Traction alopecia: don't pull too tight

Written by: Dr Aleksandar Godic
Published: | Updated: 09/03/2020
Edited by: Top Doctors®

Most people are aware that certain types of baldness runs in families, or that conditions like alopecia areata can develop as an autoimmune response, but did you also know that your hairstyle can make your hair fall out? For his final instalment in a fascinating series of articles on hair loss, one of our leading dermatologists Dr Aleksandar Godic reveals all about traction alopecia…



What is traction alopecia?


Traction alopecia is an acquired hair loss condition that develops after years of prolonged and repetitive tension on hair. It is caused by wearing tight chignon, cornrows, dreadlocks, weaves, and braids or by using hair extensions, chemical relaxers, and rollers. Any styling which pulls the hair tight with excessive force can ultimately lead to hair loss. Patients initially present with itching, redness, scaling, inflamed follicles (folliculitis), pustules, broken hairs, hair thinning and hair loss at the front of the scalp and sides (temple) of the head, although it can affect any part of the scalp, depending on the style.


Can traction alopecia be reversed?


The prolonged and excessive tension leads to permanent destruction of the hair follicles, the formation of a scar, and permanent alopecia.


Firstly, people with traction alopecia should change their hairstyle to prevent further tension on the scalp. It is also advisable to avoid scalp chemicals and heat. For patients in whom we suspect that there are few or no more vital follicles (those still capable of producing hair) present in the scalp, we advise a scalp biopsy to obtain the correct diagnosis and assess the number of vital follicles left. 


When scar tissue has replaced hair follicles, the damage is irreversible and permanent and the alopecia has progressed to an end stage. Treatment options include topical steroids or steroid injections into the scalp to prevent further progression and permanent scarring, occasionally systemic treatment is necessary, but once scar tissue develops we can offer patients wigs, hair systems, scalp tattooing and scalp camouflage.


Certain wigs can also worsen tension alopecia, so it is important that patients chose a proper one, which does not exacerbate the condition.


How is traction alopecia diagnosed and managed?


Patients who present with hair loss should see a specialist as soon as possible to get the best outcome out of the treatment. A detailed patient history is crucial to obtain the relevant information in terms of possible underlying causes and trigger factors, which need to be addressed in addition to hair loss treatment.


The examination involves the inspection of affected areas (e.g the scalp, eyebrows, beard, etc.). If the underlying cause of the hair loss is suspected to be something else, such as an under- or overactive thyroid, a general physical examination will also be conducted.


Dermoscopy of the scalp helps a dermatologist to see hair shaft and scalp abnormalities and help to obtain a correct diagnosis. A skin biopsy is sometimes required (when scarring alopecia is suspected, for example) and a blood test (levels of hormones and other things) when we suspect underlying conditions which may contribute to hair loss.

By Dr Aleksandar Godic

Dr Aleksandar Godic is a leading consultant dermatologist based in London. Dr Godic graduated in 1996 from the Faculty of Medicine, University of Ljubljana, Slovenia. He finished his Master of Science in 1997 (Thesis: Analysis of Hair Surface in Patients with Ichthyosis Vulgaris, University of Ljubljana, Slovenia), and training in dermatovenereology in 2001. In 2004 he finished his PhD (Thesis: Molecular and Genetic Analysis of Darier Disease in Slovenian Population, University of Ljubljana, Slovenia).  He spent a year of postdoctoral fellowship in dermatopathology at the University of California, San Francisco, USA (UCSF), had additional training in dermatology at the Department of Dermatology, Yale University, USA (in 2005 and 2006), and was awarded the European Board Certificate in Dermatopathology (2006).

In 2005, Dr Godic was appointed as an Assistant Professor for Dermatovenereology at the Faculty of Medicine, University of Ljubljana, Slovenia. He is a regular invited lecturer at the European and world anti-aging congresses in Paris, and in Monte Carlo, respectively. In 2014 he became a board member of the World Council for Preventive Regenerative and Anti-Ageing Medicine (WOCPM). Recently he became a Scientific Board Member of BHI Therapeutic Sciences and will start seeing patients in Slovakia who are interested in autologous (self) fat transfer supplemented with stem cells into the face, V neck, hands, scalp and earlobes. He has numerous publications in high impact factor journals and has written a chapter on hair and scalp diseases in a textbook for medical and dental students. He contributed to the monographs on psoriasis and on skin aging and skin disorders.

With more than 20 years of experience, he is a at the cutting-edge of dermatology, constantly looking for new and innovative treatments. His special interests include general dermatology, hair and scalp disorders, skin cancer, pigmented lesions, inflammatory dermatoses (acne, psoriasis, rosacea, vitiligo, etc.), skin surgery, dermatopathology, anti-aging, and cosmetic dermatology.

Further to this, Dr Godic offers a revolutionary fat transfer treatment that uses patients' own stem cells to achieve lasting, transformational results.

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