Traction alopecia is a common form of hair loss that can affect anyone. The main cause is ongoing tension or pulling on the hair follicles, usually from hairstyles or habits that put strain on the scalp. In this article we explore what causes it, its stages and the signs to look out for. We also review how to prevent it and the best treatments to help regrowth.
What is Traction Alopecia?
Traction alopecia is a form of hair loss that comes from ongoing or repeated tension. It happens when steady pulling on the hair damages the hair follicles. This upsets the normal hair growth cycle, leading to inflammation and weaker hair shafts. Over time, the constant pulling weakens the follicles, which leads to breakage and, in severe cases, permanent hair loss. Spotting the signs early is crucial, as ongoing tension can stop hair growing back. It is more common in women, but it can affect men too. It can also affect any hair type or ethnic group, though it is more likely where tight braiding or other high-tension styles are common.
Causes of Traction Alopecia
The tension most often comes from regularly wearing tight hairstyles. The styling habits most often linked to it include:
- Tight braids and cornrows
- Weaves, locks and extensions
- Ponytails and buns
- Hairpieces and wigs that pull at the natural hairline
- Daily use of hair clips or tight bands in the same spots
Beyond hairstyles, it can also come from other things that strain the follicles. These include:
- Tight headgear: wearing helmets, hats or headbands that press on parts of the scalp can lead to it, especially along the hairline.
- Hair pulling: trichotillomania, where people repeatedly pull out their hair, can cause it. This pulling weakens the follicles and causes patches of hair loss.
- Chemical treatments: overusing relaxers, perms or straightening agents can weaken the hair shaft, so it breaks more easily when combined with tension from tight styles.
Stages of Traction Alopecia
Like any condition, you can split traction alopecia into a number of stages. This helps show how far it has gone and which treatments may help. In general there are 3 key stages:
- Early stage: thinning hair, especially around the hairline or areas under strain. There is little follicle damage at this point, and regrowth is still possible with changes to hair care.
- Moderate stage: bald patches start to form, and the follicles may take more damage. You may also feel sore or notice bumps on the scalp.
- Severe stage: there may be permanent follicle damage, leading to scarring and lasting hair loss. At this point, you may need medical treatment, and natural regrowth is unlikely without it.
Signs & Symptoms
One of the keys to preventing lasting damage is spotting the symptoms early. The causes are very treatable, so you can often reverse it in the early stages. Here are the main signs to look out for:
- Thinning at the temples or hairline: this is usually the first visible sign of a thinning hairline, as the hair around the edges is the most at-risk.
- Small bumps on the scalp: these are easy to mistake for spots or a rash. However, they can be the result of follicles that swell under steady tension.
- Redness and soreness: if your scalp feels sore, red or tender after tight hairstyles, this can be a sign of strain.
- Broken hairs: you might notice shorter hairs or thinning patches where the hair has snapped off.
- Bald patches: in more advanced cases, you may get bald spots, mostly around the areas under the most tension.
- Itching or stinging: a sore feeling around the area can also be an early sign of follicle damage.
Treatment Options
As soon as you spot the signs, it is really important to seek treatment quickly. The sooner you act, the better your chances of stopping the hair loss and helping regrowth. Your doctor will confirm what is going on and help you choose the best treatment. Options may include one or more of the following:
- Change your hair care first: the first step is to remove the source of tension. Change your routine and avoid any hairstyles that pull on your hair. Give your hair a break from braids, buns, weaves and extensions, and pick loose styles that do not press on the scalp. Also swap elastic bands for softer fabric ties or clips that do not pull.
- Mental health support: if the cause is hair pulling, therapy is key to help you manage it. Alongside a professional therapist, you may find support groups and forums useful.
- Topical treatments: once the strain on the follicles eases, several topical treatments can help spark regrowth and calm the skin. Minoxidil is one of the most widely suggested over-the-counter options for regrowth. It works by prompting the follicles to grow new hair and can help in the early stages. For severe swelling, a doctor may prescribe topical steroids to bring it down and aid healing. Natural options like aloe vera or tea tree oil may also soothe the skin and support a healthy scalp.
- Professional medical treatments: in more advanced stages, where the follicles have taken bad damage, you may need medical treatment. Platelet-rich plasma (PRP) may help healing and regrowth where follicles are still alive. Where scarring alopecia has set in and natural regrowth is not possible, a hair transplant may be the only option.
How to Avoid Traction Alopecia
Preventing traction alopecia comes down to easing the strain on your hair. Since the main cause is tight hairstyles and habits, it makes sense to take pressure off your scalp. Here are some gentler styles and habits:
- Loose braids: if you like to braid your hair, pick looser styles that do not pull tightly on your scalp.
- Low ponytails: instead of high, tight ponytails, wear a low, loose one to ease strain on your hairline and avoid pulling at the roots.
- Bantu knots: you can wear these without much tension on the roots, for a stylish look that is kinder to your scalp.
- Natural hair: embracing your natural texture often means less handling and tight styling, which eases strain on the follicles.
- Careful use of extensions and weaves: if you use extensions or weaves, make sure they are not too heavy and have a professional fit them. Pick methods that do not pull at the roots, such as tape-ins or clip-ins, and avoid keeping them in too long.
- Avoid tight headgear: cut back on tight helmets, hats or headbands that press on the scalp. If you need headgear, make sure it fits well and is not always in the same spot.
- Break the hair-pulling habit: for anyone dealing with trichotillomania, help from a therapist can ease the urge to pull. Cognitive behavioural therapy (CBT) often works well for this.
- Limit chemical treatments: go easy on relaxers and perms that weaken hair. Use them sparingly and let your hair recover between sessions, and pick gentler formulas or alternatives to harsh chemical processes.
- Gentle hair accessories: avoid tight clips, pins or elastic bands. Pick softer, fabric-covered bands or clips that do not pull, and try not to put them in the same spot every day.
In addition, it is worth regularly switching up your hairstyles so you are not wearing the same one every day. This helps prevent steady strain on any single part of your scalp. Try to give your hair breaks from any style that adds tension, as these breaks let your follicles recover and strengthen naturally.
Traction alopecia is a form of hair loss caused by ongoing tension and pulling on the hair. Spotting the early signs is crucial to prevent more damage. Whether regrowth is possible depends on how early you catch it and start treatment. In the early stages, while the follicles are still intact, the hair can often grow back with the right care. Stopping the damaging habits, using regrowth products like minoxidil and looking after your scalp can all lead to good regrowth. However, in severe cases where scarring sets in or the follicles die, regrowth may be very hard or not possible. If you have any worries, seek help early from a doctor, as early action is key to avoiding lasting damage.
We understand that hair loss is a deeply personal journey. This is why we created personalised hair loss and regrowth treatments for both men and women through our online clinic. Our doctors create custom topical hair loss treatments using actives such as finasteride, minoxidil, spironolactone and tretinoin where appropriate for each and every patient. We also treat skin concerns like acne, hyperpigmentation, melasma and signs of skin ageing with bespoke skincare treatments. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin and hair starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
