Traction Alopecia Hair Loss
Traction alopecia is defined as hair loss causes by prolonged traction on hair follicles. This traction is produced by various hair styling practices including tight ponytails, tight braids, straightening procedures such as hot combs, or the use of tight curlers, and the use of hair weaves that may be attached too tightly or may be pulled off before reapplication. These hair styling practices are often shared by members of specific ethnic groups and thus certain patterns of traction alopecia are more common in certain groups. In my practice, the most common groups to present with traction alopecia are young Latina women who wear their hair in tight ponytails at the vertex of the scalp, African American children due to tight braiding practices and African American women due to various straightening practices and the use of hair weaves.
Initially the alopecia caused by chronic traction is reversible. However, if the traction continues over many months to years, the alopecia becomes permanent. The margins of the scalp are most commonly affected by traction alopecia. There is usually preservation of the marginal fringe of hair because these marginal fringe hairs are too short to be involved in the traction process. In active disease, there may be a folliculitis as evidenced by small follicular pustules. Over time the involved area seems devoid of any large follicles and only small vellus peach fuzzy type follicles remain. Unlike usual scarring alopecias, the affected area in permanent traction alopecia does not appear shiny, the skin seems normal.