Traction alopecia is associated with sustained tension on the scalp hair. Traction causes hair to loosen from its follicular roots; however, hair loss also occurs secondary to follicular inflammation and atrophy. Sometimes also referred to as ‘cosmetic traumatic alopecia’ as it occurs when the hair has been held under tension by cosmetic practices like braiding or ponytails or the individual has slept in rollers.
If tension continues to the hair roots the constantly pulling hair too tight and in the same direction can cause baldness to these specific, localized roots only. Onset is gradual and often takes 2 to 3 years to become apparent and it often occurs symmetrically around the fronto-temporal hairline, occipital scalp involvement is less common. Vellus (short, fine) hair is usually spared in the affected area.