Traction Alopecia

Is your hairstyle thinning your hairline?

Traction alopecia is hair loss caused by repeated pulling on the hair, most often from tight braids, locs, extensions, weaves or ponytails. It usually starts at the hairline and temples. Caught early, it is often fully reversible. Left for years, the follicles can scar and stop producing hair permanently.

Is this you?

• Your hairline or temples look further back than they used to, or the edges are thinning

• Small bumps, soreness or tenderness where your style pulls tightest

• Short, broken hairs, sometimes a fine fringe of baby hairs, along the hairline

• Thinning where extensions, clips or a weft repeatedly sit

• Headaches or a tight scalp on styling day, with relief when the style comes out

• A patch that stays smooth and does not regrow between styles

These symptoms overlap with several other conditions, including frontal fibrosing alopecia, alopecia areata and pattern hair loss, so the pattern alone cannot tell you which one you are dealing with.

What is happening and why

Hair follicles are resilient, but they are not designed to be under constant tension. When a style pulls on the same follicles day after day, it inflames them and gradually loosens the anchor of the hair. At first the follicle recovers when the tension stops. This is the reversible stage. It is well established, however, that prolonged, repeated traction can eventually replace follicles with scar tissue, at which point the loss is permanent. This is why the same braids that were fine at 20 can become a problem at 35. The damage is cumulative.

Traction alopecia is common in people who wear braids, locs, extensions or tight buns, which means it disproportionately affects people with textured and Afro hair, though it can affect anyone, from ballet dancers to turban wearers. There is no shame in any of this, and it does not mean giving up protective styles. In most cases it means adjusting how they are worn.

A small number of other conditions, notably frontal fibrosing alopecia and Central Centrifugal Cicatricial Alopecia (CCCA), a scarring condition seen most often in Black women, can produce near identical hairline and crown changes. Telling them apart requires examining the scalp itself, which is exactly what the assessment is for.

How I assess it

Your appointment starts with a conversation about your styling history, what styles you wear, how tight, how long they stay in, and how often they are refreshed, alongside your general health, because more than one process can be happening at once.

I then examine your scalp with trichoscopy, a high magnification lens that shows what a mirror or a phone photo cannot. It tells me whether follicular openings are still present, which is the single most important question, because it tells you whether regrowth is possible. It shows whether there is active inflammation, and whether the pattern points to traction or to a scarring condition that needs a dermatologist. I take clinical photographs so change can be tracked objectively over the months that follow, and where blood tests would be useful, I will guide you on what to ask your GP to arrange.

Assessing traction properly means understanding the styles themselves as well as the scalp, and textured and Afro hair is my particular specialism. This is where the question of which condition is behind your hairline actually gets answered.

Treatment options, and why the right one depends on the cause

Well established approaches. It is well established that the single most effective step in early traction alopecia is removing or reducing the tension. Done knowledgeably, that means adapting your styling rather than giving it up. Where follicles are scarred, realistic options look different, which is why staging comes first.

Emerging and adjunctive in clinic therapies. Evidence is growing that microneedling can support regrowth in some non scarring hair loss. Early research suggests growth factor mesotherapy may help some people, and results vary. Whether either is worth considering depends on whether your follicles are still viable, and that can only be established at assessment.

Self care and styling. Looser installs, lighter extensions, longer breaks between styles and gentler edge handling all matter, but the right combination depends on what stage your hairline is at, which is worked out at assessment.

A treatment matched to the wrong cause, or the wrong stage, can waste months while the window for regrowth narrows. See also: pattern hair loss and scalp conditions.

When to see your GP

See your GP or ask for a dermatology referral if you have scarring, shiny or smooth patches that never regrow, redness, pustules or persistent soreness, rapid loss not linked to styling, or hair loss alongside other symptoms such as fatigue or skin changes elsewhere. A trichologist identifies the likely cause and refers on where medical treatment is needed.

Getting help in Ipswich and Suffolk

I am based in Ipswich and see clients from across Suffolk, including Woodbridge, Felixstowe, Stowmarket and Bury St Edmunds, many of them women with braids, locs and extensions who have struggled to find a specialist in textured hair locally. The only way to know whether your edges are at the reversible stage, and which condition is actually behind them, is to look at the scalp properly. That is what a consultation is for. You can book your consultation.

FAQs

Written by Stephanie Sey, Clinical Trichologist (Institute of Trichologists).

Last reviewed July 2026.