Traction Alopecia: Yes…Your weave is pulled too tight!
As a dermatologist with a special interest in hair conditions, it consumes me how many Black women I see with permanent hair loss from our own styling practices!! One of the most common forms of hair loss that plagues our population is called traction alopecia.
Traction alopecia can be a permanent, scarring form of hair loss that typically occurs around the hairline and crown. You do not need to be a dermatologist to diagnose this. We have all seen it on girlfriends, family members, and unfortunately, many prominent celebrities.
It is thought to be caused by hairstyling practices that pull hair tightly away from the scalp, such as braids, weaves, and locks. Similar to trauma that happens elsewhere on the skin; the body senses the insult, sends inflammatory cells to the site of trauma, and tries to heal it with a scar. This is exactly what occurs with traction alopecia. The tight pulling leads to inflammation around the hair follicle and if the inflammation remains untreated, fibrosis or scar tissue forms and the hair is permanently lost.
This condition is most common in Black females but can be seen in anyone with traumatizing hairstyling practices. For example, in India, many Sikh males that wear their hair in tight buns under their turbans can also suffer from this problem.
Luckily, there are ways to prevent traction alopecia and also ways to treat it.
Most importantly, do not allow the hair to be pulled too tight!!!! Yes, we all love to see our friends flaunt a great weave down their backs, so I will never be one to restrict wearing these types of hairstyles. HOWEVER, I cannot stress the importance of being able to recognize signs of when the hair is being pulled too tight. This includes any pain, tenderness, burning or itching. These are signs of inflammation!!!
Secondly, see the previous paragraph…It’s that important. Many of my patients will tell me that they did not notice the hair loss until months to years after wearing braids or a weave. So it is very important to pick up on signs of inflammation as soon as possible, so that you have a possibility of being treated and holding onto the hair that you have.
As far as treatment options are concerned, the most important first step is seeing a dermatologist as soon as you notice any problem. The longer you wait for an evaluation, the more time for scar to form and for the hair loss to become permanent.
When you are seen, likely a biopsy will be performed to determine if there is any inflammation left to treat or if scar is already present. If there is inflammation present, treatment may include steroid injections to the scalp, topical steroids, or oral antibiotics. Even if there is scar present and the hair loss is felt to be permanent, hair transplantation is always an option to help restore the hairline.
In summary, Black women love to experiment with myriad fabulous hair styles. Unfortunately, many of these styling practices can lead to permanent hair loss and deflated senses of self. Therefore, it is of the utmost importance to recognize when the hair is being traumatized to prevent traction alopecia from occurring.