Overview

The term alopecia refers to hair loss. Traction alopecia is hair loss that’s caused by repeatedly pulling on your hair. You can develop this condition if you often wear your hair in a tight ponytail, bun, or braids, especially if you use chemicals or heat on your hair.

Traction alopecia can be reversed if you stop pulling your hair back. But if you don’t intervene soon enough, the hair loss may be permanent.

Doctors in Greenland first identified the condition in the early 1900s. They discovered that women who wore tight ponytails had lost hair along their hairline.

Symptoms

Early on, traction alopecia might show up as little bumps on your scalp that look like pimples. As the condition progresses, the main symptom is missing and broken hairs. The hairs along the front and sides of your scalp are most often affected. However, you may also notice hair loss on other areas of your scalp, depending on your hairstyle.

In addition to hair loss, traction alopecia can cause these symptoms:

  • redness of the scalp
  • bumps
  • soreness or stinging of your scalp
  • itching
  • scaling
  • folliculitis (inflammation of the hair follicles)
  • pus-filled blisters on your scalp

Eventually, the hair follicles can become so damaged and scarred that they can’t produce new hair.

The symptoms of traction alopecia are different from those of other forms of alopecia. In other types, the hair loss occurs in patches all over the scalp. In traction alopecia, usually just the hair that’s been pulled is affected.

Causes

You develop traction alopecia from wearing your hair pulled too tight. Pulling on the hair repeatedly loosens the hair shaft in its follicle.

For example, you might lose hair if you often:

  • pull your hair back into a tight ponytail or bun
  • wear tight braids, cornrows, or dreadlocks
  • use hair extensions or weaves
  • put your hair up in rollers overnight

People with very long hair can also get traction alopecia due to the weight of the hair pulling on the scalp. Men can also have it in their beard if they twist it too tightly.

This condition is common in African-American women, although it can affect people of any ethnicity. It occurs more frequently among people in professions that tend to put their hair up in a tight bun, such as ballerinas and gymnasts.

Although the condition can affect people of any age, it’s more likely to happen as you get older because your hair becomes more damaged the longer you pull on it.

Prevention

To prevent traction alopecia, wear your hair down. If you have to pull it up into a ponytail or bun, keep it loose and low on your head.

Here are a few other ways to prevent this condition:

  • Change your hairstyle every couple of weeks. For example, alternate between braids and wearing your hair down.
  • When you pull your hair up into a ponytail, don’t use rubber or elastic bands to hold it in place. They can pull out your hair.
  • Avoid chemically processing your hair if you use weaves or braid your hair. The chemicals can damage your hair, making it more likely to break.
  • If you have weaves or extensions, wear them for only a short period of time and take a break between each use.
  • When you braid your hair or put it in dreadlocks, make the braids thick. Thinner braids pull more tightly.
  • Don’t use hair relaxers.
  • Keep the heat setting low on your hair dryer and flat iron.
  • Don’t sleep in rollers. Wrap your hair instead.
  • If you wear a wig, choose one with a satin wig cap. It won’t pull as hard on your scalp.

Treatment

To treat traction alopecia, see a dermatologist. The doctor will examine your scalp. He or she might take a sample of tissue called a biopsy to look for other possible causes of hair loss.

The main treatment for traction alopecia is to change your hairstyle. Avoid wearing your hair in a tight style, especially overnight. You’ll know it’s too tight if it hurts. Remove braids, cornrows, or dreadlocks. Avoid pulling your hair up into a ponytail or bun, or loosen the style.

If your hair is very long, cut it. Minimize the use of chemicals and heat, which can damage your hair.

Your doctor might prescribe one of these treatments for traction alopecia:

  • antibiotics to prevent infection in any open sores
  • topical steroids to bring down swelling on your scalp
  • antifungal shampoos
  • minoxidil (Rogaine) to regrow hair
  • biotin supplements to strengthen your hair

If you’ve lost a lot of hair and it’s not growing back, a hair replacement procedure may be an option.

Outlook

Traction alopecia is reversible, but you need to treat it quickly. If you stop wearing your hair in the tight hairstyle that caused it, your hair will grow back normally. But if you continue styling your hair the same way, the hair loss can be permanent.