Traction Alopecia

Sustained traction on the hair shaft causes mechanical trauma to the follicle outer root sheath and dermal papilla. Early stages produce perifollicular inflammation; chronic traction leads to progressive fibrosis around the follicle and, ultimately, permanent scarring alopecia if the cause is not removed. The frontotemporal hairline is the most commonly affected zone.

Underrecognised in India; increasingly seen with fashion trends involving extensions, tight braids, and repeated blow-out styling. Also common in athletes using tight ponytails.

• Hair loss along the hairline (most commonly frontal and temporal)
• Follicular pustules or papules early in disease
• Fringe sign - short broken hairs along hairline
• Loss of follicular ostia in late scarring stage
• Direct correlation with hairstyle pattern

• Tight braids, dreadlocks, ponytails worn daily
• Hair extensions with adhesive or weave
• Chemical relaxers followed by tight styles
• Headbands with excessive tension

• Trichoscopy - peripilar casts, lack of follicular openings in late disease
• Clinical history (hairstyle pattern correlation)
• Scalp biopsy (to confirm fibrosis in late disease)

Tests are performed by a qualified dermatologist or trichologist after clinical assessment.

Timeline: Early-stage traction alopecia (< 6 months, no scarring) can recover fully within 3–6 months of removing the cause. Scarring stage is permanent.

Consult a dermatologist as soon as you notice frontal hairline recession - early intervention reverses the process. Late-stage disease with follicular scarring may be permanent.