Traction alopecia is caused by chronic traction (pulling) on the hair follicle. It mostly occurs in African-American women and men who braid their hair too tightly. It is also common in other ethnic groups known for traditional hair styles that involve pulling the hair.

There is also seen a pronounced traction alopecia in the beard area of this Sikh man. The Sikh men do not cut scalp or beard hair. The beard hairs are pulled straight and then twisted and tightly knotted. Daily knotting often results in this form of alopecia.

Men who attach hairpieces to their existing hair also suffer from this type of hair loss. The traction alopecia in such cases can also lead to permanent hair loss if the hairpiece is attached in the same location over a long period of time.

If we put the examples from ethnic groups aside, traction alopecia occurs most often in pre-teenagers, teenagers, young adults then it does in older men and women.

It is a very unfortunate state that hair styles and fashions and hair styling methods are causing baldness and hair loss among today’s younger generations. The hair loss is caused by long term hair pulling and breakage due to very tight hair braiding, hair weaves and cornrows.

The over use of hair style aids such as sponge hair rollers or curling irons may also promote traction alopecia. It often shows as distinct patches of hair loss in those areas where the hair and hair follicles have been put under excessive strain. The hair loss may occur anywhere on the scalp depending on the nature of the hair style or process that is causing the traction alopecia. Prolonged traction alopecia can lead to cicatrization of the new hair follicle and permanent hair loss.

Traction alopecia is reversible if diagnosed in the early stages. Permanent hair loss can occur too slowly for immediate detection. Hair loss is often occurs in the front, and hair line but is also subject to the immediate adjacent area to where the hair is being pulled and damaged.

An effective treatment is to simply avoid hair styling that puts excessive strain on the hair. Even with removal of the cause of traction alopecia it may take up to three months for the hair to recover. Areas of scalp subjected to chronic hair pulling may never fully recover.

Traction alopecia is generally a non-scarring, non-inflammatory form of hair loss although long term use of hair styles involving traction over 3 or more years may result in a mild immune cell infiltrate and irreversible scarring damage to some hair follicles. Any form of chronic excessive hair pulling will eventually lead to fibrosis around hair follicles and total destruction of some hair follicles. Once destroyed the hair follicles will not re-grow under any circumstances hence chronic traction alopecia can also be described as a scarring cicatricial alopecia.

Permanent traction alopecia does not respond to medical treatment such as minoxidil or finasteride due to non-genetic nature of hair loss. The only way one can treat this condition is with hair transplant or follicular unit hair grafting. Number of patients with traction alopecia coming to hair transplant clinics is generally increasing and the treatment is providing them a good response.