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  • Traction alopecia is a form of hair loss in which excessive tensile forces cause damage to the hair follicle and hair loss.

  • Is more common in patients of African descents, due to frequent use of tight hairstyles.

  • Patients often present with perifollicular erythema, inflamed papules, or pustules in areas of traction hairstyling.

  • Early recognition (within 1 year of onset) is crucial for hair regrowth.


  • Obtain a thorough history on patients’ hair care routine and styling methods.

  • Look for the “fringe sign,” which is defined as a band of short terminal hairs retained on the hairline, along the margin of the patch.


  • Primary treatment is discontinuing or modifying hairstyling techniques.

  • Adjunctive therapies such as antibiotics or corticosteroids can help with the inflammation.


  • Hairstyles causing pain, redness, pimples, or hair loss should be discontinued.

  • Earliest signs of traction alopecia are pain during hairstyling and traction folliculitis.

  • The features of traction alopecia are biphasic, meaning that the alopecia is reversible in early stages, but irreversible in late stages.


  • It is important to obtain a thorough history of traumatic hairstyles even if remote.

  • It is important to consider traction alopecia in any area where hair is exposed to excessive traction.

  • It is important that patients understand what practices should be avoided and have realistic expectations .


  • Although hair loss most frequently occurs in the frontal or temporal scalp, the location depends on the site of traction.

  • Hair casts are a clue for clinicians that excessive traction is still taking place.


  • Avoid traction hairstyles for at least 2 weeks after hair relaxation.

  • When you can, keep hair as loose as possible.

  • Vigorously brushing or massaging the hair will not help with regrowth.

  • Hair extensions can cause traction.


Traction alopecia is a form of hair loss initiated by prolonged tension on the hair, leading to damage of the hair follicles. This excessive traction on the hair shaft and follicle can be caused by certain hairstyles such as tight buns, high ponytails, weaves, hair extensions, and braids. The severity depends on the extent and the duration of hair traction. The risk of hair loss is higher in the setting of chemically relaxed or heat treated hair.1

Traction alopecia is one of the most common alopecias in patients of color. One-third of adult women of African descent and up to one fourth of adolescents and teenagers of African descent are affected.2 Traction alopecia also occurs with certain religious and occupational hairstyling. In the early stage of disease, patients typically present with folliculitis and have a positive prognosis with behavior modification. However, without intervention it can progress to cicatricial alopecia.3

In patients with an unclear history of ...

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