Traction Alopecia, Scalp Pulling & Hair Loss
Unlike alopecia areata, which is an autoimmune disorder, traction alopecia is preventable and has a known underlying cause. While traction alopecia is not tied to a disease, it can still lead to permanent hair loss if a person wears certain hairstyles resulting in long-term scalp pulling. The good news is avoiding certain hairstyles treatment can usually reverse hair loss caused by traction alopecia.
Traction Alopecia Causes
Traction and friction related to certain hairstyles, combing/brushing hair too vigorously or tugging at it over time can cause traction alopecia. Persistent gentle pulling is typically painless and may go unnoticed until bald spots or alopecia starts to appear. Any of the following can cause stress and tension to one’s hair:
- Very tight ponytails or pigtails
- Tight braids or cornrows
- Extension (single) braids
- Hair weaves or wigs attached with glue, clips, or tape
- Headbands (even fabric ones) worn day after day
- Tight hairpieces
- Frequent use of hair pins, hair bands, and clips (especially day after day in the same hairstyle)
- Tight headgear worn frequently or for long stretches of time that tend to rub or pull repeatedly on the same area of hair (e.g. cycling helmets)
- Repeated use of hair rollers
- Repeated pulling of the hair with the hands (a condition called trichotillomania)
Traction alopecia can impact people of all ages and both females and males, however, it affects specific populations more frequently due to differences in hair structure, hairstyles, and sometimes lifestyle factors or career choices. For instance, traction alopecia is more common in black people of African descent because their hair is tight and curly, causing hair to be more fragile and prone to breakage. Tight curls affect how hair is anchored into the follicle beneath the skin surface. Many black women in particular use hair treatments and hairstyles to control the curl such as straightening, relaxing and braiding, which can cause damage to the hair root and follicles and eventual hair loss. In fact, research shows women with relaxed hair have the highest prevalence of traction alopecia. Ballerinas and gymnasts who frequently pull their hair back tightly in buns or ponytails may be more vulnerable to traction alopecia. Other professional athletes who wear headgear that places tension on the hair may also be at greater risk of developing traction alopecia (e.g. swim caps and cycling helmets).
Traction Alopecia Signs
If hair is pulled back in a ponytail, the hairs at the margins of the scalp are put under the greatest friction and tension, with early hair loss resulting in a receding hairline. Tight braiding in cornrows can lead to marginal or central alopecia with widening part lines. Twisting hair into a bun on the top of the head can produce horseshoe-shaped hair loss. Rough brushing or even massaging the scalp too vigorously repeatedly can produce diffuse hair loss. Other symptoms include:
- One side of hair is thicker than the other
- Scalp sensitivity after undoing a hairstyle
- Relief after untying hair
- Itchy scalp after wearing braids or a weave
- A headache resulting from too tight a hairstyle
- Pustules (blisters filled with pus) or papules (little pimples) caused by tension to the hair follicles
- Red or painful scalp (sign of inflammation)
Traction Alopecia Treatment
It is important to visit a dermatologist to ensure hair loss is not caused by a different form of alopecia. It is possible for hair to grow back if damage is not permanent, however, no further tension can be applied to the scalp or hair loss will continue. A topical preparation of high strength minoxidil is the standard treatment for traction alopecia. A dermatologist can also recommend medicated ointment if blisters are present on the scalp. Traction alopecia is often resolved within six months if it is caught and treated early. In severe cases, it can take as long as one year for a damaged scalp to regrow hair. When hair follicles are badly traumatized over a long period and scar tissue has formed, hair will not grow back by itself. A possible sign of this is shiny areas of the scalp.
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