Traction Alopecia: Causes, Symptoms and How to Treat It

Noticing hairline thinning, soreness after styling, or small bumps around your parting can be unsettling, particularly when your hair is an essential expression of who you are. If you regularly wear braids, weaves, tight ponytails or extensions, these symptoms may be early warning signs of traction alopecia, hair loss caused by repeated, prolonged tension on the hair follicle.*

In the UK, traction alopecia disproportionately affects Black women and women with tightly curled or coiled hair due to the widespread use of protective styles that create constant scalp tension*. However, it can affect anyone who frequently wears high-tension hairstyles, including dancers, athletes and military personnel.

The good news is that traction alopecia is usually reversible if identified early. Understand how to spot the signs, improve scalp tension, and support healthy hair regrowth.

*British Association of Dermatologists. (2024). Traction Alopecia. 

What Is Traction Alopecia?

Traction alopecia is a form of hair loss triggered by mechanical strain rather than hormonal imbalances or autoimmune responses. When hair is pulled tightly over long periods, constant tension damages the follicle unit and weakens the hair shaft.

You may also hear it referred to as "tension alopecia" or "friction alopecia." Unlike female pattern hair loss, which develops gradually over the crown due to genetic or hormonal factors, traction alopecia occurs specifically where physical tension is applied.

What Does Traction Alopecia Look Like?

Traction alopecia usually develops gradually. Recognizing the early signs allows you to make changes before long-term damage occurs.

Early Signs of Traction Alopecia

In the early stages, the hair follicles become inflamed (folliculitis) from constant strain.* You might notice:

• Scalp tenderness, soreness or a feeling of tight discomfort after styling

• Small red bumps or pimples around the base of the hair follicles

• Mild thinning along the hairline, temples, parting or crown

• Tension headaches shortly after getting your hair done

• Tiny keratin rings (hair casts) sliding up the hair shaft

During this early stage, the hair follicle remains alive, and hair loss is usually fully reversible once tension is removed.

Advanced Stages of Traction Alopecia

If tension continues over months or years, constant inflammation can destroy the follicle, replacing it with fibrous scar tissue (fibrosis)*. In advanced stages, you may see:

• Shiny, smooth patches of scalp with no visible follicle openings

• Significant recession along the frontotemporal hairline or temples

• Permanent thinning that does not regrow after removing tight hairstyles

Common Areas Affected

Traction alopecia appears wherever styling tension is strongest. Common areas include:

• The hairline and temples: Frequent pulling from braids, weaves or tight ponytails.

• The parting: Tension from heavy extensions or tight weaving tracks.

• The crown: Heavy buns, high ponytails or dreadlocks.

A helpful indicator of traction alopecia is the "fringe sign." This occurs when a fine rim of short, unpulled hairs remains visible right at the front margin of the hairline, while the hair directly behind it thins from tension.

*Billero V, & Miteva M. (2018). Traction alopecia: the burden of hair care practices. Int J Dermatol. 

When Should You See a GP?

While early-stage traction alopecia can be managed by changing your hair routine and using supportive topical options, certain symptoms require professional in-person medical assessment.

Speak to a GP or dermatologist if:

• Your scalp is smooth, shiny or shows signs of scarring with no visible follicle openings.

• You have severe scalp pain, pus-filled pustules, crusting or open sores.

• You develop sudden, smooth, circular bald patches anywhere on your scalp (which may indicate alopecia areata).

• Hair loss develops primarily at the crown without physical styling tension.

• Your hairline continues to recede despite completely removing all tension for several months.

Differentiating Traction Alopecia from Central Centrifugal Cicatricial Alopecia (CCCA)

It is crucial to distinguish traction alopecia from Central Centrifugal Cicatricial Alopecia (CCCA)*.

CCCA is a primary scarring alopecia that disproportionately affects Black women. Unlike traction alopecia, CCCA typically starts at the center of the crown (vertex) and spreads outward in a circular pattern. It is not caused by styling tension alone and involves underlying scarring inflammation that requires prompt GP or dermatology referral for specialized treatment to prevent permanent hair loss.

* Blattner C, Polley DC, Ferritto F, Elston DM. Central centrifugal cicatricial alopecia. Indian Dermatol Online J. 2013 Jan;4(1):50-1.

Who Is Most at Risk of Traction Alopecia?

Anyone can develop traction alopecia if their hair is subjected to prolonged physical strain. However, UK epidemiological data shows a higher prevalence among Black women and women with tightly coiled or afro-textured hair.

This higher incidence is linked to cultural styling practices rather than intrinsic hair weakness. Afro-textured hair shafts have a unique curved structure that makes them more susceptible to mechanical breakage when exposed to high-tension styles, heavy extensions or chemical relaxers.

Other groups frequently affected include:

• Dancers, gymnasts and swimmers: Due to tight, sleek buns worn daily.

• Military personnel and emergency workers: Required to secure hair tightly under headwear.

• People who wear religious head coverings: Securing undergarments or hair wraps tightly against the scalp.

• Anyone regularly using heavy hair extensions or weaves: Adding extra weight to natural hair roots.

What Causes Traction Alopecia?

Traction alopecia is caused by continuous, repetitive pulling on the hair root.* Common causes include:

• Tight protective styles: Box braids, cornrows, faux locks and micro-braids pulled tightly at the root.

• Weaves and hair extensions: Glued, sewn or clamped extensions that apply constant gravitational weight to delicate follicles.

• Sleek, high-tension styles: Buns, ponytails and slicked-back styles held tightly with elastics or gel.

• Chemical relaxers combined with tension: Chemical treatments alter the protein structure of the hair shaft, making it more brittle and susceptible to tension damage.

• Heavy, very long hair or locs: Natural weight causing pull on the scalp, particularly when put up.

• Tight headwear or accessories: Headbands, tight hats, or hair clips worn repeatedly in the same position.

Can Traction Alopecia Be Reversed?

Yes, traction alopecia can often be reversed if caught early.

• Early, non-scarring stage: If hair follicles are inflamed but not scarred, relieving scalp tension usually stops hair loss. Regrowth can begin within 3 to 6 months once the follicles recover.*

• Advanced, scarring stage: If constant tension has caused scarring (fibrosis), destroyed hair follicles cannot grow new hair. However, relieving tension can prevent further recession, and medical or surgical options may help restore surrounding areas.

How Is Traction Alopecia Treated?

Managing traction alopecia involves stopping mechanical pull, supporting regrowth in active follicles, and seeking specialist care for scarred areas.

Step 1: Loosen Your Hair Routine & Relieve Tension

Removing the source of physical tension is the most important step in treating traction alopecia. Medical treatments cannot succeed if tension continues.

• Take breaks between styles: Allow your scalp at least 2 to 4 weeks of rest between wearing braids, weaves or extensions.

• Loosen the tension: Ask your stylist to braid less tightly, especially around sensitive areas like the hairline and temples.

• Avoid heavy extensions: Opt for lighter, shorter extension pieces to reduce gravitational pull on the follicle.

• Change your parting: Alternate ponytail heights and parting locations regularly to distribute scalp wear.

• Be gentle when removing styles: Take your time removing braids or extensions to avoid plucking or snapping hair strands.

Step 2: Supportive Medical Treatments for Active Follicles

If you have relieved tension but want to support hair regrowth in early or non-scarring stages, topical or oral medications can help stimulate active follicles.*

Topical Minoxidil

Topical minoxidil is an established treatment for stimulating hair growth. It works by increasing blood circulation and nutrients to hair follicles, encouraging them to enter an active growth phase.

• What to expect: With consistent application, early signs of regrowth may be visible within 3 to 6 months.*

• Initial shedding: You may experience a slight increase in hair shedding during the first 2 to 8 weeks. This is normal and indicates that finer hairs are shedding to make way for stronger strands.

• Formulation notes: In the UK, 2% topical minoxidil solution is licensed for female pattern hair loss, while 5% formulations or compounded 7% serums are used off-label under clinical supervision**

Oral Minoxidil Options

Low-dose oral minoxidil (e.g. 1.5 mg daily) may be considered by a clinician if topical treatments cause local scalp irritation or prove inconvenient.

• Off-label use: In the UK, low-dose oral minoxidil is prescribed off-label for hair loss under specialized clinical supervision.

• Side effects: Common side effects include mild lightheadedness, headache, fluid retention, or unwanted facial hair growth (hypertrichosis).

The Role of Anti-Androgens (Spironolactone)

Spironolactone is an anti-androgen medication indicated for Female Pattern Hair Loss (FPHL). Because traction alopecia is caused by mechanical tension rather than hormones, spironolactone is not a direct treatment for isolated traction alopecia. However, if a clinician determines that you have coexisting FPHL alongside tension-related thinning, a combination treatment containing spironolactone may be considered.

Important Safety Warnings:

• Pregnancy & Breastfeeding: Minoxidil and spironolactone must not be used during pregnancy or while breastfeeding. Spironolactone can cause harm to a developing fetus and requires effective contraception.

• Pet Safety Warning: Topical minoxidil is extremely toxic to pets, especially cats and dogs. Always wash your hands thoroughly after applying it, allow your scalp to dry completely before touching pets, and keep containers stored securely.

Step 3: Surgical Restoration for Advanced Scarring

In advanced traction alopecia where hair follicles have been permanently replaced by smooth scar tissue, topical or oral medications cannot regenerate new follicles.

For long-standing, permanent scarring, surgical hair transplantation (such as Follicular Unit Extraction) may be considered. This procedure relocates healthy follicles from unaffected areas of the scalp to the scarred hairline. Surgical options require an in-person assessment by a specialist hair transplant surgeon or consultant dermatologist.

*British Association of Dermatologists. (2024). Hair loss female pattern

**Medicines and Healthcare products Regulatory Agency (MHRA) / Electronic Medicines Compendium (emc). (2026). Summary of Product Characteristics (SmPC) for Topical Minoxidil 5% w/v.

How to Differentiate Traction Alopecia From Other Hair Loss

Because hair loss can have multiple overlapping causes, it helps to understand how traction alopecia differs from other common conditions:

Practical Prevention: Protecting Your Hair and Edges

Preventing traction alopecia involves adopting gentle hair care habits that minimize scalp strain:

• Practice style rotation: Alternate between protective styles and loose, natural styles to give your scalp regular rest periods.

• Protect your edges: Ensure edge hairs are left out of tight braids or cornrows.

• Choose gentle accessories: Use soft fabric scrunchies instead of tight elastic bands.

• Moisturize your scalp: Keep your scalp hydrated and avoid aggressive pulling when detangling dry hair.

• Listen to your scalp: Pain, soreness or bumps after styling are warning signs that your style is too tight. Ask your stylist to loosen the tension immediately.

Traction Alopecia: The Bottom Line

Traction alopecia is hair loss caused by physical tension on hair follicles. It disproportionately affects Black women and those who wear protective styles, but it can affect anyone who frequently wears tight hairstyles.

The most critical step in treating traction alopecia is relieving scalp tension. Caught early, hair loss is usually fully reversible. Supportive treatments like minoxidil can help stimulate regrowth in active follicles. If you notice signs of scarring, shiny scalp patches, or severe pain, speak to a GP or dermatologist for a tailored assessment.

Frequently Asked Questions

Is traction alopecia permanent?

Traction alopecia is not permanent if caught early. If you relieve scalp tension while the hair follicles are still active, hair usually regrows within 3 to 6 months. However, if tension continues over long periods, it can cause permanent scarring (fibrosis), meaning hair will not regrow naturally.

How long does traction alopecia take to recover?

It depends. Once all tension is removed, initial regrowth can take 3 to 6 months to become visible. Full recovery depends on the duration of the tension and overall hair growth speed.

Do hair extensions cause hair loss?

Hair extensions can cause hair loss if they are too heavy, applied too tightly, or worn continuously without breaks. Lightweight extensions applied with proper tension management carry a much lower risk.

Can wearing a hat or cap cause hair loss?

Hats, caps, or helmets rarely cause hair loss unless they fit tightly enough to cause continuous friction and pulling in the same area over extended periods.

What hairstyles are least likely to cause traction alopecia?

Loose styles carry the lowest risk. Examples include loose natural curls, low slung ponytails secured with fabric scrunchies, loose twists, and open styles that do not pull at the root.