Hair loss conditions Affects men and women
Traction alopecia: hair loss from tight hairstyles
Traction alopecia is hair loss caused by repeated pulling on the hair, most often from tight hairstyles. Caught early, hair can fully regrow once the tension stops. If the pulling goes on for a long time, follicles can be permanently damaged, so changing how you style your hair matters more than any medicine.
What is traction alopecia?
The British Association of Dermatologists (BAD) describes traction alopecia as hair loss caused by constant pulling, usually on some hairs more than others, which leads to bald or thin areas. It is different from trichotillomania, where people feel an urge to pull out their own hair.
Where the hair is lost depends on where the tension is highest. Tight ponytails tend to cause loss at the front and side margins of the scalp, and tight buns at the sides and back. Weaves and hair extensions, and tight braids such as cornrows and dreadlocks, are also common causes, with loss often seen between the braids. Chemical relaxers add to the risk, and hair clips, tight head scarves and very long, heavy hair have also been linked to it.
It can affect people of any ethnic background, including those who wear cultural, religious or work-related hairstyles. The BAD notes it is often seen in women and children of African descent who regularly use braids or chemicals to manage tightly curled hair, and it has been seen on the scalp and beard of some Sikh men.
Timing is everything. The BAD says traction alopecia can get better when it has been present for only a few weeks or months, if the tension stops. Long-term, repeated pulling can permanently damage the follicles, and at that point it becomes a form of scarring alopecia.
Signs to look for
- Thinning or hair loss along the front, sides or back of the hairline, where styles pull hardest
- Short, finer hairs still present within the thinning area
- A rim of slightly longer hairs at the edge of the patch, known as the fringe sign
- Itching, soreness or flaking of the scalp
- Redness, small spots or white flakes attached to the hairs (hair casts) where tension is highest
- In long-standing cases, smooth, shiny skin where hair used to grow
What causes it
Tight ponytails and buns
Ponytails pull at the front and sides of the scalp; buns pull at the sides and back.
Braids, cornrows and locs
Tight braiding concentrates tension on small sections of hair, with loss often appearing between the braids.
Weaves and extensions
Attaching weaves or extensions adds weight and pulling to the hair they are fixed to.
Chemicals and heat
Chemical relaxers increase the risk when combined with tight styles. The BAD also advises avoiding excessive heat from straighteners.
Clips, headwear and heavy hair
Hair clips, tight head scarves and very long, heavy hair can all add tension over time.
How it is diagnosed
A GP or dermatologist can usually diagnose traction alopecia from your styling history and the pattern of hair loss. If the diagnosis is unclear, a scalp biopsy may be needed.
It can occur alongside other conditions. The BAD notes that women with central centrifugal cicatricial alopecia, a scarring condition that starts on the top of the scalp, often also have traction alopecia at the hairline. If you have thinning on the crown as well as at the edges, or the scalp looks smooth and shiny, a dermatologist should look at it. WMG Health's page on signs of scarring alopecia explains what to look for.
Treatment options
Every option below has trade-offs, and choosing not to treat is a reasonable decision too. Medicines are only prescribed after a doctor has reviewed your history and confirmed they are suitable for you.
What to expect
If traction alopecia is caught early, the BAD says hair can completely regrow once tight hairstyles are stopped. Regrowth may start around 3 months after you change your styling, once the hair cycle has restarted, and can take longer to look full.
If the pulling has gone on for years and the follicles have been destroyed, the hair loss in those areas is permanent, and no medicine will bring it back. That is why the earliest signs, such as thinning edges, soreness or small spots along the hairline, are worth acting on.
Protect any thin or bald areas from the sun with a hat or sunscreen.
When to see a doctor promptly
See your GP soon, rather than waiting or self-treating, if you notice any of these:
- An itchy, sore or painful scalp with redness or spots where hair is pulled
- Smooth, shiny areas where hair no longer grows
- Thinning on the top of the head that is spreading outwards, or hair breakage on the crown
- No regrowth after several months of avoiding tight styles
Where to get help
WMG Meds does not treat traction alopecia with medication. The most effective step is changing how you style your hair to take the tension off, and no prescription replaces that.
If your scalp is sore, red or flaky, or hair has not started to return a few months after you stopped tight styles, see your GP or a dermatologist. A dermatologist can check for scarring and consider treatments for inflammation. WMG Health's page on signs of scarring alopecia can help you decide whether to get checked.
If, separately, you have gradual thinning on the top of your head with a widening parting, that may be pattern hair loss, which our assessment can look at. See female pattern hair loss or male pattern hair loss to understand the difference, and mention any traction history to the doctor.
Frequently asked questions
Will traction alopecia grow back?
If it is caught early, yes. The BAD says hair can completely regrow if tight hairstyles are stopped, with regrowth starting around 3 months later. Long-standing traction alopecia can permanently destroy follicles, and that hair loss does not recover.
Do I have to stop wearing braids or extensions?
It is the tension and how long it lasts that does the damage. The BAD advises avoiding high-risk practices such as tight braiding and extensions, choosing loose styles, and avoiding chemical relaxers. If you already have thinning edges, giving your hair a break from all tension is the safest option.
How long does it take to see regrowth?
The BAD says regrowth may start around 3 months after you stop the hair practices causing it, once the hair cycle is restored. It can take considerably longer for the area to look full again.
Can minoxidil help traction alopecia?
Sometimes, but it is not the main answer. The BAD says topical minoxidil may stimulate growth once the traction has stopped, but is not always effective, and it does nothing if the pulling continues. This use is outside its licence for pattern hair loss, and WMG Meds does not prescribe for traction alopecia.
Is traction alopecia a type of scarring alopecia?
Early on it is not: the follicles are intact and hair can regrow. Long-standing traction can destroy follicles, leaving smooth, shiny skin, and at that stage the loss is permanent. Our scarring alopecia page explains the signs.
Sources
- British Association of Dermatologists: Traction alopecia, patient leaflet
- British Association of Dermatologists: Central centrifugal cicatricial alopecia, patient leaflet
Facts checked against these sources on 4 October 2026. This page is general information, not a diagnosis. Read our editorial policy.