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Traction Alopecia is Irreversible: This Is What You Can Do to Prevent It


Almost half of Black women experience some form of hair loss, traction alopecia the most common among them. However, few doctors are familiar with Black hairstyling practices, leaving many to sort through useless – or even harmful – information and advice on their own.

Once traction alopecia is noticeable, it can’t be reversed. But if caught early enough, it is possible to prevent further damage. And if you’re already experiencing it, doctors say you still have a few options. 

Dermatologist Dr. Crystal Aguh, M.D. a board-certified dermatologist and director of both the Hair Loss and Scalp Disease clinic and Ethnic Skin Center at Johns Hopkins School of Medicine – and one of just a small group of Black dermatologists across the country specializing in hair loss – offers advice and tips on how to recognize the warning signs of traction alopecia and how to stop it in its tracks.

What is Traction Alopecia?

Traction alopecia (Keyword: traction – refers to pulling) is mainly specific to the stress of tight hairstyles. It is a type of hair loss that occurs due to repetitive, prolonged pulling forces of the hair.  

What Causes Traction Alopecia?

The author of “90 Days to Beautiful Hair and Fundamentals of Ethnic Hair-The Dermatologist’s Perspective,” Aguh shares that when the same hairstyles like weaves, braids, ponytails, rollers or rods are worn for long periods of time or are improperly performed— promoting excessive tension and weight—they cause a loosening of hair strands from the hair follicles that inflicts undue trauma because the follicles have become inflamed, damaged and eventually scarred. If sustained over long periods of time, it can lead to permanent hair loss.

Although traction alopecia is seen among all ethnic groups and ages, it is most commonly found in Black women who tend to wear hairstyles that impose some degree of ongoing tension on the hair and scalp.

How do I Know if I Have Traction Alopecia?

Dr. Aguh says hair loss is the number one, and potentially the most obvious symptom, of traction alopecia. While it can occur anywhere on the head, it is most often seen along the hairline, where hair-pulling forces are most prevalent. 

The hair loss is often preceded by soreness, itching and small, flesh-colored or white bumps around the hair follicles, serious warning signs that traction alopecia could occur. Initial hair fall can be temporary, but if hairstyling habits are unchanged, perpetual hair loss is imminent. 

How to Avoid Traction Alopecia

Dr. Aguh recommends rethinking or at least giving the scalp an occasional break from the type of hairstyles that frequently induce traction alopecia, like too-tight ponytails, tight braiding, excessive flat ironing, chemical abuse and improper installation of hair extensions and hair pieces. 

Rotating various hairstyles is also a helpful way to avoid traction alopecia as ongoing, repetitive styling in the same directions tends to trigger it as well.

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How to Treat Traction Alopecia

When it comes to traction alopecia, Dr. Aguh advises prevention is the name of the game. You’ll want to treat your scalp as kindly as possible and give your hair a break from tight styling while you’re ahead, especially if your scalp feels sore.

In many cases, if traction alopecia is treated early, some hair recovery is possible, but since it tends to develop over several years, restoring it gradually becomes much harder, if not impossible. The possibility of recovering the hair greatly depends on the time since its onset, so if it’s long-standing, this means scarring in the hair follicle is likely present – and a hair strand will be unable to grow.

Those in the late stages of traction alopecia can seek treatments such as steroids or topical minoxidil, which are a solid bet, but, unfortunately, not always a guarantee at regrowing some of the hair.

The Final Takeaway

The good news: wearing your hair in a taut ponytail once in a while will not cause permanent hair loss and you’ll likely notice some irritation and soreness before experiencing irreversible damage. But taking a healthy break from the hairstyles that cause it or avoiding them altogether is an effective way to prevent traction alopecia – and possibly even regrow some of the lost hair. 

The not-so-good news: If you’re already experiencing hair loss from tight styles and poor chemical application, you’ve likely scarred the follicle, which means it may not grow back. At that point, the best option is to see a dermatologist for a firm diagnosis, available options and possible treatment, sooner rather than later. 

Resources such as the Black Derm Directory offer assistance in connecting with Board-Certified, Black dermatologists anywhere around the world.

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