​Traction alopecia: What are the treatments?

Traction alopecia

Traction alopecia is a type of hair loss that comes from a variety of things that lead to hair being pulled. Pony tails, braids, weaves, cornrows all have the potential to cause traction alopecia.

Can regrowth occur?

If traction alopecia is identified soon after the first hairs are lost, then regrowth can often occur provided the hairstyle that caused the traction is stopped immediately. Sometimes the hair can even grow back on its own - but treatments such as minoxidil can help it grow back faster or to a greater extent. Many forget that early traction is associated with inflammation under the skin as well and so that is why a corticosteroid is often used as well. Minoxidil, together with use of corticosteroids is my favourite choice for early traction. Minoxidil is often used daily for 9-12 months and then stopped. Corticosteroids are used either a few times per week (ie if a topical cortisone is used or once every 2-3 months if steroid injections are used). For the majority of individuals with early forms of traction alopecia, any amount of hair that regrows will stay around when the minoxidil and corticosteroids are stopped. 

After 9-12 months, one usually has a good sense if significant regrowth is going to occur or not. If regrowth does not occur fully, once can consider hair transplantation or use of a wig or hairpieces.

Can patients with traction alopecia always be helped non surgically?

Traction alopecia is not always regrowable - especially if it has been present for a long time. The reason for this is that advanced traction alopecia is associated with the formation of scar tissue under the scalp. Such scar tissue blocks hairs from growing and directly kills hairs as well. For some individuals with traction, hair loss continues even when the pulling is stopped. In other words, not only does the patient notice they are not growing hair back but they notice that it is getting worse and worse over time. This form of traction requires oral or topical anti inflammatory treatments before hair transplantation can be considered.