Traction Alopecia: 3 Signs Your Hairstyle May Be Too Tight
Key takeaways:
Traction alopecia is hair loss from excess stress on the hair. This is common in Black women who wear hairstyles like braids, weaves, and ponytails.
Avoiding relaxers and hairstyles that pull the hair tightly can prevent this type of hair loss.
Multiple treatments are available for traction alopecia. If it goes untreated, traction alopecia can lead to permanent hair loss.
Have you ever been wearing a nice, sleek ponytail and then felt itching on the edges of your scalp? Or maybe there was a time when you had braids and you noticed some bumps at the back of your neck. At some point, you may have even suspected that there was some thinning of the edges of your hair near your temples. These may have been signs of traction alopecia.
What causes traction alopecia?
Traction alopecia is hair loss caused by hairstyles that pull on or put tension on the hair. This usually occurs when someone wears a hairstyle for prolonged periods of time or wears it repeatedly.
When the hair is pulled too tightly, the hair root, or follicle, becomes damaged and inflamed. The hair shaft may pull out completely or the inflammation may cause pus-filled bumps to form at the root. And the hairs at the point of tension will become finer and thin out.
If the damage happens repeatedly and nothing is done to stop the process, this may result in scarring and permanent hair loss.
Are Black women more at risk for traction alopecia?
Traction alopecia can be seen in people of any race or ethnicity. It can also be seen in people of any gender. The common thread is the use of hairstyles, like ponytails or tight buns, that are linked to this type of hair loss.
That being said, traction alopecia is often seen in Black women. Some studies show that this type of hair loss affects about one-third of Black women. This is likely because of the use of hairstyles like cornrows and hair extensions. But there is also some evidence that using hair relaxers may increase a person’s risk.
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What are signs of traction alopecia to look for?
Within hours of wearing a hairstyle that pulls on your hair, you may start to develop some of the warning signs of traction alopecia. Below are three signs your hairstyle is too tight.
1. Redness
Redness of your scalp or around your edges is often one of the first signs that your hairstyle is too tight. This can be a sign that your hair follicles are irritated because of the increased scalp tension.
You may also notice some swelling of the scalp along with the redness.
2. Pain or burning of your scalp
Your hairstyles shouldn’t hurt; pain or soreness can be a marker of inflammation. If your hairstyles are painful, this could be a sign that they’re pulled too tightly. Over time, this may lead to damage and permanent hair loss.
3. Bumps or crusting
Bumps along the point of tension on the hair can be a sign that your hair is at risk of coming out. This may even progress to the point of sores or crusting on the scalp. And that can lead to hair casts (thin white bands on the hair shaft) or pus-filled blisters.
You should immediately change your hairstyle if you see any of these changes to your scalp.
If you continue to wear hairstyles that pull on the hair, eventually, the hair will thin. And you can have permanent hair loss. This usually occurs at the front of the hairline and around the edges.
What is the treatment for traction alopecia?
Luckily, there are treatments available for traction alopecia. But the key is getting treatment as early as possible.
Depending on the extent of the damage, there are a few different approaches to treatment:
Prevention: You can prevent further damage to the hair by avoiding tight hairstyles. When you feel tension on your hair, loosen your hairstyle. Also, avoid using chemical straighteners that can further weaken the hair.
Reduction of inflammation: Your provider may recommend steroids or antibiotics to control the inflammation. Some medications are applied to the surface of the scalp, like fluocinolone (Synalar) and clindamycin (Cleocin). Others are taken by mouth, like doxycycline (Monodox, Doryx), or injected directly into the scalp, like triamcinolone (Kenalog).
Stimulation of hair growth: When there is thinning of the hair, oral minoxidil may help promote hair growth. Or hair transplants are a surgical option.
Camouflaging hair loss: In cases in which hair loss has become permanent, you can use wigs and toupees to cover the areas. Weaves are not a good option as they can cause more tension on the remaining hair.
The bottom line
Traction alopecia is a preventable form of hair loss that affects people who frequently wear tight hairstyles. This is a common issue for Black people who wear braids and weaves or who get frequent relaxers.
Prevention is key. When you see the warning signs of traction alopecia, change your hairstyle right away. And talk to your healthcare provider if you’re concerned your hairstyle is causing damage or hair loss.
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References
Akintilo, L., et al. (2021). Management of traction alopecia: Our experience and a brief review of current literature recommendations. Journal of Drugs in Dermatology.
American Academy of Dermatology Association. (n.d.). Hairstyles that pull can lead to hair loss.
Billero, V., et al. (2018). Traction alopecia: The root of the problem. Clinical, Cosmetic and Investigational Dermatology.
Goren, A., et al. (2018). Frontal pattern hair loss among Chinese women is frequently associated with ponytail hairstyle. Dermatologic Therapy.
Khumalo, N. P., et al. (2008). Determinants of marginal traction alopecia in African girls and women. Journal of the American Academy of Dermatology.
Kim, S. R., et al. (2022). Treatment of traction alopecia with oral minoxidil. JAAD Case Reports.
Samrao, A., et al. (2011). The “fringe sign” - A useful clinical finding in traction alopecia of the marginal hair line. Dermatology Online Journal.
Trüeb, R. M. (1995). “Chignon alopecia”: A distinctive type of nonmarginal traction alopecia. Cutis.
Uwakwe, L. N., et al. (2020). Intralesional triamcinolone acetonide in the treatment of traction alopecia. Journal of Drugs in Dermatology.
Wright, D. R., et al. (2011). Hair care practices and their association with scalp and hair disorders in African American girls. Journal of the American Academy of Dermatology.
Zhang, W. (1995). Epidemiological and aetiological studies on hair casts. Clinical and Experimental Dermatology.
