Traction alopecia: how to protect your hairline
Dr Sharon Belmo, Consultant Dermatologist
Traction alopecia is one of the most common causes of hair loss I see in clinic, and one of the most preventable. It is caused by sustained tension on the hair, usually from styling. When it is recognised early and the source of tension is removed, the hair can grow back fully. Left untreated, however, the loss can become permanent, so knowing the early signs is well worth your while.
What is traction alopecia?
Traction alopecia is hair loss caused by repeated or prolonged pulling on the hair follicle; the word traction simply means pulling. The tension most often comes from hairstyles that pull on the same hairs day after day. The hairs at the edges of the scalp, around the hairline and temples, are finer and under the greatest strain, which is why these areas are usually affected first.
What sets traction alopecia apart from many other forms of hair loss is that it changes over time. In the early stages it is non-scarring and reversible: once the tension is taken away, the follicles can recover and the hair can regrow. If the pulling continues over months or years, the follicles become inflamed, then scarred, and eventually close. At that point the hair loss is permanent.
Which styles carry the most tension?
Hair loss follows the areas of greatest tension, so the styles that pull hardest carry the most risk. Those most often involved include:
Tight ponytails and buns, which strain the hair around the hairline
Weaves and extensions, where the added weight pulls directly on the roots
Tight braids, cornrows and locs, where loss can appear along the hairline as well as in the partings between braids
Chemical relaxers combined with tight styling, as relaxed hair is structurally weaker and more prone to breakage
Very long or heavy hair can add to the strain, as can tight clips, wig grips, bands and tightly tied headwraps. Many of these styles are valued for cultural, personal and practical reasons, and often professional ones too. In many cases, they therefore cannot be abandoned altogether. The aim is to reduce the tension, so that your hairline is not paying the price for the style.
Early signs to watch for
Catching traction alopecia early depends on noticing small changes before obvious thinning develops. Early signs include tenderness, soreness or a tight, pulling sensation after a style is put in; small bumps or spots along the hairline; redness or darkening of the skin where the style pulls; and short, broken hairs at the edges. A style that causes pain, headaches or bumps is a signal to loosen or remove it, not something to put up with until it settles.
Another clue I look for is a thin fringe of fine hairs that remains along the very front of the hairline, with thinning just behind it. This pattern is very characteristic of traction alopecia.
Why acting early matters
While the follicles are under strain but not yet scarred, they can recover. Regrowth is gradual, and it can take several months before new hair becomes visible, so patience is needed. Once the follicles have scarred, however, no change in styling and no treatment will bring the hair back in that area. Every month that a damaging style continues is a month in which reversible hair loss moves closer to becoming permanent.
How to protect your hairline
A few straightforward habits go a long way towards keeping your hairline healthy:
Ask for styles to be installed loosely; braids, weaves and ponytails should never feel tight or painful
Give your hairline regular breaks between protective styles, rather than moving straight from one into the next
Vary your styles so that the same area is not under tension every time
Avoid combining chemical relaxers with tight styling, as the two together raise the risk considerably
Choose lighter, shorter extensions where possible, and consider leaving the edges out of braids altogether
Remove extensions and weaves if they feel heavy or painful, and do not leave them in for longer than 4–6 weeks
If hair loss has already started
If you have already noticed thinning at your hairline, the most important first step is to remove the tension, as this alone gives the follicles their best chance to recover. It is then important to have your scalp assessed by a dermatologist. Thinning at the hairline is not always traction alopecia: other conditions, such as frontal fibrosing alopecia, can look very similar and are managed quite differently. Examining the scalp with a dermatoscope, and occasionally taking a small scalp biopsy, allows the diagnosis to be confirmed and shows whether the follicles are still viable.
Where the follicles are still viable, treatments such as minoxidil can encourage regrowth, alongside a range of non-surgical hair restoration treatments. If the scalp is inflamed, a short course of anti-inflammatory treatment may be used to settle it. Where the hair loss has become permanent, hair transplantation can restore density, provided the tension that caused the loss is not reintroduced.
The encouraging news is how much of this lies within your control. Small adjustments to the way you style your hair can protect your hairline for years to come. As a consultant dermatologist specialising in hair loss in Afro-textured hair, I assess and treat traction alopecia at every stage, from early tenderness to long-standing loss. If you are concerned about your edges, I would be glad to see you for a consultation at my Harley Street clinic, where we can agree a plan to protect your hairline and, wherever possible, restore it.
About the author
Dr Sharon Belmo is a Consultant Dermatologist and the founder of a private dermatology practice dedicated to Skin of colour, Black skin and hair. She has particular expertise in hair loss in Afro-textured hair, and sees patients at 152 Harley Street, London.
If anything in this article reflects what you are experiencing, Dr Belmo offers specialist consultations to provide an accurate diagnosis and a treatment plan tailored to you.
