Certain hairstyles and hair accessories can contribute to hair loss. Learn what traction alopecia is, how it can be prevented and which treatment options are available.
You may have heard dermatologists expert in hair disorders explain that what we do to the hair above the surface of the scalp — using styling gel, shampoo, hair dye, hairdryers or curling irons, for example — does not normally cause alopecia because these factors do not reach the hair follicle, the structure located several millimetres beneath the scalp where new hairs are produced.
Strictly speaking, however, there is one important exception: traction alopecia, which is associated with repeated use of very tight hairstyles or hair accessories.
What is traction alopecia?
Traction alopecia is a form of traumatic alopecia characterised by hair loss in specific areas of the scalp that are repeatedly subjected to excessive tension. It is mainly associated with the repeated use of very tight hairstyles such as braids, dreadlocks or tight buns, including styles traditionally worn for professional reasons by dancers, swimmers or cabin crew.
When the hair shaft is repeatedly exposed to excessive tension, hair may be lost in the areas under greatest traction, most commonly around the sideburns, temples and/or hairline. Over time, this persistent pulling can damage both the internal structure of the hair and the follicular root.
Is traction alopecia reversible?
Traction alopecia is often reversible if it is recognised and addressed early. If a tight hairstyle causes headache, marked relief when the hair is released, itching, redness, irritation or inflammation of the scalp, this may indicate that the hair follicles are being subjected to excessive mechanical stress.
If the cause is not addressed despite these warning signs, however, the follicle may eventually sustain irreversible damage and the lost hair may not regrow.
How to style your hair to help prevent traction alopecia
Preventing traction alopecia involves avoiding the factors that cause excessive tension. Very tight updos, accessories and hairstyles should therefore be avoided, particularly when worn continuously.
For ponytails, thicker hair ties or fabric-covered scrunchies are preferable, as they place less localised pressure on the hair shaft. They should also not be fastened excessively tightly. Repeated use of sewn-in hairpieces, dreadlocks, tight braids and extensions should also be limited.
Treatment of traction alopecia
The cornerstone of treatment is modifying hairstyling habits to eliminate chronic mechanical stress on the hair shaft and follicle. However, some patients do not recognise the problem until hair loss has been present for some time, in which case medical treatment may be necessary.
A range of topical, oral and injectable medical treatments may be considered for hair loss depending on the individual diagnosis, severity and progression.
Treatment in our Hair Disorders Unit is individualised. When the follicular root has not been permanently damaged, options may include oral or topical medication, injectable treatments and, in selected cases, regenerative medicine approaches. When significant permanent follicular damage has occurred and irreversible alopecia has developed, hair transplantation may be considered.
Recommendations from our specialists
One of the most important features of traction alopecia is that it may be reversible when detected at an early stage and when the underlying cause is removed. However, diagnosis is not always straightforward, which is why specialist assessment is important. Traction alopecia may sometimes be confused with other types of hair loss, including alopecia areata, frontal fibrosing alopecia, discoid lupus erythematosus or tinea capitis. An accurate diagnosis helps ensure that the underlying problem is addressed appropriately rather than treating a different form of alopecia unnecessarily.
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