Traction alopecia: hair loss from tight hairstyles and how to recover

Alopecia is a general term for hair loss. BAD explains that traction alopecia is a type of hair loss caused by constant pulling, usually on some hairs more than others, leading to bald patches. Often the cause is hairs being pulled repeatedly by tight hairstyles.

The NHS notes that it is normal to lose hair, between 50 and 100 hairs a day, and that some types of hair loss are permanent, like male and female pattern baldness, while others are temporary. Traction alopecia sits between: reversible early, but potentially permanent if the pulling continues.

BAD says the commonest cause is tight hairstyles, with the pattern of loss depending on the style and where the tension is highest. Usually it is the longer hairs at the edge of the scalp that are pulled most.

• Tight ponytails, causing loss at the front and side margins of the scalp.

• Tight buns, causing loss at the sides and back.

• Weaves or hair extensions.

• Tight braids such as cornrows and dreadlocks, with loss seen between the braids.

• Hair clips and tight head scarves.

• Excessively long hair, because of the weight.

BAD says the risk is further increased if these hairstyles are combined with chemicals used on the hair such as chemical relaxers. It notes that it can affect people from all ethnic backgrounds and has been seen in some people with cultural, religious and occupational hairstyles.

It says traction alopecia is often seen in women and children of African descent who regularly use braids or chemicals to make it easier to manage tightly curled hair, and that it is possible that tightly curled Afro-textured hair may be more susceptible to breakage and traction alopecia. It has also been noted on the scalp and beard area in some Sikh men. BAD says it is uncertain whether there is a true genetic predisposition and that it is mainly due to hair-styling practices.

BAD says some people may experience itching, soreness or increased flaking of the scalp. Hair loss can occur anywhere on the scalp where there are pulling forces, often at the front, sides or back.

Smaller hairs within the patch are often unaffected, and a rim of slightly longer hairs, called the fringe sign, may be seen at the edge of the patch furthest from the traction. Within the patches the skin usually looks normal, but if tight hairstyles are still used there may be redness, spots and white flakes attached to hairs (hair casts) at the margins nearest the tension. In longstanding traction alopecia the scalp may look smooth and shiny where the hairs have been permanently destroyed.

BAD says the diagnosis is usually based on the history and pattern of hair loss, and a scalp biopsy may be required if the diagnosis is unclear. The NHS says a GP may be able to tell you what is causing your hair loss by looking at your hair, and asks you to tell them if the hair loss is affecting your wellbeing.

The NHS lists other causes of temporary hair loss, including illness, stress, cancer treatment, weight loss and iron deficiency, so it is worth getting the cause confirmed rather than assuming.

BAD says stopping tight hairstyles is the most important step to prevent hair loss worsening or becoming permanent while giving the best chance of recovery, and that regrowth may start around 3 months after stopping.

Other treatments BAD describes include topical minoxidil solution or foam at 2% or 5%, applied twice daily to the affected areas, which may stimulate growth and can be stopped once you are happy with the growth as long as the traction has been stopped; it is not available on prescription, can be bought over the counter or online, is expensive and not always effective, and can irritate the skin. Potent topical steroids can help itch or redness, and steroid injections may be offered for small areas of inflammation but can thin the skin.

For cosmetic cover, BAD mentions wigs and hair pieces, which can be obtained through the NHS with a consultant's prescription though charges apply, and camouflage fibres or sprays. For permanent loss, BAD says surgical treatments such as hair transplantation are not offered under the NHS but can be sought privately and leave small scars. The NHS says some wigs are available on the NHS but you may have to pay unless you qualify for help, and that no hair loss treatment is 100% effective.

The practical message from BAD is to reduce tension, since stopping tight hairstyles is the most important step. It names tight ponytails, buns, braids, weaves, extensions, clips and head scarves, and notes that combining tight styles with chemical relaxers raises the risk further.

BAD says some people have itching, soreness or flaking of the scalp, and that when the problem is identified early the hair can completely regrow, so it is worth acting on early changes.

The NHS says losing hair can be upsetting, as for many people their hair is an important part of who they are. Your GP may be able to help you get counselling, and you may benefit from a support group such as those listed by Alopecia UK.

On the NHS, a GP can assess hair loss and refer to dermatology if the diagnosis is unclear or the loss is permanent. Not all treatments are available on the NHS, so some people pay for minoxidil or hair transplantation.

Private dermatology or hair clinics can offer treatments sooner. The NHS advises seeing a GP for a diagnosis before going to a commercial hair clinic, so the cause is clear before you pay for treatment.