Traction Alopecia By Dr Ruth Benjamin MB BS LTTS

Traction alopecia (TA) is caused by excessive tension or hair being pulled too tight in the same direction. It occurs when hair shafts are extracted from their host follicles due to tight hair styling techniques e.g., ponytails, top knots, hair extensions, chignons, pleats, plaiting, tracks, cornrowing etc.

Hair follicles do not tolerate these traumatic potentially injurious activities well and many are destroyed thereby. Needless to say, this can cause significant regions of permanent baldness.

Sites affected can be anywhere, however the anterior and occipital margins, parietals and auriculars are frequently seen areas of such needless injury.

EPIDERMIOLOGY:

• This is the most common form of alopecia seen in black community because of traditional method of hair styling.

• It is also seen in Asian Sikh boys who twist their hair and turbans very tightly on the scalp.

• However, it can affect any ethnic background or age.

PREDISPOSING FACTORS AND PATHOGENESIS:

This type of alopecia can be caused by:

• Chemical relaxers.

• Regularly wearing tight cornrows, dreadlocks, chignon, and braids All the above methods can cause mechanical damage of the hair follicles. Thus, in area of traction inflammatory response is seen which presents as perifollicular erythema with pustules and papules. In case of chronic and repeated traction, atrophy of hair follicles occur which causes permanent hair loss.

Early Stage:

• Itching

• Redness

• Folliculitis or perifollicular pustules and papules

• Multiple short broken hairs

• Thinning • and hair loss

Late stage:

• Scarring alopecia with decrease hair follicular marking occurs.

• Generally, traction alopecia affects the hair line. Thus, the most common sites of hair loss in TA are frontal and temporoparietal areas but any area of the scalp can be affected because it depends on an individual’s hair hairstyle.

• “Fringe sign” is present, that means some hair is retained along the frontal and temporal rim of the hairline.

TREATMENT:

• Cuts long hair

• Avoid braiding and hair extensions.

• Avoid chemical relaxants and excessive heat from hair straighteners and so on.

• Protect your scalp from sunlight especially bald areas.

Medical treatment:

• Topical minoxidil solution: may stimulate hair growth.

• Topical corticosteroid: may improve symptom of itchiness or redness of the scalp.

Surgical treatment:

• Hair transplantation: In case of permanent hair loss

Other methods of treatment:

• Hair pieces and wigs

• Cosmetic camouflage: this is a small, pigmented spray that may help to hide the hair loss areas, but these are not waterproof. Thus, they are easily washed away if the hairs get wet.

PROGNOSIS

It can be cured but it depends on the stage of the hair loss. So, if traction alopecia (TA) is identified earlier and the person stops his tight hair styles, then the hair can re-grow again, but longstanding TA can cause permanent hair loss.

Editor’s note: As Barbers we are often the first point of contact with our guest’s scalp and hair issues, and our guests themselves. A lot of the time we are the first and only people to point out these issues in the first instance. You should always refer your guests to a doctor or hair specialist however, I think we should all have some knowledge on the most common issues we see quite regularly in the chair. This gives us a better understanding of what our guest is going through, and we can give support and comfort to them by being equipped with some knowledge on these subjects.

Professor Barry Stevens is one of the world’s foremost experts in Trichology. He heads the Trichological Society in London, and his papers are internationally recognised as a leading source of accurate information on scalp and hair disorders by Doctors and Trichologists alike. He has been a consultant to the BBC, The Thermal Hair Appliance Industry, Unilever Hair Cosmetics and has been awarded for “Outstanding Services to Hair Sciences – Worldwide”