What is Traction Alopecia?
Traction alopecia is a condition that happens when someone’s hairstyle constantly pulls on the hair roots. This condition is often seen in women of African descent who have tightly curled, spiral hair. The good news is, traction alopecia can be prevented. With the right information and education, it can totally be avoided.
What Causes Traction Alopecia?
Traction alopecia (TA) is a condition where your hair falls out because it’s consistently being pulled or tugged on.
Risk Factors and Frequency for Traction Alopecia
Traction alopecia, a hair condition caused by tight braids, is commonly seen in people with Afro-Caribbean hairstyles. This problem usually starts in childhood, and can be reversed if caught early. If it becomes chronic, however, it can lead to permanent scarring and hair loss. It affects both children and adults, with data from South Africa showing that nearly one-third of adult women experience changes to their hair due to this condition.
- The condition is most common in females, affecting up to 31.7% of adult women.
- In children between ages six to 15, the prevalence ranges from 8.6% to 21.7%.
- A particular study found that 18% of African American girls aged 5.4 to 14.3 years old show signs of traction alopecia.
- The condition is also more prevalent in African schoolgirls than boys (17.1% versus 0%).
- Male adults that wear cornrows and dreadlocks are likely to be affected too, but the rate is significantly lower than females (2.3% versus 31.7%).
- The youngest reported case was an eight-month-old child.
- Even though it can start in school-aged children, the rate of occurrence increases with age and is the highest among adult women.
Signs and Symptoms of Traction Alopecia
Traction alopecia is a hair loss condition commonly related to styles that pull the hair tight, such as certain Afro-Caribbean hairstyles with tight braids. Hair loss usually starts around the temples, the ear-front region, and above the ears, but it can also happen on other parts of the scalp where tight styles like “corn row” patterns are used. Other symptoms can include inflammation of hair follicles, presence of hair shells, reduction in hair density, few hairs being replaced with fuzzier vellus hairs, and occasional broken hairs in the affected areas, which eventually leads to hair loss leaving scars. It can also cause headaches that get better when the hair is loosened. The hair loss pattern is characteristic, reflecting where the hair was pulled tight. The problems usually start in childhood when they might still be reversible. Temporal thinning could also be part of a genetic pattern seen in people without any tension on their hair. Styles that often result in hair loss include ponytails, hair twisting in Sikh boys, tight scarfs, chignon, braids, cornrows, twists, sister locks, dreadlocks, weaves, extensions, and using curlers.
- Starts with hair loss around temples and above the ears
- Other symptoms like inflammation of hair follicles, presence of hair shells
- Reduction in hair density
- Replacement of a few hairs with fuzzier vellus hairs
- Occasional broken hairs in the affected areas
- Headaches that get better when the hair is loosened
- Characteristic hair loss pattern reflecting where the hair was pulled tight
- May start in childhood and might still be reversible
- Can also include a temporal thinning as part of a genetic pattern
About evaluating the condition, traction alopecia shows up as hair loss usually along the marginal hairline, which includes the front, sides, or back portion of the head. Hallmark signs include less distinct follicular markings and the presence of a fringe of thinner or miniaturized hairs. The unique sign is the retention of smaller diameter hairs along the front and/or side hairline, called the ‘fringe sign,’ correlating with the presence of vellus hairs seen under a microscope. Presence of hair shells is a sign of ongoing or continued traction alopecia. Hair loss following linear, curved, or geometric patterns should make the examiner suspect traction alopecia. On the other hand, body hair, eyebrows, skin, and nails are not affected by this condition.
Testing for Traction Alopecia
The severity of a condition known as traction alopecia, which is hair loss caused by pulling on the hair, is determined using a method called the Marginal Traction Alopecia Severity Score (M-TAS). This is a method that uses photographs to measure how severe the hair loss is. It focuses on the hairlines at the front and back of your head and rates them on a scale from 0 to 9. This method has been used in scientific studies to see if there is a link between specific risk factors and the seriousness of traction alopecia. The M-TAS might also be a useful tool to track how well a treatment is working.
Another method used to diagnose traction alopecia is dermoscopy. This is a kind of skin test that can help identify common signs of the condition. One typical sign is the presence of hair casts which are loose, cylindrical structures found around the hair shaft. They can be white or brown in color.
In cases where the hair loss is in patches along the hairline, dermoscopy might show a decrease in the number of hair follicles, no follicular openings, and lots of hair casts at the edges of the patch. If the hair loss is more spread out, dermoscopy might show normal hair density but with a lot of hair casts present. Both of these observations can assist in confirming if a patient has traction alopecia.
Treatment Options for Traction Alopecia
The treatment for traction alopecia, or hair loss caused by pulling or tension on the hair, depends on how long you’ve had the condition and whether the hair loss is permanent. There are three different stages of this disease, each requiring different strategies for treatment.
The first stage, called the prevention stage, mainly involves education. Parents, children, teenagers, and young adults are taught proper hair care practices to avoid tension on the hair follicles, especially since the hair follicles are more susceptible to damage during this time.
If you’re in the early stage of traction alopecia, when the hair follicle is still intact, the focus is on reducing tension on the hair. This can be achieved by using hairstyles that lessen the tightness of braids or avoiding excessive pulling. It’s also suggested to avoid using chemicals or heat on the hair and brushing the affected area. If there are signs of inflammation, like redness, flaking or tenderness in the scalp, corticosteroid creams or injections might be used. These reduce inflammation and help the hair to heal. If there are small abscesses (pustules) on the scalp, oral or topical antibiotics may also help because of their anti-inflammatory effect.
In the final stage of the disease, where the hair loss has been longstanding, surgical options like hair transplantation could be considered. Techniques like micro-grafting and mini-grafting, which involve transplanting small pieces of hair and skin to bald areas, could be beneficial.
A recent experimental treatment involves using alpha-1 adrenergic receptor agonists, which cause the tiny muscles attached to the hair to contract. This makes it harder to pull out the hair. A medication called phenylephrine, which falls under this category, has been tried topically (applied to the skin) for traction alopecia. Results from one study involving female patients suggested that this medication could reduce hair loss caused by traction. It was also found that after using topical phenylephrine, more force was needed to pull out the hair, thus protecting it from harmful tension.
What else can Traction Alopecia be?
These are some skin conditions that one might be diagnosed with:
- Atopic dermatitis
- Epidermal nevus
- Friction alopecia
- Histiocytosis
- Scleroderma
- Seborrheic dermatitis
- Secondary syphilis
- Tinea capitis
- Traction alopecia
