Q&A: ‘Being proactive’ best way to prevent traction alopecia, improve symptoms
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Traction alopecia, a subtype of alopecia that typically leads to hair loss along the hairline, is common among people with skin of color and especially affects Black women, according to the Skin of Color Society.
Tight hair styling and pulling from the scalp causes trauma to hair follicles, which can result in traction alopecia. There are, however, treatments that can alleviate this hair loss and help prevent its progression.
Healio spoke to Ben Behnam, MD, FAAD, cofounder of Happy Head, about the causes and treatment options for traction alopecia.
Healio: What is traction alopecia?
Behnam: Traction alopecia is a type of hair loss caused by hair being pulled at for a long period of time along the hairline. As a result of that chronic, constant pull, the hair follicles begin to die, and the hair will no longer grow back.
Healio: What is the difference between traction alopecia and other types of alopecia?
Behnam: Typically, with traction alopecia, the scalp is mainly affected along the hairline. If you look at the hairline, patients will be missing 1 to 3 inches of hair.
For example, classic female pattern hair loss usually occurs on the top of the head where the patient parts her hair. Despite hair loss occurring on the top of the head, the hairline is generally maintained. Another type of alopecia is central centrifugal cicatricial alopecia, which is when hair loss occurs on the crown of the head. Still, other types of alopecia are also characterized by bald spots located across the scalp, not necessarily the hairline.
So again, what really makes traction alopecia so obvious and distinct from other types of hair loss is the fact that it’s in the frontal area where the hair is being pulled on for many, many years. As a result, the hair follicles die, and a receding hairline is created.
Healio: Which patients are most susceptible to traction alopecia?
Behnam: Because traction alopecia is caused by chronic pulling of the hair, this disease primarily affects the African American population. This is due to the cultural way that the hair is tightly braided and pulled back. Additionally, patients tend to be women aged between 20 and 50 years.
Healio: What are the treatment options?
Behnam: This can be difficult. It really depends on the degree of traction alopecia. If it’s a mild-moderate amount, you can stop it in its tracks. Dermatologists should tell the patient not to put their hair in tight ponytails, make sure the hair is relaxed and avoid anything such as very tight hats that will pull on the hair. Those are the primary options.
The secondary option is an oral medication, yet this depends on age. For example, if the patient is a female below the age of 50, there are two medication options. One is spironolactone, a blood pressure medication that serve as an off-level option for females suffering from hair loss. Another option is oral minoxidil, another blood pressure medication. Additional treatments include topical minoxidil and derma roller.
Platelet-rich plasma injections can also work quite a bit in that area as long as the progression of the disease is moderate and there are still remaining hair follicles. However, if the traction alopecia is very severe with a hairline regression of several inches, then the only thing that can possibly be done is a hair transplant. Sometimes a hair transplant isn’t even possible depending on the extent of the hair loss, but that is the remaining option.
Healio: Where can people find more information about traction alopecia?
Behnam: The best thing to do is simply search “traction alopecia” on Google. It’s a very good destination for photos and information. Additionally, our website has information about traction alopecia.
Healio: Any closing comments?
Behnam: The most important thing to treat traction alopecia is to take preventative measures. Avoid pulling hair back into tight, high ponytails. Try to loosen the hair, allowing it to relax. Being proactive about this disease is the best way to prevent the hairline recession.
Reference:
- Patient dermatology education: Traction alopecia. https://skinofcolorsociety.org/patient-dermatology-education/traction-alopecia/. Accessed Nov. 10, 2022.
For more information:
Ben Behnam, MD, FAAD, can be reached at help@happyhead.com.
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