Traction Alopecia When Is It Too Late? Can You Reverse It?

Traction alopecia is a common but preventable type of hair loss caused by repeated tension on the hair and scalp, often due to tight hairstyles like braids, cornrows, ponytails, buns, or extensions. Over time, this constant pulling damages hair follicles and can lead to permanent bald patches if left untreated.

This condition affects millions worldwide, but it’s especially prevalent among women with tightly curled or coiled hair, particularly those of African descent. In fact, studies show that up to 31.7% of adult women and 18% of girls in some communities experience signs of traction alopecia.

The good news? Traction alopecia is completely reversible in its early stages. But if the tension continues and the follicles are scarred, the damage can become permanent. That’s why understanding the early warning signs, treatment options, and prevention techniques is crucial, whether you’re someone experiencing hair loss or a caregiver, stylist, or parent of someone at risk.

What Causes Traction Alopecia?

The root cause of traction alopecia is physical stress on the hair follicles. This typically comes from hairstyles or habits that pull tightly on the scalp over extended periods.

Common Causes Include:

• Tight braids or cornrows
• Sleek, high ponytails or buns
• Weaves or hair extensions
• Tight headbands, scarves, or turbans
• Repeated use of chemical relaxers or heat styling
• Habitual pulling or twisting of hair (trichotillomania)

Over time, the pressure from these styles can cause inflammation at the follicle base, leading to thinning, breakage, and ultimately, follicular damage.

Who Is Most at Risk?

Anyone can develop traction alopecia, but certain groups are more vulnerable due to hair texture, cultural styling practices, and frequency of styling.

High-Risk Groups Include:

• Women of African descent: Due to the natural fragility of tightly curled hair and cultural styling preferences
• Children and adolescents: Especially when tight hairstyles are introduced early
• Dancers, athletes, or professionals: who wear hair pulled back regularly
• Men with dreadlocks, braids, or man buns
• People who frequently use weaves, wigs, or extensions

What Are The Stages of Traction Alopecia and Their Symptoms

Traction alopecia doesn’t happen overnight, it progresses through several stages. Recognizing these stages can help you take the right steps before permanent damage sets in.

Stage 1: Prevention Phase – No Damage Yet

At this initial stage, there are no visible signs or symptoms of hair loss. The scalp and hair follicles remain completely healthy, and no inflammation or stress has yet impacted the follicular structure. This is considered the pre-symptomatic phase, where the risk exists, but no harm has been done. Individuals in this stage often maintain tight hairstyles or damaging grooming habits without realizing the potential danger.

The most effective action at this point is education and prevention. People, especially those in high-risk groups such as individuals with tightly coiled hair, should be taught safe hair practices early. Avoiding tight hairstyles, minimizing the use of heat or chemical treatments, and using gentle, nourishing products can protect follicle health. 

Parents and stylists, in particular, play a crucial role in safeguarding children and young adults during this stage. Prevention is far easier than reversal, so proactive steps here are critical.

Stage 2: Early Stage – Reversible Hair Loss

The early stage marks the first visible sign that the follicles are under distress, though damage is not yet permanent. Individuals may begin to notice hair thinning, particularly around the edges or temples, areas most commonly affected by tension. 

Hair may start to break more easily, and increased shedding becomes noticeable during brushing or washing. Additional symptoms include itching, redness, tenderness, and sometimes the appearance of tiny bumps or pustules, indicating inflammation or minor follicular infection.

What’s happening biologically is that the constant pulling disrupts the normal hair cycle, pushing more hair into the catagen (transition) and telogen (resting) phases prematurely, while also inflaming the follicular area. Fortunately, at this stage, follicles are still viable, meaning regrowth is highly possible if action is taken swiftly.

What You Need To Do:

Immediately stop all tension-causing hairstyles, including:

• Braids
• Weaves
• Tight buns or ponytails
• Hair accessories that pull on the scalp

Avoid damaging hair practices, such as:

• Harsh combing or brushing
• Heat styling (e.g., flat irons, curling wands)
• Chemical relaxers or harsh treatments

Recommended treatment options:

• Topical minoxidil: Stimulates hair regrowth by increasing blood flow to follicles
• Corticosteroids (topical or intralesional): Reduces inflammation in the scalp
• Antibiotics: Used if pustules or signs of infection (folliculitis) are present

Expected recovery:

• With consistent treatment and proper care, full hair regrowth is typically possible within 3 to 6 months in the early stage

Stage 3: Advanced Stage – Partially Reversible

In the advanced stage, some of the hair follicles have been chronically inflamed or repeatedly traumatized, leading to early scarring (cicatricial alopecia). While not all areas are permanently affected, signs of damage become more visible. 

The scalp may appear shiny or smooth in some regions, and hair growth becomes more sparse or patchy, with fine, thin, or short hair attempting to grow but failing to thrive. Some individuals report ongoing redness, inflammation, and even headaches or discomfort, especially around high-tension areas.

At this point, some follicles are no longer viable due to early scar formation, while others might still respond to treatment. 

What You Need To Do:

Preserve any remaining healthy hair follicles and prevent further hair loss. Professional evaluation is essential for advanced-stage traction alopecia.

Recommended treatments:

• Minoxidil (topical): Helps stimulate growth in remaining viable follicles.
• Platelet-Rich Plasma (PRP) therapy: Promotes follicle repair and improves scalp health.

Diagnostic tools to assess damage:

• Scalp biopsy: Checks for presence of scarring and follicle viability.
• Trichoscopy: A non-invasive method to examine hair follicles and scalp condition.

Prognosis:

• Full recovery is unlikely at this stage.
• Partial regrowth is still possible in areas where follicles are not yet scarred.

Stage 4: Longstanding Stage – Irreversible Hair Loss

This final stage of traction alopecia is characterized by complete destruction of the hair follicles, which are replaced by fibrotic scar tissue. At this point, the scalp typically appears smooth, shiny, and bald, with no visible follicles or stubble. 

The skin in affected areas may feel tight or tender, and the absence of hair is typically permanent. This is known as cicatricial (scarring) alopecia, and the damage can no longer be reversed through natural or medicinal means.

What You Need To Do?

At this stage, hair follicles are permanently destroyed and replaced by scar tissue. Natural hair regrowth is no longer possible in these areas.

Cosmetic and surgical solutions are the only options, including:

• Hair transplantation: Viable hair follicles from other parts of the scalp or body are grafted into scarred areas.
• Scalp micropigmentation: A non-surgical method that uses pigments to mimic the appearance of hair follicles, giving the illusion of hair density.
• Wigs or hairpieces: Practical and accessible alternatives when restoration is not desired or feasible.

Preventive care remains essential to protect unaffected hair and avoid further loss:

• Stop all tension-causing hairstyles and practices immediately.
• Work with a specialist (e.g., dermatologist or hair restoration expert) to develop a long-term scalp care and maintenance plan.

How to Know If It’s Too Late to Reverse Traction Alopecia

If any of these signs are present, the damage may be permanent:

• No noticeable regrowth after 6 months of stopping tight hairstyles and following a proper hair care routine. If hair hasn’t returned by this point, follicles may no longer be viable.
• Smooth, shiny areas on the scalp, especially along the hairline or crown. This often means that hair follicles have been replaced by scar tissue, and no new hair can grow in these regions.
• Lack of visible hair follicles or stubble in affected areas. In healthy scalp areas, even when hair is short or shaved, small follicular openings or stubble are usually visible. Their absence can suggest scarring.
• Chronic tenderness, burning, or discomfort in the scalp. Persistent inflammation can be a symptom of long-term follicular damage and underlying scarring.
• Scalp biopsy confirmation of fibrosis or scarring. A dermatologist may recommend a biopsy to examine the tissue microscopically. The presence of fibrotic tracts, absent sebaceous glands, or destroyed follicular structures confirms that the hair loss is permanent.

Frequently Asked Questions

How do you know if traction alopecia is permanent?
Traction alopecia becomes permanent when hair follicles are irreversibly damaged, leading to scarring. Indicators include a smooth, shiny scalp with no visible follicles, no regrowth after six months of discontinuing tension-causing hairstyles, and a scalp biopsy confirming scarring.

How to know if hair follicles are dead?
Dead hair follicles no longer produce hair. Signs include a smooth, shiny scalp with no visible hair or stubble, and scarring or fibrous tissue replacing the follicles. A scalp biopsy can confirm if the follicles are dead.

Does traction alopecia get worse?
Yes, traction alopecia can worsen if the underlying tension is not addressed. It progresses through stages—from reversible hair thinning to permanent hair loss with scarring, making early intervention crucial to prevent irreversible damage.

How do I grow my edges back from traction alopecia?
To grow back edges, stop using tight hairstyles that cause tension, such as braids and ponytails. Use gentle hair care, avoid heat and chemicals, and apply treatments like minoxidil to stimulate growth. In severe cases, consider consulting a dermatologist for advanced therapies.

How to tell if hair is regrowing?
Hair regrowth can be identified by the appearance of fine, short hairs (vellus hairs) in previously bald areas. Over time, hair density increases, and the scalp becomes less visible. Monitoring these changes over several months can help assess regrowth progress.