What is traction alopecia? 

Talk about bad hair days...Your too-tight ponytail could be making your hair fall out!

What causes traction alopecia is tension or stress on the hair. Repetitive or prolonged pulling of the hair can cause hair to break or fall out. Traction alopecia was first noticed in Greenland in 1907, reported by patients whose pigtails were too tight. 

Repetitive and tight hairstyles, such as cornrows or braids, are the main cause of traction alopecia. The constant pulling of the hair results in damage to the dermal papilla and hair follicle, which ultimately can result in hair loss in areas where the hair is stressed, yanked and pulled. Women who wear tight buns or chignons, people who often keep their hair in firm braids, and anyone who often pulls their hair back tightly is at risk of developing traction alopecia. 

Chemical processing also can be a cause of traction alopecia because it weakens the hair in a similar fashion to excessive pulling. Chemical processes such as hair dye, chemical straightening, bleaching and perming can result in damage to the strength of hair -- specifically tensile strength, or the elasticity of hair. 

Where does it show? 

Generally, traction alopecia shows up along the frontal and temporal scalp. It can occur anywhere, depending on where the hair has been pulled. 

Traction alopecia can show along parts or hairlines where hair has been damaged due to excessive and repetitive pulling and tightness. If you often part your hair down the center tightly, the hair loss will show along that part. If you wear a tight bun, hair loss may show itself along your full hairline and forehead. If you often wear cornrows or lines of braids, the alopecia may appear in many parts of your scalp. In this case, hair pulling occurs in numerous places. 

Misdiagnosis 

Sometimes, it is hard to know if you have traction alopecia or a different kind of hair loss. The condition is often mistaken for other types of alopecia, such as alopecia areata, androgenetic alopecia, primary lymphocytic cicatricial alopecia, trichotillomania and telogen effluvium. This is especially common if there is no clear history of "traction" or pulling on the hair.

Some of these types of hair loss cause a similar pattern of hair loss, so the condition can be easy to diagnose if you don't know -- or don't have clear signs of -- the causes of traction alopecia. It's important to tell your doctor about your hairstyles if you experience hair loss. These clues might seem unimportant, and you may feel your hairstyles aren't something you'd normally discuss with a doctor. But it may help the doctor diagnose you properly and lead the doctor to the right form of treatment. 

Who develops traction alopecia? 

Traction alopecia is most common in women and men of African descent. Constant or tight braiding and tight hairstyles can cause traction alopecia in this ethnic group. It's often found in Sikh men and Japanese women, who also tend to wear tight, pulled-back hairstyles. 

Interestingly, traction alopecia develops more in children and young men and women than in older men and women. 

Treatment 

If detected early, traction alopecia can be treated and cured. It's important to catch the symptoms of the condition early in order to stop further damage from incurring. Because it can be confused with other types of hair loss, it's important to know about different types of hair loss, the causes and to inform your doctor about your hair habits. 

The simplest ways to cure early forms of traction alopecia are to loosen hairstyles or to stop chemical treatments that may be contributing to the condition. You often can reverse the signs of traction alopecia by simply curbing its cause -- tight hairstyles, cornrows, or chemical wear and tear. Many patients are unaware that the cure, with an early form and early detection, is simple and direct: Just stop the tension on your hair. 

Late-stage traction alopecia is a different story. It is much harder to deal with hair loss from tightness and pulling at a late stage than it is at an early stage. Early symptoms of traction alopecia can be reversed with loosening hair or stopping chemical damage, but late-stage traction alopecia usually can be treated with hair grafts and other more extreme treatments. 

Hair Transplants 

Patients with late-stage traction alopecia are great candidates for hair transplants and often have good or excellent outcomes. If the stress that caused the hair loss is removed and discontinued, and if the hair is replaced with a transplant, the patient should not have further problems. Although transplants might seem extreme, they are often the only way to fill in the gaps created by traction alopecia and are not generally a difficult surgical process. 

It is becoming more and more common for young African-American women to request hair transplants due to traction alopecia. This is a troublesome trend because if symptoms were detected earlier, such procedures would be unnecessary. 

Prevention 

Traction alopecia is not a genetic condition and is completely preventable. It's important to know the signs and symptoms of traction alopecia and to be especially cautious if you tend to wear tight hairstyles. Choose looser styles or vary the location of braids and parts in order to avoid future problems. 

When it comes to preventing hair loss, most people would agree that a hairstyle isn't important enough to risk severe and embarrassing hair loss later in life. Knowledge and a conscious effort to maintain a healthy hairstyle are the simplest ways of avoiding future trouble. 

If you think you may have signs of traction alopecia, visit a doctor. Be sure to tell him or her about your common hairstyles and discuss information about chemical treatments that might be relevant to your hair loss.