Sun | Sep 26, 2021

Dear Doc | I need help in figuring out my hair loss

Published:Sunday | February 24, 2019 | 12:00 AM

Q. Dear Doc, I need your help in figuring out my hair loss. I started wearing weaves and braids a few years back. I was told these were protective styles for my hair that was creamed at the time... and that it would rest my hair from the processing and make it healthier. Fast forward three years and whereas my hair is longer, it is thinner, especially at the front and sides. The hairdresser says its my baby hair and I should just brush it up and it will grow in. But at work they laughed and told me is all my weave caused it and I better start wearing wigs. Is this true?

A. Yes this is true and a problem a lot of women who wear those hairstyles have. It is what we call Traction Alopecia. It is a form of hair loss that results from prolonged or repetitive tension on the hair. It commonly occurs along the front (frontal) and the side near the ears (temporal) hairline.

Traction Alopecia, occurs when the hair follicles are subjected to prolonged and repetitive tension. It is most commonly diagnosed in women of African descent with kinky hair. The is due to the high frequency of use of traction hairstyles such as, braids or hair weaves in this population. Now here is where I expect to get some negative reactions, but this has been proven by Traction Alopecia occurring in other populations in association with the use of traction hairstyles, as well.

The use of chemical relaxers increases the risk for developing Traction Alopecia, because traction applied to chemically relaxed hair has a higher likelihood for Traction Alopecia than non chemically treated hair.

The exact development of Traction Alopecia is yet to be elucidated. Traction on the hair is thought to induce an inflammatory process at the hair follicle that is either asymptomatic or appears as a folliculitis. As a result of this inflammation, hair follicles may become smaller or dormant, resulting in finer hairs, and reduced hair thickness.

Hair loss from Traction Alopecia is reversible in the early stages, if the cause of traction and the inflammatory reaction is discontinued. With continued traction, irreversible damage to the hair follicles leads to permanent hair loss.

A history of certain symptoms associated with hairstyles such as pain, pimples, and crusts, is also associated with increased risk for traction alopecia. Up to 81 percent of women with traction alopecia admits to a history of tight painful braids, painful pimples, with or without formation of crusts. The presence of hair casts is also a sign of ongoing traction alopecia. Hair casts are moveable collections of white scale that encircle the hair.

The manifestations of traction alopecia depends on the stage and severity of disease, and can include inflammatory papules (small bumps), pustules (small pimples/white heads), reduced hair thickness, reduced hair length, and bald patches. With persistent traction, noticeable hair loss occurs, which may progress from decreased hair density to patches of complete baldness.

Now what your hairdresser is calling baby hair is what we call the 'fringe sign', which is fine or miniaturised residual hairs retained at the margin of the hairline with hair loss behind the fringe, typically being present. It will not be growing in, I'm sorry to inform you.

A high index of suspicion is often necessary to diagnose Traction Alopecia, particularly since patients rarely associate their hair loss with their hairstyling practices.

Questions that are helpful with the diagnosis include:

1) When did the hair loss start, and was it sudden or gradual in onset? - Hair loss in Traction Alopecia typically is gradual.

2) Where have you noticed the most hair loss? – Hair loss is usually around the hairline at the front and sides above the ears. It may also occur around the back hairline.

3) Do you have symptoms in the area of hair loss? – Patients with traction alopecia usually have symptoms of tenderness, pimples, stinging, or crusting at some point before the hair loss started.

4) What is your normal hair care routine? – A history of current or previous traction hairstyles is necessary for a diagnosis of traction alopecia. Also important would be other hair practices, such as frequent use of direct heat on the hair (eg, flat irons or curling irons), and chemical relaxers, as these practices increases the hair’s fragility and may contribute to additional hair loss .

The treatment options for traction alopecia include hairstyle changes and medications aimed at halting progression of the disorder and promoting regrowth of hair. If treatment is unable to induce adequate hair regrowth, as is often the case for late-stage disease, then hair transplantation or cosmetic techniques to camouflage hair loss can be done.

Within one year of onset is desirable for treatment because the potential for hair regrowth is best; this diminishes with increasing duration of traction and increasing severity of alopecia. The most important intervention for early-stage traction alopecia is discontinuation of the traction hairstyle. This would include avoidance of particular styles of braids, weaves, twists, dreadlocks, ponytails, hair buns, hair extensions, and any other styling techniques that exert tension on the hair. Additional interventions, such as topical steroids, or oral antibiotics, are often used to in an attempt to minimize additional hair loss and augment regrowth of hair.

But more important than anything else is, traction alopecia is preventable?

Women need to be aware that experiencing pain, tenderness, or pimples from a hairstyle should not be tolerated.

Educating hairdressers may also be of benefit for the prevention and early detection of traction alopecia.

-Hairstyles should be painless; a painful hairstyle should be removed immediately.

-Hairstyles causing skin redness, pimples, or hair loss should be removed immediately.

-Traction hairstyles (eg, braids or weaves) should be worn infrequently and for short periods.

-It is preferable to avoid traction hairstyles on chemically relaxed hair.

-Massaging or vigorously brushing the affected scalp does not stimulate hair regrowth and is not recommended for traction alopecia.

I do suggest you visit a dermatologist for a full assessment of you hairline.