Traction alopecia results from chronic mechanical tension on hair follicles, typically from tight hairstyles, braids, weaves, tight ponytails, religious headwear with mechanical contact points, or hair extensions. The early stages are reversible if traction is removed. Chronic traction leads to permanent follicle damage and scarring alopecia that is largely untreatable medically. The pattern is most commonly seen at the temporal hairline and around persistent tension points.

The condition is dramatically more common in women than men, and disproportionately affects communities where culturally significant hairstyles involve sustained tension, including Black women, Sikh men with tied hair, and Orthodox Jewish women wearing tight head coverings. Recognition often comes too late, after years of cumulative damage. Early signs include perifollicular pustules (early inflammatory phase), hairline recession in characteristic patterns, and broken hairs at the perimeter of tension areas.

Treatment options are limited once established. Removing the source of tension is essential and may allow partial recovery if the condition is detected early. Topical minoxidil has modest evidence for promoting regrowth in the reversible phase. Hair transplantation can address established scarring traction alopecia with reasonable outcomes for the appropriate patient. Prevention is far more important than treatment: tension hairstyles should not produce pain or discomfort when styled (a useful self-test), and rotating styles to relieve specific tension points is meaningfully protective.