Traction Alopecia

Traction alopecia, also known as traumatic, “nurse’s cap”, or “hot comb” alopecia, is a hair loss condition that is usually caused by strong tensional forces that are exerted on hair as a result of some ethnic, traditional, and modern practices of hair styling, often connected with the use of hair rollers, twists, locks, braids, etc. Women, especially those of the Indian and African descends, seem to be affected more often than men.

Depending on the area where hair is pulled, hair loss in traction alopecia is usually localized. Prolonged tensional forces on hair can lead to damaging of its roots and follicles, and to the development of permanent hair loss. To prevent irreversible hair loss, the condition ought to be recognized on its early stage.

Traction alopecia was first reported in 1907 to describe hair loss in young women from Greenland, who preferred to style their hair in tight ponytails. The same hair loss pattern was also described in traditional Japanese females who wore hairdo. Indian men who observe  Sikhism are prone to traction alopecia, as well, because they grow their hair long and pull it tightly into a bun. A modern fashion to use hair extensions and dreadlocks is mostly associated with the development of the condition in young people.

The prolonged trauma exerted on the scalp hair causes it to gradually loosen from its roots and develop secondary inflammation and subsequent atrophy. Hair loss is usually symmetrical and affects frontal or temporal areas of the scalp. The first symptoms could manifest as hyperkeratosis (excessive scaling and seborrhea) and the degeneration of hair that starts growing thin, short, and fine instead of thick and long. If tension is not removed, folliculitis (inflammation and scarring of the hair follicles) develops, which leads to irreversible balding.

Different traumatic styling practises can create different types of traction alopecia. Marginal alopecia is usually due to the use of rollers or curlers in children, which provoke hair loss in the temporal area of the scalp. Another contributing factor could be strong and repeated facial muscle contractions. One more type of traction alopecia, called chignon, or nonmarginal, alopecia, usually happens in the occipital area and is due to styling hair into a tight bun.

Traction alopecia is a condition that exists in many regions of the world. In the United States, the most affected categories are African American women, who straighten their hair or style it into braids, and female athletes, cooks, and nurses, who secure their hair tightly for the cake of hygiene or comfort. Internationally, the condition is mostly spread among Sikh men and Japanese women.

Traction alopecia can lead to the development of emotional trauma and other psychological disorders, such as low self-esteem, social withdrawal, and changes in self-perception, especially in women. It can be treated if caught on early stages, before permanent damage to the hair roots has developed. The only effective measure to cope with the condition is to stop mechanical damage of hair. Letting hair stay loose is the best solution for the problem. However, if irreversible hair loss has occurred, hair transplantation is the only available treatment.

Robin Makris

Zelnorm

International Pharmacy