Traction Alopecia

March 21, 2018 | By Dr. Sangay Bhutia (Hair Transplant Specialist in Delhi)

This is a common form of hair loss caused by long term pulling forces on the hair follicle. This is generally seen in women who do tight hair styling like tight ponytail or braids. This has also been seen in Sikhs who tightly tie their hair and also wear turban as this causes lot of pulling stress on the hair follicle. This type of hair loss can also manifest in beard area of persons who use hard brush and fixer & then tightly tie the beard by twisting. Many a times it may be due to the weaves, extensions that may be heavy and cause traction on the follicle.

The common presentation is the recession of hair in frontal area that may extend up to temporal region also. But the pattern of hair loss also depends on the hairstyle, which is causing it. Diagnosis requires a high clinical suspicion and a detail clinical history should also include the hair styling and hair care practices in the past. This is very important as when diagnosed early, it can be reversible but long-term traction will lead to permanent hair loss.

Clinical examination of scalp helps in establishing the diagnosis and also helps in differentiating it from frontal fibrosing alopecia and alopecia areata.

There may be redness or pustules in the region of the hair loss called peri follicular erythema or folliculitis. Samrao et al in 2011 described "Fringe Sign" which is a clinical indicator of traction alopecia. This is a basically presence of short terminal hairs at the periphery of marginal hair loss.

In late stages (scarring) there will be increased interfollicular spaces with no redness and inflammation .

How to manage?
In early stages causative hair style should be changed but in certain situations where this cant be done due to religious practice and sentiment then loosening of hair style can be done. It has been shown that heat-treated and chemically treated hair is more prone to hair loss from traction than the non-treated hair. In early stages when there is inflammation or redness then antibiotcs and anti- inflammatory medicine help reducing the inflammation. 2% and 5% minoxidil lotion has shown to promote hair growth in early problem. In late and long term situation one can consider hair transplant as the treatment option for baldness.