Traction Alopecia: How Braids and Weaves May Cause Hair Loss

For millions of African American women tight braids and long-wearing weaves are a part of the daily beauty regimen, but few know of the extensive and potentially permanent damage that can result from it. In the hair restoration research community it’s been long known that a condition known as traction alopecia can cause hair loss due to stress from braids, pig tails, or weaves, but this form of hair loss is gradual and usually reversible. Within the female African American community though, a new condition known as central centrifugal cicatrical alopecia (CCCA) has been causing serious and sometimes permanent hair loss in women.

For dozens of years CCCA was called “hot comb alopecia,” because doctors believed that the hair loss they were noticing in African American patients was linked to hair straightening via hot comb treatments or chemical relaxers, but wider studies proved this wasn’t the case. Instead, scientists now believe part of the cause is traction-inducing hairstyles like weaves and braids that stress scalps for extended periods of time.

CCCA takes hold when the long term scalp agitation creates bumps that fill with puss and later bacteria. These bumps lead to scarring which permanently damages follicles, resulting in a steadily growing bald patch. The scalp will appear shiny and smooth without the tiny speckles of follicles. The hair loss is accompanied by an itching, burning, or pin and needles sensation. Most instances start at the crown or vertex of the head and progress to larger, more noticeable spots. CCCA is often exacerbated when women notice the hair loss and are increasingly compelled to use weaves to cover the thinning.

Recently, the Cleveland Clinic Institute of Dermatology and Plastic Surgery gave a questionnaire on hair loss to 326 black women in the Cleveland area. Of those surveyed, 28% had central hair loss, and 60% of those with hair loss showed clear symptoms of CCCA. While the researchers behind the study believe that hairstyles initiate or exacerbate the hair loss, they still don’t know what, if any, other conditions cause CCCA. Around 18% of women with CCCA were diabetic, statistically relevant seeing as only 8% of those surveyed were diabetic. The women who had diagnosable CCCA also displayed higher levels of bacterial skin infections, another potentially relevant avenue for research. Most women in the study were middle aged or older, but some dermatologists have seen cases of CCCA in girls as young as 15.

So what should you do if you suspect you have CCCA? Aside from undoing braids, weaves, and any tension causing hair adornments, you need to see a dermatologist. Susan C. Taylor, MD, a dermatologist and diplomat of the American Board of Internal Medicine and the American Board of Dermatology, says the diagnosis for CCCA “is made by performing a scalp biopsy and analyzing the hair follicles obtained under the microscope.” Once the condition is identified, she adds, “oral and topical antibiotics are often prescribed for a four to six month period of time because they decrease inflammation. Topical or injected steroids are often applied directly to the scalp, again for a 4 to 6 month period.”

Though scientists are still learning about this odd condition, early identification and treatment can prevent continued hair loss. Since follicles damaged by CCCA are permanently scarred, most topical hair restoration methods like Rogaine won’t be very effective, but hair transplant surgery will. If you’re interested in learning more about hair loss or transplant surgery, contact us today. Our Hair Loss Forum representatives can schedule you a free consultation with qualified hair loss specialists in your area!