Traction Alopecia and How to Avoid it

Do you have traction alopecia? When people begin to lose their hair they start wondering about the cause. There are so many different causes for people losing their hair that it can seem impossible to know what applies to you personally, and what is excessive, useless and misleading information. There is no single best way to get to the bottom or hair loss but an important step is just thinking about what you’ve exposed your hair too. Going to a doctor is also a good idea but this may not always work. Primary care doctors like internists and family practitioners are too busy or don’t know enough about hair to make good informed recommendations. A dermatologist would be a better place to start. They are trained experts in hair and skin, they know the available and appropriate tests. Since hair and skin is their specialty dermatologists will take you seriously if you bring your concerns about hair loss and balding to them.

There are some causes of hair loss you may be able to figure out yourself. One of these is traction alopecia. Traction means friction and alopecia means hair loss. Traction alopecia is a form of hair loss that happens when the hair is pulled, pushed or has some force excreted on it for a long time. In the United States traction alopecia is most common among young African American females (Fu, 2009). This is not the case everywhere. In Asia you would see it most often among religious Shikh men who use a turban around their heads (James, 2007), and among older Japanese females who use more traditional Japanese hair cuts. Traction alopecia can also be a work hazard, in South Korea where nurses still use a traditional nurse cap which causes traction alopecia because of the way it is fastened to the hair and head (Hwang, 1999).

Why is this important to you? Well if you are part of the groups named above it is important because you can stop and reverse the problem by identifying it and removing its exposure to your hair. Traction alopecia can be reversed if the cause is identified and removed early (McMicheal, 1998). Even if you are not one of the groups above, you may have another cause leading to traction alopecia by a similar mechanism. Traction alopecia is not a problem of race or genetics problem so much as a problem of physics and biology. Anyone who exposes their hair to friction, from a baseball cap, a construction helmet, a tight ponytail or braids can begin to develop traction alopecia (Aaronson, 1969). In people who have a secondary cause of baldness, like a medical problem or family predisposition traction alopecia will only make things worse. There is no reason to expose your hair to more risks than absolutely necessary.

The science behind traction alopecia is that periods of pressure on the hair follicle, the cell group responsible for hair growth, causes it to go from the healthy growth phase which is called anagen phase, to the resting phase, called telogen. In telogen growth stops and the hair is able to loosen and fall out. Both of these phases are a normal part of hair life cycle. In traction alopecia the follicle leaves anagen early, has a short period of inflammation, redness and selling (Slepyan, 1958), that wouldn’t occur in normal phase conversion and then the follicle remains in telogen or worse, it can die off completely. At this point you are at risk for remaining hairless and bald. If you catch it early, before the cells die, even if you’ve lost some hair, you can reverse it. If it goes on too long traction alopecia can enter a permanent phase where the area affected becomes scared and chance of regaining your hair at that point are much slimmer.

People who recognize traction alopecia are lucky. Not because they are going bald but because they now know how to prevent it – simply “let the hair be” – not massing with it too much, and not stretch it. Top wearing hair weaves that are too tightly tied to your natural hair, don’t wear wigs that offer too much pressure on your head. The same goes for hats, hair pieces and other objects that you may be wearing because you are embarrassed by your baldness. They may only make things worse down the line. The best treatment is avoidance and if you notice you are loosing hair think about what you’ve exposed yourself too and see if you can identify something that has been putting too much pressure on your hair roots. Even tight ponytails, to baseball caps may be part of the problem. If traction alopecia is causing your hair loss and making you bald, simply recognizing it is the first step on your way to reversing and curing your baldness.

Bottom line – if you already suffer from traction alopecia, what to do except avoidance? Consult with an expert (hair dresser or stylist is NOT an expert), and take action to help your hair recover. Minoxidil might help as it stimulates the follicles to produce hair, also improved nutrition that includes proteins, vitamins and minerals (focusing on “hair foods” such as Biotin, B group vitamins, Zinc, Iron etc), as well as gentle natural shampoo might help. Get rid of hair waxes, hair fans and chemicals (try to avoid hair color or stick to gentle and natural colors & brands). Go natural – your target is to help your hair follicles to heal.

Medical References:

1-Fu JM. Price VH. “Approach to hair loss in women of color.“ Smnr Cut Med & Surg. 28(2):109-14, 2009 Jun.

2-James J. Saladi RN. Fox JL. “Traction alopecia in Sikh male patients.“ J Am B Fam Med. 20(5):497-8, 2007 Sep-Oct.

3-Hwang SM. Lee WS. Choi EH. Lee SH. Ahn SK. “Nurse’s cap alopecia.” Int J Derm. 38(3):187-91, 1999 Mar.

4-McMichael AJ. “Scalp and hair disease in the black patient.” In: Johnson BL, Moy RL, White GM, eds. Ethnic skin: medical and surgical. St. Louis, MO: Mosby, 1998: 214–230.

5-Aaronson C. “Etilogic factors in traction alopecia” South Med J. Feb 1969, 185-186.

6-Slepyan AH, “traction alopecia” Arch Derm (Chicago) 78:395, 1958