Traction Alopecia

1. What are some common causes of traction alopecia?

Traction Alopecia is a specific type of hair loss which results when tension is applied to hair follicles (roots) for an extended period of time. Traction Alopecia, therefore, differs from most other causes of hair loss as it is behavioral and directly results from the patient’s own activity.

2. Why do these hairstyles result in hair loss?

The problem is caused as hair is excessively pulled, braided (corn rows), twisted, weaved, overly styled, or otherwise abused time after time. These cause an ongoing pulling force on the hair roots (Hair Follicles) which ultimately causes the hair bulb to gradually separate from the follicle and permanent hair loss. Unlike hair plucking which is painful, persistent and prolonged gentle pulling may go unnoticed until hair loss begins to appear.

3. Do you see men very often with this problem? (Please, specify also if you have seen men who liked to wear tight ponytails or man buns)

Although Traction Alopecia is much more common in women as they are more likely to braid and excessively over style their hair (particularly in some specific ethnic groups just as African Americans) we have seen it affect men similarly who may:

  • Wear excessively tight hair buns, ponytails or braids for a long period of time.
  • Wear hairpieces that must be attached/clipped to existing hair.
  • Wear helmets, particularly compression-helmets like those worn while playing sports, horseback riding and car racing. (Baseball caps usually don’t fit tight enough on the scalp to generally cause a problem)

4. Are there any steps to treat or reverse this type of alopecia?

Preventing traction alopecia first requires identifying and treating the root cause of the problem. Behavioral changes are necessary to ensure that hair loss will not worsen. This can be as simple as adjusting the hair style (to braid the hair more loosely, or to remove the braids intermittently to reduce tension buildup on the hair follicles for example). If the individual unconsciously twists, pulls, or plucks their hair due to stress or anxiety a more comprehensive psychological approach must be taken to combat the habit.

Once further damage and hair loss has been stopped, then treatment is available to permanently restore the lost hair follicles. As non-invasive methods such as the use Low Level Laser Therapy (LLLT) often have limited positive results, Hair Transplantation is usually the best and most permanent treatment option for treatment.

5. What should men do who want to wear a man bun, but don’t want to lose their hair? For example, is a looser bun better?

The solution must resolve the underlying cause. If the patient is losing their hair due to their hair style for example having an overly tight hair bun or hair braids then the answer is adjusting or changing the hair style.  If the patient is losing their hair due to wearing of a tight helmet over an extended period of time then the best response is to reduce the total time duration that the person has this type of helmet on their head.