Traction Alopecia

Discover the symptoms and causes of Traction Alopecia as well as the prevention and treatment options available.

Overview

What is traction alopecia? Do ponytails cause hair loss? You’re in the right place to find out. Traction alopecia is a type of hair loss caused by a continuous pulling force on hair roots. This can be from tight ponytails, braids, or even tightly slicked-back hair. This constant pulling damages the roots, ultimately resulting in hair loss.

Hair loss from traction alopecia can become permanent if left untreated, so it's essential to act quickly if you’re experiencing this type of hair loss.

Below, we’ve provided more information about traction alopecia and how it may start to affect your hair. We’ve also explained how traction alopecia is diagnosed and the treatment options available to prevent permanent hair loss and help you regrow your hair.

Symptoms

What are the Symptoms of Traction Alopecia?

Early signs of traction alopecia include thinning and broken hairs along the frontal hairline. People also may feel tenderness, stinging, or pain in the area of hair loss. Skin-colored or white pimple-like bumps may develop around your hair follicles in affected areas of your scalp.

The most noticeable symptom of traction alopecia is hair loss, usually around the front and sides of the scalp. You may also notice hair in other areas of your scalp, especially parts where your hair is subject to tension due to your hairstyle.

Hair loss from traction alopecia is usually symmetrical. 

One common sign of traction alopecia hair loss is “fringe sign.” This occurs when you lose hair in certain areas of your scalp but retain some hair at the frontal rim of your hairline — the retained hair is known as the fringe sign.

In addition to hair loss, other symptoms of traction alopecia can include red skin, itching, scaling, and the development of folliculitis and/or pustules. People with traction alopecia may also experience headaches that go away when hair is loosened.

Do these symptoms sound familiar?

Causes

Causes of Traction Alopecia

Traction alopecia is caused by mechanical stress and tension on the hair follicles. This leads to inflammation, follicle miniaturization, and potentially permanent scarring, all of which contribute to hair loss. We’ll further explain the causes below.

  • Scalp Inflammation: The persistent tension can cause the skin around the hair follicles to become irritated and inflamed.

  • Follicle Miniaturization: Continued stress and inflammation can cause the hair follicles to shrink over time, producing thinner and shorter hair (this process is known as hair follicle miniaturization or diminution of the hair follicle). If the tension persists, the follicles may eventually stop producing hair altogether.

  • Scarring and Permanent Loss: In severe or prolonged cases of traction alopecia, the damage can lead to scarring of the scalp tissue, which permanently destroys the hair follicles, leading to irreversible hair loss in those areas. Scarring alopecia is not reversible, as the hair follicles are permanently damaged.

Risk Factors

Risk Factors for Traction Alopecia 

Tight hairstyles are the most prominent risk factor for traction alopecia, but they’re not the only one. Additional risk factors include:

Race: Of all demographics, Black women are the most likely to experience traction alopecia. Research shows that the hair follicle in African hair tends to have an elliptical shape with flattened and irregular hair shafts, which can make the hair more susceptible to breakage. However, recent studies have found that the main risk factor for traction alopecia is hair care practices, not hair type.

Hair Length: Longer hair is heavier and poses a greater risk of pulling at the root, especially when pulled back or wet.

Certain Careers & Hobbies: Regularly doing activities requiring the hair to be pulled back into tight buns, like ballet, swimming, or gymnastics, can lead to traction alopecia.

Hairpieces: If you wear a hairpiece, wig, or weave that pulls on your hair, you may be at increased risk of developing traction alopecia.

Chemical Processing: Chemical processing (relaxers, perms, and dyes) doesn't directly cause traction alopecia, but it can make the hair more vulnerable to damage, increasing the risk when combined with other factors like tight hairstyles.

Diagnosing

Diagnosing Traction Alopecia

A dermatologist can diagnose traction alopecia by doing a clinical exam. The healthcare provider will ask you about your medical history and hairstyling practices. 

They will examine your scalp and hair (sometimes with a magnifying device known as a dermatoscope), looking for signs of traction alopecia, including acne-like bumps, the “fringe sign,” and patchy or diffuse hair loss (which helps to distinguish traction alopecia in men from the pattern hair loss characteristic of androgenetic alopecia).

In some cases, they may also suggest a blood test or perform a skin biopsy, which is generally done to rule out other types of hair loss, like alopecia areata, male pattern baldness, or central centrifugal cicatricial alopecia. 

According to the American Academy of Dermatology, it’s normal to shed between 50 and 100 hairs per day, so your provider may also ask questions or perform a hair pull test to see if your hair loss falls outside of the “normal” range.


Treatment

Treatment for Traction Alopecia

Is traction alopecia reversible? It’s a question many people ask. Traction alopecia is almost always treatable when it’s detected early. Here’s how. 

Change Your Hairstyle

Most of the time, you can prevent traction alopecia from worsening by changing how you style your hair. In many cases, this is all it takes to see hair regrowth, especially for traction alopecia that is still in its early stages.

If you usually wear your hair in a tight hairstyle, such as braids or a bun, try switching to a loose style that doesn’t put extra pressure on your hair follicles. If you style your hair using products that contain chemicals, try to reduce the amount that you use.

Medications

Traction alopecia may cause your skin to become scaly and inflamed. If you notice this, it’s best to talk to your healthcare provider or schedule an appointment with a dermatologist. 

Your healthcare provider may prescribe medication to control inflammation, irritation, and other skin issues. Medications used to treat traction alopecia include:

  • Topical or injectable corticosteroids

  • Antibiotics

  • Antifungal shampoo

  • Hair health supplements such as biotin 

If you’re prescribed any of these medications or care products, make sure to use them exactly as instructed by your healthcare provider. 

Hair Loss Medications

While not specifically a treatment for traction alopecia, a topical medication like minoxidil helps slow hair loss and regrow hair lost to the condition. This works by improving blood flow to the scalp and encouraging hair follicles to transition from a resting phase into active growth. 

Minoxidil comes in liquid or foam form. Our guide to applying minoxidil for hair growth explains in more detail how this medication can stimulate hair growth in areas affected by traction alopecia. 

Although traction alopecia is easy to treat when detected early, it can cause permanent hair loss if left untreated for a long period of time.

If you have permanent hair loss from traction alopecia, medications like minoxidil aren’t likely to be effective. This is because long-term traction alopecia damages the hair follicles so badly that they’re largely replaced by a form of scar tissue.

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Prevention

Traction Alopecia Prevention Tips 

Below, you’ll find tips for preventing traction alopecia, and you may not have to ditch tight hairstyles altogether.

  • If you usually wear your hair in a tight hairstyle, such as braids or a man bun, try switching to a loose style every few weeks. If you stop wearing tight hairstyles in the early stages of traction alopecia, regrowth is definitely possible. 

  • If you wear dreadlocks or cornrows, try thicker braids, which pull less than thinner ones.

  • Avoid hair relaxers and other chemical products.

  • Use low heat settings when blow drying or using a curler or flat iron.

  • If you wear a wig, wear a satin wig cap, which reduces friction and pulling.

  • Take a break every few weeks when wearing weaves or hair extensions.

  • When possible, avoid elastic hair ties, which can pull hair and lead to breakage. Instead, try scrunchies made with satin or hair ties made using a softer nylon material. 

Since traction alopecia can cause permanent hair loss, it’s best to take action as soon as you’re aware that you’re losing hair. We can connect you with a healthcare professional online who can help you access the right hair loss treatment for regrowth from traction alopecia.


4 Sources

  1. Aboud AM, et al. (Updated 2024). Alopecia. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538178/
  2. Larrando J, et al. (2023). Traction Alopecia. Retrieved from https://jamanetwork.com/journals/jamadermatology/article-abstract/2804567
  3. Pulickal JK, et al. (2020). Traction Alopecia. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470434/
  4. Tanus A, et al. (2015). Black women's hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560533