Traction Alopecia: Causes, Prevention, and Management

Traction alopecia = hair loss from chronic mechanical tension on follicles.

High-Risk Styles

• Tight braids, cornrows, dreadlocks
• High ponytails, buns, weaves, extensions
• Turbans, hijabs worn tightly
• Chemical relaxers + tension (synergistic damage)

Pathophysiology

• Sustained traction → follicular inflammation → fibrosis → permanent miniaturization
• Early: reversible (non-scarring); Late: scarring alopecia

Clinical Signs

• Thinning/hair loss at frontal/temporal margins (pattern matches tension)
• Perifollicular erythema, pustules, scaling
• "Fringe sign" — retained vellus hairs at margin

Management

• Primary: Eliminate traction (loose styles, natural hair)
• Early: Topical/minoxidil, intralesional steroids for inflammation
• Advanced: Hair transplantation (if donor supply)
• Prevention: Education on loose styling, rotation, protective styles without tension

Cultural sensitivity essential; many high-risk styles have cultural significance.