Management of Traction Alopecia: Our Experience and a Brief Review of Current Literature Recommendations

Traction alopecia (TA) is a common hair loss condition secondary to prolonged traction, hair shaft trauma, and sustained pulling leading to follicle loosening and perifollicular inflammation. Although often categorized as nonscarring, increasing evidence indicate that late-stage TA can cause permanent hair loss and scarring from chronic folliculitis and sustained hair tension.¹ TA is often seen in women of African descent, although cases have been reported in African men, Hispanic women, Japanese women, Sikh men, and ballet dancers.^2,3 Early effective treatment is needed to prevent progression and potential scarring; therefore, a review and summary of published literature for best practices is necessary and valuable. (Table 1)

Leading recommendations for TA are preventive behaviors, as TA is often reversible after hairstyle modifications. Discontinuing or minimizing practices contributing to traction or scalp damage such as chemical relaxers, tight locs/braids/cornrows with or without extensions, ponytails, or tight turbans can be effective at any stage, though marked benefits are noted during early TA.³ Tact and respectful clinician-patient dialogue is required when encouraging patients to change hair care practices, as hair often holds important cultural significance. Simply telling patients to stop high tension hairstyles without understanding why such styles may be important and delving into alternatives may not align with cultural competency principles.