Traction alopecia is hair loss caused by repeated tension on the follicles (braids, ponytails, extensions, tight hairstyles). In its early stages, it is reversible if you change your hairstyle; if it persists, it can become permanent. Consult your doctor early.
What is traction alopecia?
It is an acquired and mechanical alopecia: chronic traction damages the follicle and can lead to miniaturization and, in prolonged cases, scarring. It affects all genders and ages. It usually starts in the frontal and temporal hairline, although it can affect other areas depending on the hairstyle.
Rapid differential
- Non-scarring (early): viable follicles. It can be reversed by removing the traction.
- Cicatricial (late): Permanent, patchy follicular loss. Requires medical management and, if stable, coverage options.
Signs and symptoms: warning checklist
- “Fringe sign”: Fine hairs preserved at the edge of the frontal hairline. This is a sensitive and specific finding.
- Pain, burning, or tightness of the scalp when the hairstyle is undone.
- Brittle hair and perifollicular scales.
- Thinning areas in the hairline, temples, or nape of the neck that progress over time.
If you see two or more items, loosen the traction and request a dermatological diagnosis.
Hairstyles and habits that increase the risk
- Tight braids and cornrows, dreadlocks/locs, sew-in or glue-in extensions.
- High ponytails and tight buns, ballerina updos, headpieces, or tight turbans.
- Combined use of heat and chemicals (straightening, bleaching) that weaken the hair shaft and aggravate traction damage. Reducing tension and alternating styles is the most effective and impactful intervention.
Is traction alopecia reversible?
Yes, in early stagesby eliminating tractionand correcting habits. In prolonged cases, irreversiblescarring occurs. The window of reversibility is clinical and varies by person; acting early improves the prognosis.
If you change your hairstyle and the area stops receding and fine new hairs appear within 3–6 months, this is usually a good sign. If the plaque is smooth, shiny, and without visible pores, scarring may be present and reversal is limited. (General guidance; requires medical evaluation.)
Treatment at D'Atri: phased plan
Goal 1. Stop the cause
- Eliminate or loosen the traction.Switch to looser styles and rotate hairstyles. Avoid accessories that pull. This is the critical intervention.
Goal 2. Soothe inflammation and symptoms
- High-potency topical corticosteroids and, in outbreaks with pain/itching, intralesional triamcinolone.
- In associated folliculitis: antibiotics with a limited anti-inflammatory effect. These measures slow progression and improve comfort.
Objective 3. Stimulate viable hair
- Topical minoxidil daily as an adjuvant.
- Low-dose oral minoxidil may be considered in selected cases under medical supervision. Emerging evidence.
Objective 4. Regeneration and coverage
- PRP/mesotherapy: adjuvants for scalp quality; they do not replace changing habits or controlling inflammation.
- Hair Implant (FUE Technique): option only when the alopecia is stable, without active traction and with realistic expectations. We evaluate donor density and risk of recurrence due to habits. (Strict selection). Regular follow-up allows the plan to be adjusted and relapses to be prevented.
“Home Remedies”: Dos and Don’ts
How to prevent traction alopecia
Handy Snippet Checklist: “10 Protective Habits”
- Choose loose hairstyles and alternate styles every 1–2 weeks.
- If you wear braids or extensions, ask for low tension from the start.
- Avoid sleeping with high ponytails or tight buns.
- Limit the heat (iron, curling iron) and add thermal protectors.
- Space chemicals (straightening, discolorations).
- Use padded accessories and without hooks that pull.
- Protect your scalp with sunscreen during outdoor activities.
- If pain or tightness occurs, undo your hairstyle immediately.
- Teach girls and adolescents how to not tighten their hair.
10. Check early for marginal clearance or “fringe sign”.
Special cases and cofactors
- Hair that is fragile due to chemicals or heat: Multiplies the damage due to traction. We adapt a “low manipulation” plan and hair shaft repair.
- Populations with cultural hairstyles: we work on respectful prevention of the style, prioritizing low-tension and rotation techniques.
- Mixed diagnoses: May coexist with CCCA or other types. Biopsy guides management when in doubt.
Quick Action Guide
- Loosen your traction today.Switch to looser styles.
- Trichological evaluationwith trichoscopy to measure activity.
- Medical plan: anti-inflammatory + minoxidil + education in habits.
- Controls every 8–12 weeks until stabilized.
- Advanced optionsIf there are sequelae: PRP as an adjuvant and eventual FUE when stable.
Why choose D'Atri Hair Medicine
At D’Atri Medicina Capilarwe diagnose and treat traction alopecia with a comprehensive approach: high-precision trichoscopy, education on habits, anti-inflammatory and stimulating therapies, and close follow-up. When appropriate, we plan FUE in stable contexts for natural results. 15+ years, 8,000 patients, and a leading teaching team in FUE Technique training.
Book your personalized diagnosis and receive a clear plan with measurable goals and support from the medical team.
Frequently Asked Questions
“Cure” means eliminating the cause. Hairstyle changes and medical treatment can reverse early stages. If scarring is present, the goal is to stabilize and improve coverage.