What Is Traction Alopecia & Can It Be Reversed
When most of us think of the typical person suffering from severe balding, our mind usually imagines a greying, old man losing their hair thanks to genetics and age. Medically known as androgenetic alopecia, this may be the most common form of balding, affecting 80 million people in the U.S., but it’s far from the only way we lose our hair.
Traction alopecia occurs when hair has been pulled too tightly against the scalp. It’s also one of the few forms of hair loss attributed to mechanical causes, and not genetics, hormones, or other disease processes. Traction alopecia is commonly reported in women of African descent, though it has nothing to do with ethnicity or hair type. Instead, it’s the specific hair styles and techniques popular in these communities that ultimately cause traction alopecia. However, just because it’s more common in women, doesn’t mean that it doesn’t occur in men. With the recent surge in popularity of the “Man bun”, you may be putting your locks at risk.
As frustrating as any form of hair loss may be, the bright side of traction alopecia is that sufferers don’t have to fight against genetics. If caught early, traction alopecia is an easy form of hair loss to treat and prevent by simply changing your hairstyle.
What is Traction Alopecia?
Traction alopecia is essentially hair loss caused by hair regularly and aggressively pulling at the hair. As the hair follicles/bulbs/scalp is increasingly irritated, sufferers will feel stinging, pain, and tenderness. Small red bumps (folliculitis) may also appear. If these initial symptoms are ignored, permanent hair loss can occur. Early on, traction alopecia can be reversed. However, if trauma continues and irritation persists, scarring of the damaged hair follicle can occur. Once scarred, the hair stops growing entirely and cannot be reversed without invasive medical intervention.
What Causes Traction Alopecia?
Traction alopecia is almost always caused by hair styles that pull hair too tight against the fragile skin of the scalp. Though often associated with braids, weaves, and dreadlocks, traction alopecia also occurs with ponytails, buns, pigtails, extremely long hair, extensions, etc. Helmets and turbans are also known culprits.
What Are Symptoms of Traction Alopecia?
Telltale signs that you may have traction alopecia include:
- Scalp tenderness
- Red bumps on or near the scalp
- Broken hairs near the hairline
- Thinning or patchy areas of missing hair near the hairline
- Relief in scalp when tight bun released.
If you notice these symptoms as soon as they appear, the damage can be reversed. However, waiting longer increases the chance of developing more severe, or even permanent hair loss.
Once scarring, or scarring alopecia occurs, treatment becomes significantly more difficult. Medical intervention by a dermatologist or hair restoration expert (703-844-0184) is strongly recommended as soon as symptoms occur.
How Can I Treat Traction Alopecia?
When caught early enough, traction alopecia can be completely treated and reversed without a doctor. If no scarring has occurred and there is no significant pain or swelling, simply letting your hair down and avoiding any hairstyles that causes scalp tension should resolve the issue.
However, be patient. The hair and scalp will need time to regrow. It can take several months, or even a full year to see progress. During this time, don’t be tempted to wear your hair tight at any time and be as gentle as possible to your hair and scalp.
If your traction alopecia has advanced to the point of significant balding, pain, swelling, or scarring—or you don’t see any new growth after a year of wearing your hair loose—it’s definitely time to see a dermatologist or hair restoration specialist (703-844-0184 | Neograft Hair transplantation | Dr. Sendi)
First, your specialist will likely test your hair to ensure the cause of your hair loss is in fact traction alopecia. This may include a biopsy of your scalp; a minor outpatient procedure where a small sample of your scalp is submitted to the lab for microscopic examination.
Then once officially diagnosed, typical treatments include:
- Topical hair growth creams like minoxidil (Rogaine)
- Biotin or other natural hair growth supplements
- Oral or topical medications to reduce inflammation to the scalp
If scarring has occurred, no pills or creams will bring your hair back. The only way to reverse permanent hair loss is through a hair transplant procedure. Though this is an invasive surgery, it does have a high success rate for bringing your hair back to its former glory.
How Can I Prevent Traction Alopecia?
Traction alopecia is extremely preventable. Prevention doesn’t have to mean forever giving up the hairstyles that you love—though you might have to take regular breaks. Use proper hair styling techniques and strategies to minimize damage. Above all, avoid constantly pulling your hair too tightly into any style.
Maintaining your hair should never hurt. If you notice regular pain, stinging, or tension along your hairline, it’s time to try a different style. Braids or dreads, are better when they’re thick. Thin braids and dreads tend to pull more at the scalp. If you love the man bun but it’s giving you tension headaches, let it down and set your locks free.
Also, choose high-quality hair care products and minimize the use of chemicals. If you’re good to your hair and scalp, your hair and scalp will be good to you in return.
Minoxidil: Your Questions, Answered
Minoxidil is an FDA-approved drug for the treatment of androgenetic alopecia (hair loss). Prior to it being approved by the FDA for hair loss treatment, it was used as an oral pill to treat patients with high blood pressure. A common side effect of oral minoxidil is “hirsuitism” or increase hair growth on the body, face and scalp. In addition to increased (unwanted) body hair, in pill form, minoxidil has other side effects that made it impractical as an oral hair loss treatment.
In the 1980’s, the scientists at the UpJohn Corporation invented a topical formulation of minoxidil in a 2% and 5% strength, called Rogaine. When applied to the scalp it harnessed the benefit of hair growth in areas of balding while avoided the unwanted side effects that came with the pill form.
Who Should Use Minoxidil?
Minoxidil topical solution can be used by adults over 18 years old who are experiencing gradually thinning hair. People who have vertex/crown hair loss tend to respond best to the treatment, but it is effective throughout the scalp.
There are 2% and 5% formulations of the drug available for both men and women which both come in liquid solution or foam. There are also over-the-counter versions of both formulas except for the 5% strength for women, which is still under patent as it was not released until much later than the original 2%. There is really no difference between the men’s, women’s or the over-the-counter versions except the price or color of the boxes. We recommend all patients use the 5% strength and decide if they prefer the foam or solution.
How Does Minoxidil Work?
Minoxidil topical solution is intended for external use only. It is to be applied to a dry scalp per the instructions from your doctor. Once applied, it should be left on your head until it dries by itself – do not use a hairdryer in an attempt to speed up the process.
Science does not currently understand exactly how minoxidil works. It is known that unlike Propecia, minoxidil does not affect the levels of DHT. Some scientists believe that minoxidil works in part by having a vasodilatory effect upon the blood vessels. The dilation could allow for improved oxygen, blood, and nutrient flows to the hair follicles. What we do know is that it is activated in the scalp by an enzyme called sulfotransferase which is found in hair follicles. When activated it shortens the telogen (shedding) phase and prolongs the anagen (growth) phase therefore causing the miniaturized hair follicles to grow longer and stronger.
How Soon Before Results Start Showing?
Many people start seeing benefits after 4 months of using minoxidil. However, the full benefit usually isn’t realized until 12-14 months after starting treatment.
Minoxidil must be used on a continual basis in order to maintain hair growth. If you stop using minoxidil, you might experience “catch-up hair loss” in which you will start to lose hair at an accelerated rate until they catch-up with the level of hair loss that you would have had, had you never used minoxidil in the first place.
Who Shouldn’t use Minoxidil?
It was originally created to help people with high blood pressure. Therefore, if you suffer from low blood pressure, you should avoid using minoxidil unless directed by your doctor. Pregnant women and people with heart problems should also avoid using the drug.
People who have experienced hypersensitivity with the other components of minoxidil should avoid using it as well. Speak with your doctor if you have any questions regarding the drug or the ingredients.
Minoxidil will not regrow hair in areas of scarring hair loss. If you have experienced trauma or deep burns in your scalp, you should let your doctor know. People who have hair loss from hair grooming methods as cornrows or tight ponytails should also consult with their doctor because minoxidil may not be helpful.
Are there Any Side Effects of Minoxidil?
Topical minoxidil is considered safe for long-term usage to treat androgenetic alopecia. However, if you start to notice any side effects such as burning, redness, itching, or irritation, you should inform your doctor and discontinue its use.
Unwanted hair growth can occur in areas adjacent to where it is being applied. It’s also suggested that you wash your hands completely after touching the medication. If topical minoxidil comes into contact with other areas of skin on your body, unwanted hair growth can occur.
Many people use minoxidil or finasteride before they undergo a hair transplant to help improve the native hair. Recent studies have shown that using a combination of both works best in treating male androgenetic alopecia. Your doctor may suggest that you take minoxidil at the same time you take finasteride.
What is the Success Rate of Minoxidil?
Researchers conducted a 1-year study of 984 men who had male-pattern hair loss and were using minoxidil 5%. At the end of the study they found that the hair loss areas in the scalp had become smaller in 62% of the study participants. Hair loss remained unchanged in 35.1% of the participants and grew larger in 2.9% of them.
Each person reacts differently to minoxidil and results will vary from person to person. Normal hair usually only grows ¼ – ½” per month so it will take at least 4 months before you start to notice hair regrowth.
Do Shampoos Help With Hair Loss?
Androgenic alopecia, most commonly known as male pattern hair loss, is an extremely common issue for many men as they age. In fact, approximately half of all men over the age of 50 are afflicted. Though many happily embrace a hairless future, others choose to fight it in hopes of gaining back the confidence connected to their locks.
Thanks to scientific breakthroughs and innovations, there are a multitude of options when it comes to improving hair growth. Surgical procedures are incredibly successful but invasive and often reserved for when previous methods have failed. Several medications also boast great results, but many also don’t want to rely on daily pills, and their possible side effects.
Instead, most men prefer to start with simple, noninvasive solutions—most notably, shampoos. With so many products on the market, some companies will try to take advantage of those desperately seeking their old head of hair.
So, how can you be sure you’re not wasting money on snake oil? You can spend $3-$100 on a bottle of shampoo, but it is worth it? First, let’s look at how shampoos developed to minimize hair loss and increase hair growth actually work.
How Do Hair Growth Shampoos Work?
Though there are various ways that people lose hair, our own hormones and genetics are almost always to blame. Typically, this is due to the effects of testosterone and dihydrotestosterone (DHT). Hair loss shampoos will use various ingredients intended to suppress these hormones. Ingredients include:
Widely regarded as the most important ingredient to look for in shampoos made to treat hair loss, ketoconazole is actually an antifungal solution which also has anti-androgenic properties that may prevent hair growth. Similar to finasteride, ketoconazole can prevent the action of testosterone or DHT on the hair.
There currently are few large studies proving ketoconazole actually is absorbed into the scalp enough to fully achieve this goal. However, some smaller studies have shown that shampoos with 2% ketoconazole may be as effective as minoxidil regimens. Ketoconazole also has anti-inflammatory effects which can help keep the scalp healthy and free of the grease and scale that may impede hair growth.Promotive effect of topical ketoconazole, minoxidil, and minoxidil with tretinoin on hair growth in male mice.
An all-natural nutrient essential for creating healthy hair, biotin, also known as Vitamin B7, Vitamin H, or Coenzyme R helps strengthen hair. Essentially, it’s a co-enzyme that helps synthesize the fatty acids and amino acids needed to produce keratin, which is what hair is mostly made of.
Though results have not been scientifically proven, a quick Google search shows that anecdotally, many believe biotin has helped them thicken and strengthen their hair, especially when taken orally. Less is known about biotin’s benefit when used topically in a shampoo.
It is indisputable that biotin is required for hair synthesis and is incredibly safe to use. From a marketing standpoint, it also makes for a great ingredient to add to hair loss shampoos. It might help—and it certainly won’t hurt—your hair.
It’s good for so much more than getting you out of bed in morning. Caffeine has been scientifically proven to potentially promote hair growth in human tissue . Basically, the stimulant plays a role in counteracting the effects of testosterone, which in turn increases hair growth potential. Role of Caffeine in the Management of Androgenetic Alopecia
Don’t think drinking coffee will help though. For results, data suggests you’ll have to apply caffeine topically so it can be absorbed into the scalp and directly to the hair follicles themselves, making shampoos a great way to get it on your head.
Though official research has yet to confirm its effectiveness, saw palmetto has been used for centuries to treat hair loss and many believe they’ve had positive, all-natural hair growth results. Saw palmetto may work because it blocks the 5-alpha-reductase, one of the enzymes that converts your testosterone into DHT.
Like biotin, there has been little verified scientific proof of its effectiveness. Also like biotin, it won’t hurt or hinder hair growth. Especially if you’re seeking a drug-free solution, it may be worth a try.
How Do I Choose the Right Shampoo?
First off, always visit a doctor or hair growth specialist before starting any treatment. An expert will be able to pinpoint exactly why you are losing your hair. This can be an essential step in developing a comprehensive plan in battling your baldness. Don’t wait until it’s too late for noninvasive methods to be effective.
Also, don’t expect a simple bottle of shampoo to work miracles. Shampoos are most helpful for keeping your hair clean and your scalp healthy. In addition, shampoo removes debris that could increase irritation or inflammation that may impede hair growth. However, they do little to change the actual biology of your hair growth.
Once you’ve decided to try hair growth shampoos, always do these three things:
1. Check the Ingredients
You’ll always want to ensure you know what ingredients are included in the shampoo. When it comes to over-the-counter shampoos, the ingredients listed above have the most potential benefit based on current data. Others may be helpful as well, like niacin and argan oil, or tea tree oil, but have even less scientific backing or testimonials.
2. Look at Reviews
If a product doesn’t have at least a year of consistently high unbiased reviews by many users, skip it. The product pages should also always link to scientifically backed studies proving thorough research and effectiveness. Like the saying says—if it’s too good to be true, it probably is.
3. Give it Time
Remember—hair growth is slow. Even the best products take several months to show results. Don’t become frustrated and toss the bottle after a few weeks. Try to give it at least 4 months before deciding the product isn’t right for you.
Minoxidil and Prescription Hair Growth Shampoos
Minoxidil is widely regarded as the most effective topical FDA-approved drug to fight hair loss. Commonly used under the well-known brand Rogaine, this topical solution is used in several brands of hair loss shampoos, creams, serums and foams in both over-the-counter and prescription strengths.
Unlike the ingredients above, minoxidil has a higher likelihood of side effects including scalp irritation and increased body hair in places other than your scalp. If other treatments haven’t proven successful however, this is a great option with high success rates for both men and women suffering from hair loss. Users should expect approximately 4-6 months for results, with full results taking about a year.
Hair Loss Benefits of Finasteride
Approximately 85% of individuals who routinely use Finasteride see a stabilization of their hair loss or dramatic slowing of the loss.
Over 65% of patients who use this medication see an actual increase in hair numbers. While we typically see a greater response on the crown, it also helps the mid-portion of the scalp and to a lesser degree the frontal region.
The vast majority of patients will see an increase in hair weight. This means more volume of hair even if the actual numbers do not increase.
Side effects are rare and there are no reported medication interactions between Finasteride and other prescription medications. You should always consult with your primary physician before starting a new medication.
About Finasteride and Dutasteride
This category of drugs is known as 5-alpha reductase inhibitors. These medications prevent testosterone from being converted to DHT (dihyrdotestosterone) in the prostate, hair follicles and oil glands. DHT is the active form of testosterone that causes hairloss. The two medications available are Finasteride (Propecia and Proscar) and Dutasteride (Avodart). Neither drug blocks testosterone activity throughout your body as a whole, only in the specific areas that contain these enzymes. Proscar & Avodart are FDA approved to treat benign prostatic hypertrophy (BPH or enlarged prostate). Only Finasteride 1mg is FDA approved to treat hair loss. Dutasteride can be used to treat hair loss, but this is off label.
The vast majority of men (and some women) can benefit from these medications without adverse side effects.
- Women who are pregnant or potentially could become pregnant CAN NOT take these medications, as they interfere with the developing baby’s hormones.
- You CAN NOT donate blood while taking these medications, because a pregnant woman might be the one who receives your blood.
- Tell your doctor you are taking one of these medications as they can lower your PSA score. Your PSA is used to monitor for possible prostate cancer development.
- Although there is no proven risk the fetus, men may choose to stop this medication if you and your partner plan to conceive a child.
Finasteride and Dutasteride Side Effects
Decreased sex drive and difficulty in achieving an erection has been reported in ~2% of men using these medications compared to placebo groups. In all major studies the side effects went away upon discontinuing the use of the medication. There have been rare reports of men who claim to continue to have problems after they stopped the medication. In most of these reports, the men continued taking the medication for several years in spite of their symptoms. A class action law-suit is ongoing claiming “Post Finasteride Syndrome.” The true validity of this syndrome is still under debate and research.
Breasts or testicular tenderness can be seen but is rare (<1%) and goes away upon stopping the medication.
Allergic reactions are possible but in over 20 years of prescribing these medications I have not seen a person have an allergic reaction to any of these medications.
Depression – While not reported as a side effect in any of the major studies, there have been rare reports of depression in the literature and on the internet. The validity of these reports remains unclear.
Decreased sperm counts – While not a reported problem during FDA trials, there have been rare cases reported in the literature and a positive link between use and decreased sperm count. In trials evaluating this side effect, upon discontinuation sperm counts returned to normal within 3 months.
Breast cancer is very rare in men in general and no association between using these medications and breast cancer has been shown. However, if you experience any lumps, bumps, pain or nipple discharge you should report it to your physician.
Prostate cancer is the 2nd most common form of cancer in men in the United States and over 15% will be diagnosed with it during their lifetime. Prostate cancers are graded on a Gleason Score scale from 1 to 10. The vast majority of prostate cancers are low to mid grade types with Gleason Scores of 6 or less. In two large clinical trials of these medications there was a 15-25% reduction in the incidence of prostate cancer. However, if you developed prostate cancer there was a small increased risk that your cancer would be a higher grade Gleason Score 8-10. For those taking 5mg of Finasteride the risk was 1.8% vs. 1.1% on placebo and for those taking Dutasteride the risk was 1.5% vs. 1.0% on placebo. The data regarding the link between these medications and possible increased/decreased risk of prostate cancer remains controversial and under intense review.