When you look in the mirror, do you wonder what’s happening to your hairline? Are you having problems with your edges or controlling tiny broken strands? You could be experiencing the onset of traction alopecia.

Keep reading to learn what this condition is and what you can do about it before it’s too late.

Unlike other types of alopecia, it’s not caused by genetic or immune factors. Only the hair weakened by traction is affected. Anyone of any gender, ethnicity or age can experience it.

Traction alopecia occurs when hair is pulled repeatedly in a certain way over a long period of time. Damage is done to your hair follicles from the pulling (or traction) used in frequent styling. This repeated stress weakens the hair shaft at the follicle. Some changes can be reversed, but others are permanent.

Causes and Risk Factors of Traction Alopecia

Traction alopecia can occur due to various factors, including:

  • Tight Hairstyles: Wearing tight hairstyles such as braids, cornrows, and weaves can cause hair loss due to the constant tension on the hair follicles.
  • Hair Extensions and Weaves: If hair extensions and weaves are not applied correctly or are too tight, they can also lead to traction alopecia.
  • Genetics: Individuals with a family history of hair loss may be more prone to traction alopecia.
  • Hormonal Imbalance: Hormonal imbalances, particularly androgenetic alopecia, can contribute to traction alopecia.

Traction Alopecia in African American Women

African American women are particularly susceptible to traction alopecia due to their hair texture and the hairstyles they often wear. Tight braids and cornrows are common hairstyles among African American women, which can lead to hair loss if not worn correctly. This is because African hair is generally more fragile and prone to breakage compared to other hair types, making it more susceptible to damage from excessive tension and pulling. Additionally, the prevalence of high-tension hairstyles and the duration for which these hairstyles are worn can further exacerbate the risk of traction alopecia in this population.

Hair Texture and Hairstyles

African hair is characterised by lower density and tensile strength compared to other hair types. This makes it more prone to breakage and damage from excessive tension and pulling. Tight braids and cornrows, which are common hairstyles among African American women, can cause hair loss if not worn correctly. These hairstyles can lead to prolonged scalp tension, hair shaft trauma, and sustained pulling, which can induce folliculitis with nonscarring alopecia in the early stages of traction alopecia. If left untreated, this can progress to longer-lasting follicular damage and scarring alopecia.

Genetic Predisposition

Genetics also play a significant role in the development of traction alopecia in African American women or those with afro hair. Central centrifugal cicatricial alopecia (CCCA), a more permanent form of scarring alopecia, is more common in this population. This condition is linked to fibroids, which are benign uterine tumours that are more prevalent in Black women. The genetic predisposition to tension-related hair loss, combined with the tendency to wear hairstyles that can cause inflammation of the hair follicle, makes African American women more susceptible to traction alopecia.

Traction Alopecia – When Is It Too Late?

While this condition can occur in people of any age, you’re more likely to suffer from traction alopecia as you get older. This is because hair loss due to traction will progress over time if tight styling habits are maintained.

You’ll find signs of traction alopecia along your forehead, nape, sides, and temples, and it often presents as a receding hairline or thin and breaking hair. Some may experience small pimples or infections, itchiness, swelling, or redness. It takes time for the damage to become noticeable, so you might not realise that it’s happening until the problem is quite far along. Each time your hair is pulled too tightly, the follicle gets a little more damaged. Gradually, it produces hair that becomes weaker and thinner and eventually, it stops producing hair altogether. Shiny patches of smooth, bald skin on the scalp are scarring sites which indicate advanced traction alopecia.

When is it too late to fix traction alopecia?

While it is never too late to seek treatment for traction alopecia, the earlier it is detected and treated, the better the chances of reversing the damage and regrowing healthy hair. If the hair follicles are only slightly damaged, they may be able to recover and regrow healthy hair with proper treatment. However, if the damage to the hair follicles is severe and has been left untreated for a long time, it may be more difficult to reverse the effects of traction alopecia. In these cases, it is important to consult with a professional trichologist who can assess the condition and recommend the best course of action.

How to Prevent Traction Alopecia

The best way to prevent traction alopecia is by understanding how it starts. As we’ve seen, traction alopecia is more common among people who wear tight hairstyles every day. This is especially true for a lot of afro hair styling techniques, professions that require the hair to be tied back tightly, such as dancers or sportspeople, and those that wear tight head scarves or turbans.

Here are a few examples of hairstyling techniques that cause traction alopecia:

  • Tight buns and ponytails
  • Long dreadlocks or locks that are frequently and tightly retwisted/interlocked.
  • Braiding and tight corn rowing
  • Wigs, particularly lace front/closures
  • Weaves
  • Hair extensions

Remember, most stylists are not hair experts; they are styling experts. Their specialisation is making your hair look good, which isn’t always best for your hair follicle or scalp health.

Gentle Hair Styling

If you’re noticing signs of traction alopecia, the very first thing you can do is to change your styling routine. Stop the pulling and treat your hair gently. Speak up at the salon and explain your requirements to your stylist. Express yourself if your hair is being pulled painfully tight.

Chemicals and Traction Alopecia

Chemical processing of hair can significantly contribute to traction alopecia. Chemicals used in hair care products can weaken the hair structure, leading to breakage and further damage. This is particularly concerning for individuals who already experience traction alopecia due to tight hairstyles or hair extensions. Chemical processing can exacerbate the condition by causing inflammation on the scalp surface and follicles, which can lead to permanent hair loss if left untreated.

Hair Straightening and Hair Dyes

Hair straightening and hair dyeing are common practices that can cause significant damage to the hair. Chemical hair straighteners are highly alkaline and can cause hair damage and breakage. Additionally, the use of permanent hair dyes can lead to hair shaft breakage, especially when combined with chemical relaxers. This is particularly problematic for individuals with traction alopecia, as the hair is already weakened and prone to breakage.

Hair Relaxers and Chemical Processing

Hair relaxers are chemicals that are used to straighten curly hair. They work by breaking the bonds within the hair shaft, making it straighter. However, this process can cause significant damage to the hair, leading to breakage and weakening. Chemical relaxers can also cause inflammation on the scalp surface and follicles, which can contribute to traction alopecia.

Heat Styling and Chemical Processing

Heat styling tools, such as flat irons and curling irons, can also cause damage to the hair. When used in combination with chemical processing, the risk of hair damage and breakage increases significantly. This is because heat styling tools can cause the cuticle to lift, allowing chemicals to penetrate deeper into the hair shaft and causing further damage.

Keep Styles Loose

When styling your hair, remove any added weight such as extensions and aim to keep styles as big and as loose as possible. For example if you are planning to cornrow your own hair, try and use as few cornrows as possible over your head. As cornrowing can be tricky without making the plaits very small, you may wish to try single twisting your hair to keep your hair detangled and styled while limiting any tension at the roots.

Change Your Hairstyle Regularly

Styles should be changed on a weekly basis as a minimum, giving you a chance to wash your hair and scalp regularly and treat any areas of concern. Importantly, don’t be fooled into thinking that some hairstyling practices, such as braiding, weaving and using wigs, are “protective”. (Read more on protective styling for afro hair here.)

In summary, preventing traction alopecia involves minimizing or eliminating the frequency of high-tension hairstyles and promoting gentle hair care practices. This includes using gentle hair care products, reducing heat styling, and avoiding tight hairstyles. Treatment approaches for traction alopecia include hairstyling modifications, topical therapies, intralesional treatments, systemic treatments, and surgery. Patients with African hair types may require different treatment approaches, such as using topical solutions rather than ointments, due to the unique characteristics of their hair.

Consulting a Trichologist Specialist

While there are some steps you can take to manage traction alopecia on your own, consulting a professional is often the best course of action. A trichologist is a hair and scalp specialist who has extensive knowledge and expertise in diagnosing and treating hair and scalp conditions. By consulting a trichologist, you can receive personalized advice and guidance tailored to your specific situation.

Assessment and Diagnosis

A trichologist will conduct a thorough assessment of your hair and scalp to identify the extent of the damage and determine the best course of treatment. This assessment may include:

  • Visual Examination: The trichologist will visually examine your hair and scalp to identify any signs of damage, such as thinning, breakage, or scarring.
  • Hair and Scalp Analysis: The trichologist may perform tests to analyze the health of your hair and scalp, including hair thickness, elasticity, and texture.
  • Styling History and Practices: The trichologist will ask about your styling history and practices to understand how they may be contributing to the condition.

Treatment and Recommendations

Based on the assessment and diagnosis, the trichologist will provide personalized recommendations and treatment options to address your specific condition. This may include:

  • Medications: The trichologist may prescribe medications to promote hair growth, reduce inflammation, or treat underlying conditions.
  • Low-Level Laser Therapy (LLLT): LLLT uses a low-level laser or light-emitting diode (LED) device to stimulate hair growth and improve hair density.
  • Platelet-Rich Plasma (PRP) Therapy: PRP therapy involves injecting platelet-rich plasma (PRP) into the scalp to stimulate hair growth and improve hair density.
  • Hairstyling and Care Advice: The trichologist will provide guidance on how to modify your hairstyling and care practices to minimize further damage and promote healthy hair growth.

Psychological Matters

Science has examined the psychological impact of hair loss, which can have far-reaching effects. One source says, “Hair is essential to the identity of many women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman’s hair, more so than for a man. Hair loss can, therefore, seriously affect self-esteem and body image.”

Hair loss is rarely easy to accept or endure. As a society, we place an unrealistic amount of value on long, strong, and healthy hair. Therefore, disguising hair loss can boost confidence and help us cope.

In recent years, wigs, extensions, and weaves have been used extensively to disguise hair loss. However, this is incredibly problematic for those with weaker follicles, particularly in conditions where recovery may still be possible. In many cases, these disguise tactics can increase pressure on struggling follicles and worsen hair loss further, even leading to irreversible damage.

When seeking treatment for hair loss, even when it is preventable, such as traction alopecia, it’s essential to talk to specialists who understand the problem. Attempting treatment that is unlikely to be effective may be more harmful to one’s mental health than medically helpful.

Empower Yourself

Losing your hair extends beyond vanity. For many, the scarring caused by traction alopecia can result in painful psychological and emotional distress.

If you have made it to the end of this article, congratulations. Educating yourself empowers you to take positive steps toward your own well-being. Your best defence is knowing how traction alopecia starts in the first place and understanding the next steps to mitigate the problem.

Simple changes like changing your hairstyling habits may put you out of your comfort zone, but it may also be a refreshing opportunity to reinvent yourself.

If you’d like some advice, we invite you to talk to a consultant who will be able to guide you further.

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