147/CCID.S137296
– Khumalo, N. P. (2012). The “fringe sign” for public education on traction alopecia. Dermatology Online Journal, 18(9), 16. https://doi.org/10.5070/D31H81C7S1
– Samrao, A., Price, V. H., Zedek, D., & Mirmirani, P. (2011). The “Fringe Sign”–A useful clinical finding in traction alopecia of the marginal hair line. Dermatology Online Journal, 17(11), 1. https://doi.org/10.5070/D325M840MZ
– GPnotebook. (n.d.). Traction alopecia. Retrieved from https://gpnotebook.com/pages/dermatology/traction-alopecia
– Ramírez, L., et al. (2021). Management of Traction Alopecia: Our Experience and a Brief Review of Current Literature Recommendations. Journal of Drugs in Dermatology, 20(5), 578–582. https://jddonline.com/articles/management-of-traction-alopecia-our-experience-and-a-brief-review-of-current-literature-recommendati-S1545961621P0578X/
– Haskin, A., & Aguh, C. (2016). All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). Journal of the American Academy of Dermatology. (Epub ahead of print).
– Khumalo, N. P., et al. (2017). Traction alopecia: A neglected entity in 2017. Indian Journal of Dermatology, Venereology and Leprology, 83(5), 519-526. https://ijdvl.com/traction-alopecia-a-neglected-entity-in-2017/

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