The Dermatology Blog

I saw several women last week for hair loss (alopecia). Hair loss is a common condition; it can be especially traumatic for women, because hair is often an important part of their identity and of their beauty. Traction alopecia is a type of hair loss that can be prevented if caught early, but can be permanent after it develops.

There are many causes of hair loss including medications, thyroid disease, iron deficiency, even having a baby. Most of these causes result in temporary hair loss — the hair eventually grows back. Some types of hair loss, however, are permanent; this is called scarring or cicatrical alopecia. A common scarring hair loss in women is traction alopecia.

Traction alopecia occurs when hair is pulled too tightly for long periods of time. It occurs often in girls and women who braid their hair, but can also be seen in women who pull their hair back tightly in a pony-tail or a bun. Over months and years the hair loss becomes permanent, and cannot regrow. It can be seen in men, but is more common in women. It can also affect children as well as in adults.

In traction alopecia the worst hair loss is in areas where the hair is pulled the tightest, usually the forehead and temples. It can be subtle at first, but becomes apparent over years as the hair line recedes from ear to ear starting farther and farther back on the head.

The hair is lost because the tension from pulling damages the hair follicles beneath the skin. The hair follicle is like a little factory working constantly to make hair. Each follicle is in an active state for years before it takes a short rest, sheds the hair, then starts all over again. Over time, pulling the follicle damages it and eventually the damaged follicle can no longer make hair. Because you cannot develop new follicles, as more and more follicles are damaged, more and more permanent hair loss results.

Unfortunately, traction alopecia is a scarring alopecia, so lost hair will not grow back. The best treatment is to release the tension on your hair as much as possible as soon as possible. This is often difficult because it requires adopting a different hairstyle (which can be distressing in itself).

Sometimes hair can be surgically transplanted from areas on your scalp with good growth to the scarred areas. This procedure can be expensive however, and is not covered by health insurance.

Using minoxidil or Rogaine might help promote new hair growth. The drug is meant for male pattern alopeica, not for scarring hair loss however, and using it might not help much.

If you have hair loss, then see your dermatologist. He or she can examine your scalp and can often prescribe medications, perform hair transplant surgery, or make suggestions on changing your hairstyle that can save your hair.

Post written by Jeffrey Benabio, MD. You might also like:

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