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

Traction alopecia - Hair and Scalp

See also in: Overview
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 MD, 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 chemical hair relaxers, braiding, and tight ponytails. It presents initially as a nonscarring alopecia that can result in permanent hair loss if not treated or if the insult persists.

TA is caused by frequent tight braiding, use of elastic bands and tight rollers, decorative cornrows, and excessive brushing or heat at the roots. Chemically relaxed hair with these styles is more susceptible to traction alopecia.

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.

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.


L66.8 – Other cicatricial alopecia

67488005 – Traumatic alopecia

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Differential Diagnosis & Pitfalls

  • Alopecia areata – Usually causes round areas of nonscarring hair loss. However, the ophiasis type of alopecia areata is hard to differentiate clinically.
  • Trichotillomania – The patient is pulling hair out.
  • Telogen effluvium – Nonscarring hair loss as a result of Drug-induced alopecia or severe illness.
  • Frontal fibrosing alopecia – Scarring alopecia with absence of fringe sign.

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Last Reviewed:09/05/2019
Last Updated:09/10/2019
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Patient Information for Traction alopecia - Hair and Scalp
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Contributors: Eva Simmons-O'Brien MD, Medical staff writer
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Traction alopecia - Hair and Scalp
See also in: Overview
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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