Expert Q&A - Traction Alopecia with Dr. Antonella Tosti

Posted by Sasha Kaleigh on Apr 12, 2017 12:04:37 PM


Traction alopecia is a form of hair loss that is caused by excessive stress being placed on the hair shafts. Tight ponytails, braids, cornrows, dreadlocks, extension braids, and weaves are all hairstyles that can cause scalp tenderness and put painful stress on hair. Unlike most cases of hair loss, traction alopecia is preventable. To better understand traction alopecia, we connected with Dr. Antonella Tosti to learn more.

Traction Alopecia with Dr. Antonella Tosti

Q: How can people avoid hair fallout caused by traction alopecia?

Dr. Tosti: Don’t wear a very tight ponytail! This can result in traction alopecia, which is a scalp disorders caused by hairstyles that cause tension to the hair roots. Traction alopecia is a very common disorder among women of African descent as they often wear hairstyles that cause mechanical damage to the follicles such as weaves, extensions, tight braids, cornrows or dreadlocks. Traction alopecia typically affects the hairline, particularly around the temple.

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A tight ponytail can also cause headache! Tension headache is very common in women wearing a ponytail (more than 50% of cases). Pulling of the nerves of the scalp activates the sensory nerves and triggers or worsens a headache.

Q: How can traction alopecia be recognized?

Dr. Tosti: The patch of traction alopecia is not completely bald but contains short thin vellus hairs, as these are too short to be pulled by the hairstyle. The presence of short terminal hairs along the rim of the patch is also typical.


Q: Is traction alopecia reversible?

Dr. Tosti: In the beginning the disease is reversible and the hair can grow back normally if the hairstyle that produces tension on the hair is discontinued. If not, traction alopecia can permanently destroy the hair follicles and be irreversible.

Q: How can I tell if my hairstyle causes traction?

Dr. Tosti: Severe traction causes scalp inflammation and pain.  You may feel tenderness, stinging, or crusting. Your doctor can examine your scalp with the dermatoscope and look for small cylindrical structures that surround the hairs. These are called hair casts and are a sign of ongoing traction.


If you suspect your hair fall out is due to traction alopecia, be sure to speak with your physician on the best treatment plan moving forward. Keep in mind that once sufferers of traction alopecia remove the cause of tension to their hair, they can expect a recovery time of 6-9 months. For severe cases, regrowth can take up to a year. Any over-styling will only prolong recovery time, so hair should be handled with gentle care during this time.

For more information on causes of hair loss, make sure to check out our post on 7 Reasons for Female Hair Loss.

Topics: hair health, receding hairline, hair loss, expert q&a

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