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Traction alopecia – hair loss from styling

Dr Roger Henderson
Reviewed by Dr Roger HendersonReviewed on 13.10.2023 | 3 minutes read

Traction alopecia is hair loss as a result of repetitive heat damage and pulling on the hair, and hair falls out. If a particular area is traumatised over a prolonged period, this may cause permanent destruction of the hair follicles and make it impossible for hair to grow back.

What causes the damage?

Traction means tension or pulling, so consider how certain styling techniques affect the hair. Using heat styling products at the hair root causes damage – hot combing, popular in the Afro-Caribbean community, is one culprit, or using straighteners from the roots. Even keeping your hair in a tight ponytail or bun day after day can cause damage from pulling. Anything that adds weight to the hair can pull it out, including braids, hair extensions or weaves. Any chemicals to dye or relax the hair weaken it and add to the trauma of traction.

To avoid traction alopecia, minimise styling practices, and give your hair a break to allow recovery. Once you notice hair loss, cease these practices completely before permanent damage sets in.

What does it look like?

Bald patches appear where the forceful pulling has occurred. This is often around the front hairline, as we pay closest attention to this when styling our hair. You might see a receding hairline, and any hairs look short and scanty. You might see bald patches between cornrows or dreadlocks. It may feel a bit itchy or uncomfortable, and it might look a bit red and flakey.

Hair can regrow in these patches if the hair styling or other causes of pulling stops. You might notice thin hair to start, but more will regrow after three months or so.

If constant traction continues over time, hair loss may be permanent if follicles are irreversibly damaged, and these patches will look smooth and completely hair-free.

Are there any treatments?

The most important thing to do is to stop whatever is causing the traction. Cutting long hair may help ease the weight, and avoiding anything irritating the area such as tight caps or wigs can help avoid any further trauma.

When you first notice hair loss, you can try applying minoxidil 2% or 5% solution, available to buy from a pharmacy. Applied to affected areas, this aims to keep the hair from shedding, allowing it a chance to recover. It's not a permanent solution, and won't work if traction continues or if hair follicles have been destroyed. It can be expensive, and won't work on everyone.

If the area is red, itchy or flakey, your doctor may consider giving you a steroid cream for a limited period of time, to calm any inflammation.

Does anything put my hair at higher risk?

Not specifically, although many of these techniques are favoured by the Afro-Caribbean community. Experts have considered if African hair is more susceptible to breakage, but it’s more likely to come down to hairstyling practices. Some Sikh men have had traction alopecia from tying their beards and hair up.

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Dr Roger Henderson
Reviewed by Dr Roger Henderson
Reviewed on 13.10.2023
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