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Traction Alopecia

Traction Alopecia

Traction alopecia is a type of hair loss that happens over time.


It's caused by putting the hair under constant strain or tension and is usually caused by very tight ponytails, tight braids, extensions, hair weaves or wigs attached with glue or tape, certain hair clips, repeated use of hair rollers or repeated pulling of the hair with the hands (Trichotillomania). The constant tension in the affected area either pulls out the hairs' roots completely or causes the follicles to become inflamed. As time goes by, the damage to the follicles causes them to become atrophied and if the cause of the problem won't be stopped, the hair follicle will reach the point where they no longer produce hair at all. Scalp might be red and itchy. Initially, traction alopecia is non-cicatricial (without scarring), but prolonged and excessive tension leads to a destruction of the hair follicles and permanent alopecia.

It is sufficient to diagnose Traction alopecia without laboratory testing, but, with a physical examination and thorough history taking indicating a repetitive use of hairstyling techniques as outlined earlier and via elimination of indications for differentials for other types of alopecia.

Hair pull test:

The scalp should be examined for inflammation, erythema, and scaling. Hair pull test can be performed. This involves gentle traction from the base to the tips of a group of 25 to 50 hairs. Normally, only 1 or 2 hairs are dislodged.1 However, in traction alopecia the hair-pulling test results in the detachment of more than 6 strands. Examination of the scalp is very important, broken hairs can be seen close to the skin, or within follicles. Other follicles are empty where the hair has been plucked free. With persistent traction, the follicles atrophy no longer produce the typical long and coarse hair. Instead, thinner, fine, short hair is generated. Prolonged tension leads to inflammation around the hair follicles that may ultimately produce scarring.


Treatment for traction alopecia is only effective before hair follicle is permanently damaged. If the condition is recognised early enough - can be as simple as changing whatever hair styling or hair care practices that were used e.g.Avoid chemically processing the hair if you use weave or braids hair. The chemicals can damage hair, making it more likely to break. If you have weave or extensions, you should wear them for only a short period of time and take a break between each use. Don't use hair relaxers. Don't sleep in rollers. Avoid pulling hair up into a ponytail or bun, or loosen the style. Discontinuing any such practices leads to complete reversal of the hair loss and regrowth within around three months. The best treatment for traction alopecia is prevention.

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