Why Traction Alopecia Causes Hair Loss — and How to Avoid It

Hair Health Hotline is your direct access to dermatologists, trichologists, hairstylists, and other beauty pros. Each story in this series tackles a common hair or scalp concern and offers science-backed solutions to care for your strands.

Styling your hair can allow you to avoid distractions during a workout, express yourself, or protect your hair from the elements, but it also has its downsides. For one, you may have heard of traction alopecia, a form of hair loss that results from excessive tension, typically from hairstyling.

Assuming you aren't into the idea of losing hair because of your go-to styling habits, you might be wondering what types of hairstyles can cause traction alopecia and whether it can be prevented or reversed. Below, Janiene Luke, M.D., F.A.A.D., dermatologist and residency program director at Loma Linda University Medical Center, shares those details and more.

Q: I've seen posts on social media where people are dealing with hair loss from traction alopecia. What types of hairstyles usually cause traction alopecia and is there anything you can do to avoid it?

A: Traction alopecia is usually caused by tight hairstyles worn for long periods of time, and taking breaks from these styles or making sure they're not excessively tight can help you avoid the hair loss condition, says Dr. Luke. But it's probably best to back up and give you the basics on the condition.

What is traction alopecia?

"Traction alopecia is a type of hair loss that [occurs] when there is too much tension or stress put on the hair follicle, which causes mechanical damage and then results in hair loss," says Dr. Luke. As mentioned, the tension is usually a result of styling practices. "[Doctors] commonly see [traction alopecia] in [Black] patients due to popular hair care practices in this population," but it affects other populations too, says Dr. Luke.

Typically people who experience traction alopecia will notice hair loss in a concentrated area of their scalp, which will depend on where they've applied tension through hairstyling. "The most common area is the frontal [or] temporal portion of the scalp," (i.e., the along the hairline on the front and sides of your scalp), says Dr. Luke. "And what dermatologists see and something patients can look for is called the fringe sign. [That's] where you'll have little short hairs that are not able to be incorporated into the style, and then you'll see a zone of hair loss in between the short hairs and the rest of the scalp hair. While the hair loss most commonly affects the front and sides of the scalp, it also often affects the back of the scalp, particularly when it's caused by tight ponytails.

How do you get traction alopecia?

Tight hairstyles may lead to traction alopecia, especially if you're wearing the styles for weeks at a time. "Traction alopecia is really the result of chronic or continuous stress or tension on the hair follicle itself," says Dr. Luke. "It's been very well documented that frequent use of a tight bun or ponytails can contribute to it, but other hairstyles tend to be more high risk. Particular styles, such as braids or dreadlocks, can also cause that constant tension, especially if those are too tight to begin with."

Additionally, "dreadlocks are another high-risk hairstyle, particularly because it's a more permanent style and then as the dreadlocks grow out, they become heavier," says Dr. Luke. "So it's not only tension on the follicle, but it's also the added weight that makes it a more high-risk style."

Wearing hair extensions can also lead to traction alopecia, notes Dr. Luke. The weight of hair extensions can create tension, and in the case of sew-in extensions, creating tight braids to install the hair also adds tension, she says.

What are the best traction alopecia treatment and prevention methods?

If you like wearing hairstyles that can contribute to traction alopecia, taking periodic breaks from the styles can help lower your risk of developing the hair loss condition, says Dr. Luke. "There's always kind of the underlying risk, but I do actually recommend periods of hair rest where either you're not utilizing that style or you're utilizing styles that are not as high risk. So, you know, wearing your hair natural, [or] wearing a wig that doesn't have too tight of a band or is not glued."

It's also a good idea to have a style removed ASAP if it's too tight. "One way you can determine whether or not a style is too tight is if pain is associated," says Dr. Luke. "Or if there is redness in the area where the hair has been braided or sometimes people will get what [doctors] consider to be folliculitis — inflammation or even little pus bumps around the hair follicle. And then sometimes the style can be so tight that the skin actually kind of tenses up."

If you think you already have the hair loss condition, the sooner you take action, the better. "Initially traction alopecia is considered to be reversible, meaning it's not permanent damage that's been put on the hair follicles, but if the style is continuously used or too tight, then that can actually result in a more permanent type of hair loss," says Dr. Luke. Doctors can inject an anti-inflammatory medication to stimulate hair follicles and reverse traction alopecia early on, she says. In permanent cases, a hair transplant is an option, says Dr. Luke.

A range of hairstyles, which you may hate to give up altogether, can lead to traction alopecia. But making a point to give your hair breaks, keeping an eye out for signs it's been styled too tightly, and visiting a doctor posthaste if you think you are experiencing the condition can also be helpful.

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