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Traction alopecia in Child
See also in: Hair and Scalp
Other Resources UpToDate PubMed

Traction alopecia in Child

See also in: Hair and Scalp
Contributors: Zamambo Mkhize MBChB, FCDerm, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Belinda Tan MD, PhD, Oyetewa Oyerinde MD, Callyn Iwuala BA, Susan Burgin MD
Other Resources UpToDate PubMed


Traction alopecia (TA) is a condition of the scalp secondary to trauma of the hair shaft. The hair shaft is weakened by various hair grooming practices including frequent tight braiding, use of elastic bands and tight rollers, tight ponytails, decorative cornrows, and excessive brushing or heat at the roots. Chemically relaxed hair with these styles is more susceptible to traction alopecia. It presents initially as a nonscarring alopecia that can result in permanent hair loss if not treated or if the insult persists.

TA usually involves the temporal region bilaterally, but the condition can be found on any area of the scalp where hair is pulled tightly in various hairstyles, eg, braids, weaves, ponytails, and dreadlocks. Symptoms of a tender, itchy scalp and headaches may be reported.

TA is more common in women and girls, particularly of African descent. This is attributed to the unique mechanical features of African hair and the type of hair grooming that is practiced in certain cultures. African hair is drier, asymmetrical, and helical in shape, which lead to points of weaknesses along the hair shaft. This makes it more susceptible to breakage during combing and to TA when hair is worn in tight styles for prolonged periods. TA is worsened if the hair is chemically relaxed because relaxers weaken the tight disulfide bonds, rendering the hair shaft thinner and drier.

TA is seen in indigenous populations in Western Greenland, young Danish girls with ponytails, ballet dancers, and any ethnic group that styles hair with tension to the frontal region of the scalp. TA also occurs with work-related gear such as helmets, hair caps, headbands, and nurses' caps. It is also seen in religious gear, eg, nuns' coifs and Sikh men who wear turbans.


L66.8 – Other cicatricial alopecia

67488005 – Traumatic alopecia

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Last Reviewed:09/05/2019
Last Updated:10/06/2022
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Patient Information for Traction alopecia in Child
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Contributors: Janyla Seltzer, Eva Simmons-O'Brien MD


Traction alopecia (TA) is a condition of the scalp caused by trauma to the hair shaft due to prolonged, repetitive pulling / tension on the hair follicle. Grooming practices that cause TA include tight braiding, tight ponytails, and excessive brushing, which weaken the hair shaft, resulting in damage and hair loss.

Removal of the tension can reverse the hair loss. This is ideal in the early stages, where the hair loss is non-scarring and nonpermanent.

Without treatment or with persistent trauma to the hair shaft, TA can result in permanent hair loss.

The disorder is categorized into marginal TA and nonmarginal TA, depending on the type of trauma:
  • Marginal TA is the most common variation, affecting the scalp along the hairline and at the temples, above the ears. This category of TA is due to hair practices including tight ponytails, buns, or braids. The "fringe sign" is characterized by the presence of fine, miniaturized hairs along the hairline.
  • Non-marginal TA presents with patchy hair loss in areas other than the hairline of the scalp. Frequent use of hair accessories / pins, hair extensions (sewn-in or glued), or hair buns can result in the non-marginal type of TA.

Who’s At Risk

  • While TA is not limited to a particular ethnicity / race or age group, it most often occurs in Black women due to grooming practices. Furthermore, coarse, thick, and easily tangled hair is a prominent feature in some Black individuals and is another contributing factor in the development of TA.
  • TA is sometimes seen in ballet dancers; workers who wear headgear such as helmets, hair caps, and headbands; and individuals who wear certain religious attire (eg, coifs and turbans).

Signs & Symptoms

TA can present as a tender, itchy scalp with associated headaches. TA can also present with inflamed bumps (inflammatory papules, pustules, and redness) and hair loss in areas where hair is pulled tightly. It usually affects the front and sides of the hairline but may appear in other sites on the scalp or in other body areas where there is pulling on the hair follicle.

Self-Care Guidelines

  • Immediately stop hairstyles causing pain, swelling, redness, pimples, or hair loss.
  • Avoid tight hairstyles or hair accessories causing pulling / trauma to the scalp.
  • Limit wearing of hairstyles that cause tension to periods of 1-2 weeks, and ideally less than 24 hours.

When to Seek Medical Care

See a doctor when:
  • There are inflammatory changes to the scalp, with or without pain, such as bumps, swelling, or redness.
  • Self-care practices do not help.
  • Noticeable hair loss (eg, breakage, shedding, thinning) occurs.


Your physician may prescribe:
  • Topical or intralesional corticosteroids as well as antibiotics to aid in decreasing inflammation of the scalp.
  • Topical minoxidil to help with improving hair growth.
Surgical interventions may include:
  • Hair transplantation utilizing procedures called micrografting, minigrafting, and follicular unit transplantation.
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Traction alopecia in Child
See also in: Hair and Scalp
A medical illustration showing key findings of Traction alopecia : Braids hair, Alopecia, Short broken hairs
Clinical image of Traction alopecia - imageId=848460. Click to open in gallery.  caption: 'Patchy nonscarring alopecia at the anterior hairline.'
Patchy nonscarring alopecia at the anterior hairline.
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