Traction Alopecia

Traction alopecia is a form of hair loss in which mechanical damage to the hair follicle is caused by repeated tension or pulling. This type of hair loss is common among people with skin of color, especially African-American women, although it may be seen among all ethnic groups and ages. Ballerinas, gymnasts, military personnel and certain professionals who are required to wear their hair pulled back, may develop traction alopecia.

What is the cause of traction alopecia?

In general, any behavior that puts an unnecessary amount of stress or tension on the hair for a prolonged period of time may contribute to traction alopecia. Below are the 5 most common instances in which this can happen:

  1. Wearing unnecessarily tight ponytails, pigtails, or braids for a long period of time.
  2. Trichotillomania, a mental disorder characterized by incessant (and often unconscious) hair twisting, plucking, or pulling.
  3. Hairstyles that require hair to be tightly wound for a prolonged period of time.
  4. Hairpieces and weaves that must be affixed / clipped to the hair.
  5. Helmets, particularly compression-helmets like those worn while playing football, snowboarding, skiing, horseback riding, etc.

How do I know if I have traction alopecia?

Early on, you may notice small flesh colored or white bumps around hair follicles where the hair is pulled most tightly. Shortly thereafter, symmetric hair loss appears. The hair loss is usually most noticeable around the hairline. So called baby (vellus) hairs are spared and broken hairs are often present throughout the area of hair loss. Initially, traction alopecia is temporary, but if hairstyling habits are unchanged, the hair loss may become permanent.

What treatments are available for traction alopecia?

In the early stages, the best treatment for traction alopecia is to limit or eliminate any hairstyles that pull on the hair and to wear hair in loose styles (especially overnight). Reducing the amount of chemicals and heat used during styling is recommeneded. The presence of scalp tenderness, bumps or inflammation may be treated with topical antibiotics or topical corticosteroids. For moderate to severe traction alopecia, more aggressive treatments such as oral antibiotics, injected corticosteroids or topical minoxidil may be necessary. Once scarring is present, hair transplantation may be one of the few available options. The best treatment of traction alopecia is prevention.

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