Traction alopecia scarring: when hair loss becomes permanent

Last updated 2026-07-09

What is traction alopecia scarring and how is it different from regular traction alopecia?

Traction alopecia is hair loss caused by repeated or sustained pulling on the follicle. Most people know it as the thinning along the hairline after years of tight braids, weaves, or ponytails. That version is non-scarring alopecia, which means the follicle is still alive and hair can grow back if you remove the tension soon enough.

Scarring traction alopecia is a different animal.

When the pulling continues long enough, or hits hard enough, the follicle itself gets destroyed. Chronic mechanical trauma sets off an inflammatory response deep in the scalp. That inflammation slowly replaces the follicular structure with fibrous scar tissue ^[1]. Once a follicle becomes scar tissue, it cannot produce hair. Period. The scalp there may look smooth, shiny, and slightly indented compared to the skin around it, with no peach-fuzz, no fine hairs, nothing pushing through.

The American Academy of Dermatology classifies traction alopecia as a primary cicatricial alopecia once scarring has occurred, putting it in the same category as lichen planopilaris and frontal fibrosing alopecia ^[2]. That classification changes the treatment mindset. You are no longer trying to wake up sleeping follicles. You are managing inflammation, protecting the follicles that remain, and sometimes talking to a surgeon about a transplant.

For how traction alopecia progresses before scarring sets in, read our overview of traction alopecia.

What does scarring from traction alopecia actually look like?

Early traction alopecia, the non-scarring kind, is easy to spot: small bumps or pustules along the hairline, thin or missing baby hairs, and a frontal or temporal hairline that looks ragged rather than smooth ^[1]. At that stage the scalp texture still looks normal.

Scarring changes the texture.

Where follicles have been destroyed, the scalp surface turns smooth and slightly shiny. Dermatologists call this a "polished" look. The skin may read paler or darker than the surrounding scalp, depending on your complexion and how the scarring went. You will not see follicular openings, those tiny dots where hairs normally emerge, anywhere in the scarred zone. Run a finger across it and it feels different from healthy scalp: firmer, less yielding, sometimes slightly sunken.

A scarred patch usually has a clear border between affected and unaffected skin. You may still see active hair follicles right up to that edge, which matters medically. Those border follicles are the ones at risk if tension continues. Some people notice the affected area has reduced sensation, a numbness or dullness to touch, because the nerve endings tied to destroyed follicles are gone too.

Sometimes the scalp develops post-inflammatory hyperpigmentation around the scarred area, especially in women with deeper skin tones. That discoloration is a separate issue from the scarring itself, but it tells you significant inflammation happened there ^[3].

Research grading scales, including the Marginal Traction Alopecia Grading Scale (M-TAGS), score severity from 0 (no loss) to 4 (extensive scarring with complete follicular dropout) ^[4]. Grade 3 or 4 is where scarring is typically confirmed.

How long does it take for traction alopecia to become permanent scarring?

Nobody has clean prospective data on this. The closest we get are cross-sectional studies and case series. They tell us scarring is far more common in women who have worn tight styles for ten or more years, but cases show up in women with much shorter histories when the tension was extreme.

A 2016 epidemiological study in the Journal of the American Academy of Dermatology found traction alopecia in 31.7 percent of the Black women in its sample, though it did not track the scarring-versus-reversible split in a way that gives a clean timeline ^[5]. What clinicians describe instead is a window of reversibility. During that window, which could last months or several years, the follicle is damaged but not dead. Inflammation is active, but the follicle's architecture is intact enough to grow hair again if the tension stops.

Once scarring completes, the window closes.

Things that seem to speed the timeline: starting tight styling in childhood (the scalp and follicles are still developing), wearing styles nonstop without breaks, stacking tight styles on top of chemical relaxers or heat (each adds its own trauma), and ignoring early warnings like pain, bumps, and breakage at the hairline.

Childhood styling is its own concern. A 2017 review in the International Journal of Dermatology noted that traction alopecia "may first present in childhood or adolescence" and that early onset lines up with more severe outcomes later ^[6]. If a child says their braids hurt, that is a clinical warning sign, not a normal part of getting hair done.

Black women (JAAD cross-sectional study, n=326)	31.7%
African/African-American women (systematic review lower bound)	17%
African/African-American women (systematic review upper bound)	33%
General dermatology visits attributed to traction alopecia (predominantly African American clinics)	3.4%

Source: Aguh et al., Journal of the American Academy of Dermatology, 2016; Dermatologic Clinics systematic review

Can scarring traction alopecia be reversed or treated?

The direct answer is no, not in the scarred zone. Scar tissue has no hair follicles and no topical, oral, or natural treatment on the market today can turn it back into follicle-bearing tissue ^[2]. Anyone telling you otherwise is overselling what the evidence supports.

What you can do falls into three buckets: stop further damage, manage residual inflammation, and consider surgical restoration.

Stopping the damage is the one thing that changes everything. If any follicles at the border of the scarred area are still working, pulling all tension off them gives them a shot at survival. Dermatologists usually recommend dropping all tight styles for at least six months and ideally longer, switching to very low-tension protective styles if you need a style at all, and cutting chemical relaxers if they are in the mix ^[2][1].

Managing inflammation still matters after scarring, because the inflammatory process may be active at the margins. Dermatologists commonly prescribe topical or intralesional corticosteroids to calm that inflammation and protect the remaining follicles. Some reach for hydroxychloroquine or other systemic agents in aggressive cases, especially when the pattern overlaps with frontal fibrosing alopecia ^[3].

Minoxidil (topical, 5% for adults) sometimes supports regrowth in the non-scarred zones, though it does nothing for scarred areas. The evidence for minoxidil in traction alopecia specifically is thin; most of the support comes from its proven mechanism in androgenetic alopecia and telogen effluvium ^[7].

Surgical hair transplantation is the only way to add hair back to scarred zones. Results depend on how deep the scarring runs and whether inflammation is fully controlled before surgery. A scalp biopsy before transplant is standard practice to confirm the inflammatory activity has resolved, because transplanted follicles dropped into an active inflammatory environment face the same destruction that killed the originals.

To support the follicles that are still healthy while you recover from styling damage, some evidence points to scalp-applied actives like rosemary oil. A 2023 review found promising data on rosemary for follicular support, though the evidence stays limited and it will not restore scarred areas. See our breakdown of rosemary oil for hair growth for what the studies actually say.

What hairstyles cause scarring traction alopecia most often?

Any style that puts sustained tension on the hairline or temples can contribute. The ones that show up most in the clinical literature: tight cornrows, micro-braids, individual braids left in too long, weaves sewn onto tightly braided foundations, high ponytails and buns worn daily, and dreadlocks repeatedly tightened at the roots ^[5][6].

Extensions add weight on top of tension. A full set of box braids with added synthetic hair can load real mechanical stress on each follicle attachment point for weeks straight. Weaves sewn to cornrow foundations get flagged often because tension distributes unevenly and the style tends to stay in longer than it should.

Edge-laying compounds the problem. Slicking edges down with heavy gels or pomades, then wrapping the hairline tight with a scarf, drives concentrated tension into the most fragile follicles you have, those fine baby hairs with the shallowest anchoring. Learn more about why edges are so vulnerable in our guide to edges hair.

The style itself is only part of the equation, though. Tension level, duration, frequency, whether the scalp gets rest, and your baseline follicular resilience all feed into it. Some women wear braids their whole lives with no scarring. Others develop real damage fast. The risk is documented; the individual response varies.

The AAD names "tight hairstyles" as a modifiable risk factor and recommends "wearing hair in looser styles" as a primary prevention step ^[1].

For styles that keep tension low while still protecting your hair, our resource on protective hairstyles covers the lower-risk options.

How do dermatologists diagnose scarring versus non-scarring traction alopecia?

Diagnosis starts with a clinical exam. A dermatologist reads the pattern of hair loss, the texture of the scalp in affected spots, whether follicular openings are present, and any signs of active inflammation like redness, scaling, or pustules. A detailed styling history is essential, which is why bringing photos of your styling history to the appointment genuinely helps.

Dermoscopy, a tool that magnifies the scalp surface, lets the clinician hunt for follicular dropout, perifollicular fibrosis (a reddish or whitish ring around follicle openings), and the "lonely hair" sign, isolated hairs surrounded by bare scalp, which points to follicular miniaturization heading toward destruction ^[4].

The definitive test is a scalp biopsy. A small punch biopsy from the affected area, usually 4mm, gets examined under the microscope. In non-scarring traction alopecia, the biopsy shows trichomalacia (damaged hair shafts), a catagen/telogen shift, and follicular swelling, but the follicular structures are still there. In scarring traction alopecia, the histology shows fibrous tract replacement of follicles, loss of sebaceous glands, and sometimes a lymphocytic infiltrate at the follicular isthmus ^[3][2].

A biopsy showing fibrous replacement is the definitive proof that scarring has happened. At that point, regrowth in the biopsied zone is not expected.

Not every dermatologist has deep experience with hair disorders. If your first visit feels rushed or dismissive, ask for a referral to a dermatologist who specializes in hair loss (a trichologist-trained dermatologist or a hair loss clinic). It is worth chasing.

Who is most at risk for developing permanent scarring from traction alopecia?

Black women and women of African descent are hit hardest. The 31.7 percent prevalence figure from the JAAD 2016 study reflects that reality ^[5]. The disproportion is not genetic susceptibility in the usual sense. It comes from cultural styling practices that put higher tension on hair types that, because of the tight curl pattern and elliptical follicle shape, already exit the scalp at a sharper angle, which makes them more prone to mechanical disruption.

Age cuts in two directions. Very young girls whose scalps are still developing face higher risk from tight styles started in childhood. Older women who have stacked up decades of styling tension face higher cumulative risk no matter what they do now.

Women who pair tight styles with chemical relaxers face compounded risk. Relaxers work by chemically breaking the bonds in the hair shaft, which also weakens the follicle's structural integrity. Add tension to that weakened structure and follicular damage speeds up ^[6].

Scalp conditions like seborrheic dermatitis, scalp psoriasis, or folliculitis pile on inflammatory load that can make the follicle less able to survive mechanical trauma. Anyone with active scalp inflammation should be extra careful with tight styling.

There is also an underappreciated risk group: women who wear wigs secured with clips or adhesives every day. Clip tension and adhesive-related follicular damage both show up in case reports, and this group often goes underdiagnosed because they arrive without an obvious braiding history.

What does the research say about traction alopecia scarring rates?

The epidemiology here is thinner than it should be, a frustrating gap given how common the condition is. The best population-level data comes from a handful of cross-sectional studies.

The 2016 JAAD study by Aguh et al. found traction alopecia in 31.7 percent of 326 Black women sampled, making it the most common form of hair loss in that group ^[5]. A separate systematic review in Dermatologic Clinics pegged prevalence across studies at 17 to 33 percent in African and African-American women, depending on the sample ^[3].

Studies on the scarring subset specifically are scarcer. What dermatologists note in the clinical literature is that scarring gets underdiagnosed, because many women do not seek care until loss is advanced, and by then scarring may already be present without the patient knowing it started as a reversible problem.

A 2019 article in the British Journal of Dermatology reviewing cicatricial alopecias noted that traction alopecia "accounts for up to 3.4 percent of dermatology visits" in predominantly African American populations ^[9]. Against overall dermatology visit rates, that represents a large absolute number of women.

The research gap on prevention is real. There are no large randomized controlled trials testing whether specific interventions cut scarring rates in at-risk populations. The advice we have, stop the tension, treat inflammation early, avoid concurrent chemical damage, is sensible and mechanistically sound but rests on observational data and clinical expert consensus rather than high-powered trials.

What scalp care practices help protect remaining follicles after traction damage?

Once you have stopped the styling that caused the damage, the job shifts to protecting every follicle that still works. The follicles at the margins of any affected area are the ones most worth fighting for.

Scalp massage has modest evidence behind it. A small 2016 study in Eplasty (indexed through the National Institutes of Health) found that 4 minutes of daily standardized scalp massage over 24 weeks increased hair thickness in participants ^[7]. The proposed mechanism is more blood flow and mechanical stretching of dermal papilla cells. This will not restore scarred areas, but it may support marginal follicles. Gentle is the operative word: aggressive massage near inflamed tissue adds the exact mechanical trauma you are trying to avoid.

Keeping the scalp clean and free of buildup matters more than most people think. Product buildup from edge gels and pomades can block follicular openings and feed folliculitis, which piles more inflammation onto already-stressed follicles. Washing the hairline and scalp at least once a week, more if you use heavy styling products, is worth prioritizing. For edge products that don't leave residue, our edge control guide covers what to look for in a formula.

For topical support on non-scarred areas, Edge Naturale's plant-based edge formulas skip the pore-clogging ingredients common in heavy pomades. No topical product restores scarred follicles, and the brand does not claim otherwise.

Diet and systemic health matter around the edges. Iron deficiency anemia (ferritin below roughly 30 ng/mL is linked to hair shedding), vitamin D insufficiency, and thyroid dysfunction can all worsen the hair loss picture in women already dealing with follicular damage ^[8]. Getting basic labs if you're shedding heavily is reasonable, not because fixing a deficiency reverses scarring, but because it takes systemic stress off the follicles you still have.

Some evidence also supports essential oils for natural hair growth applied to the scalp in non-scarred areas, particularly peppermint and rosemary. The mechanisms are documented, the evidence base is limited but real, and the risk is low. They earn a supporting role, not a starring one.

When should you see a dermatologist, and what should you bring to the appointment?

See a dermatologist as soon as you notice hairline recession that does not bounce back after you stop tight styles for eight to twelve weeks. If your scalp texture is changing, if your hairline is moving backward in a smooth arc, or if you have areas where no hair has grown for six months or more, that is urgent. The faster you get evaluated, the more follicles you can save.

Do not wait for it to get "bad enough." That wait is how reversible traction alopecia becomes permanent.

Before the appointment, photograph your scalp and hairline in consistent lighting, ideally near a window in natural light. Bring older photos if you have them from years back. Prepare a styling history: what styles you wore, for how long, how tightly, whether you used relaxers or heat and for how many years. That history changes the clinical picture and helps the dermatologist gauge how long the damage has been building.

Ask directly whether a scalp biopsy is warranted. Many dermatologists diagnose traction alopecia clinically without a biopsy when the presentation is clear. But if there is any ambiguity about whether scarring has occurred, or if a prescription treatment is on the table, a biopsy gives you definitive information. You are entitled to ask for it.

Also ask whether the pattern could overlap with frontal fibrosing alopecia, a related but distinct cicatricial alopecia that can co-occur with traction alopecia and follows a different treatment algorithm. Telling them apart matters for prognosis and management ^[10].

Is hair transplant surgery effective for scarring traction alopecia?

Hair transplantation can restore hair to scarred areas, but only if several conditions are met first.

The inflammation has to be fully controlled and inactive before surgery. Transplant into actively inflamed tissue and it will likely fail: the same destructive process that killed the original follicles goes after the grafts. Dermatologists usually require a period of confirmed quiescence, often a year or more of stable, non-progressing loss, before they refer for a transplant consult ^[9].

The scalp's blood supply in the scarred area has to be good enough to feed grafted follicles. Dense, thick scarring can have compromised vascularity. Surgeons check this during consultation, sometimes with extra imaging or test grafting in a small area first.

Donor supply matters too. Transplantation moves hair from a donor zone (usually the occipital scalp) to the recipient zone. Women with decades of tight styling sometimes have thinner donor density, which caps how much can be moved.

Graft survival in well-selected candidates has been reported at 70 to 90 percent in individual case series, though these are not large randomized trials ^[9]. The honest read: results swing hard on the surgeon's skill with the specific scarring pattern and the depth of fibrosis.

Cost in the United States typically runs from $4,000 to $15,000 or more for a full hairline restoration, depending on graft count and clinic. Most insurance does not cover hair transplantation for traction alopecia because it is classified as elective aesthetic surgery.

For women not ready for surgery, or not candidates for it, scalp micropigmentation (SMP) can create the look of a hairline through cosmetic tattooing. It restores no hair, but it is a legitimate option that some women find meaningful.

How can you prevent traction alopecia from progressing to scarring?

Prevention is the strongest tool you have, and it works at every stage until scarring completes.

The core principle is mechanical: cut tension on the hairline and temporal follicles, give the scalp rest periods, and stop ignoring pain. Pain during styling is not normal. That tight pulling that lingers for hours after a style is done is your scalp telling you the load is too high.

Specific strategies backed by dermatological guidance ^[1][2]:

Choose lower-tension styles. Loose twists, buns that aren't pulled tight, low ponytails, and braids installed with reasonable tension carry less risk than micro-braids, super-tight cornrows, and any style that stretches the hair as far as it will go.

Limit extension weight. Heavier extensions mean more gravitational tension at each follicle anchor over weeks. If you use extensions, go lighter and cap wear at six to eight weeks.

Build in rest periods. Alternating tight installed styles with stretches of low-manipulation or no-manipulation styling gives follicles a real break.

Skip the daily aggressive edge routine. Scarf-wrapping and gel-slicking every single day concentrates tension right where your most fragile follicles live. If you need your edges laid, do it gently and not every day.

Avoid tight styling right after chemical processing. Relaxed or color-processed hair has a weakened shaft and a weakened follicle environment. That is not the moment to add mechanical tension.

Talk to your stylist directly about tension. A good stylist adjusts. A stylist who waves off your pain or tells you it is supposed to hurt is not prioritizing your scalp.

And if you are already seeing early hairline thinning, do not wait. The window between early non-scarring traction alopecia and permanent loss is real but not unlimited. Our deeper guide to hair breakage covers the parallel issue of shaft-level damage that often rides along with this kind of follicular stress.

Frequently asked questions

Can traction alopecia scarring grow back?

No. Once traction alopecia becomes scarring, meaning hair follicles have been replaced by fibrous scar tissue, those specific follicles cannot produce hair again. No topical, oral, or natural treatment reverses established scar tissue. Hair transplantation is the only method that can add hair back to scarred areas, and it requires that active inflammation be fully resolved first.

How do I know if my traction alopecia has scarred?

Signs that scarring may have occurred include smooth, shiny scalp texture in bald areas, no visible follicular openings (tiny dots where hairs emerge), a stable bald zone that has not changed in six or more months despite stopping tight styles, and reduced sensation in the area. A dermatologist confirms scarring with dermoscopy or a punch biopsy, which is the definitive test.

How long does it take for traction alopecia to scar permanently?

There is no fixed timeline. Scarring has been documented in women with as few as a few years of tight styling when tension was extreme. More commonly, it builds over a decade or more. Factors that speed the process include starting tight styles in childhood, combining tight styles with chemical relaxers, wearing styles continuously without breaks, and ignoring early warning signs like pain and hairline bumps.

Is traction alopecia scarring the same as frontal fibrosing alopecia?

They are related but distinct. Both are cicatricial (scarring) alopecias that affect the frontal hairline. Frontal fibrosing alopecia is an autoimmune-mediated condition; traction alopecia is mechanically caused. They can co-occur, and telling them apart sometimes requires a scalp biopsy. Treatment approaches differ, so an accurate diagnosis matters for prognosis and management.

What does a scalp biopsy show in scarring traction alopecia?

Histology from a scarred area shows fibrous tract replacement of hair follicles, loss of sebaceous glands, and sometimes a lymphocytic infiltrate at the follicular isthmus. Follicular structures are absent or destroyed, compared to non-scarring traction alopecia, where follicular architecture remains but shows stress changes like trichomalacia and a catagen/telogen shift.

Can children get permanent scarring from tight braids?

Yes. Traction alopecia can begin in childhood, and because a child's scalp and follicles are still developing, the damage may be more severe. Clinical literature notes that early-onset traction alopecia lines up with worse outcomes later. A child who keeps saying braids hurt is showing a clinical warning sign. The style is either too tight or leaving too little rest between installations.

Will minoxidil help with scarring traction alopecia?

Minoxidil will not help scarred zones, where follicles are gone. It may support regrowth in non-scarred parts of the hairline that have thinned but still have living follicles. The evidence specifically in traction alopecia is limited; most support for minoxidil comes from androgenetic alopecia research. A dermatologist can advise whether it fits your specific presentation.

Does hair transplant surgery work for traction alopecia scarring?

It can, but conditions have to be met: active inflammation must be fully resolved (typically a year or more of stable loss), blood supply in the scarred area must be adequate, and the patient needs enough donor hair. Graft survival in well-selected candidates has been reported at 70 to 90 percent in case series. Cost in the US ranges roughly from $4,000 to $15,000 or more, and most insurance does not cover it.

Is traction alopecia scarring more common in Black women?

Yes. A 2016 JAAD study found traction alopecia in 31.7 percent of Black women surveyed, making it the most common form of hair loss in that group. This reflects hairstyling practices that involve high tension rather than a genetic predisposition to scarring itself. The disproportion is documented, and it is exactly why culturally informed scalp care education matters.

What hairstyles are safest if I already have early traction alopecia?

At the first sign of traction alopecia, the safest approach is low-manipulation styles with zero tension on the hairline: loose twists, soft buns secured without elastics at the hairline, or simply wearing hair down. If you need a protective style, loose box braids without added extension weight and installed with light tension at the roots carry less risk than cornrows or tight sewn-in weaves.

Can scalp massage help after traction alopecia damage?

Gentle scalp massage may support circulation and follicular stimulation in non-scarred zones. A 2016 NIH-indexed study found 4 minutes of daily scalp massage over 24 weeks increased hair thickness in participants. It will not restore scarred areas, and aggressive massage near inflamed or damaged tissue can add harm. Gentle circular fingertip pressure, not vigorous rubbing, is the right approach.

What is the M-TAGS grading scale for traction alopecia?

The Marginal Traction Alopecia Grading Scale scores severity from 0 (no visible hair loss) to 4 (extensive hair loss with apparent follicular dropout and likely scarring). It gives clinicians and researchers a standardized way to assess severity and track progression. Grades 3 and 4 are where scarring is most strongly suspected and where a biopsy is most useful for confirmation.

Do relaxers increase the risk of scarring traction alopecia?

Yes, when combined with tight styling. Chemical relaxers weaken the structural integrity of the hair shaft and the follicular environment. Applying mechanical tension through tight braids or weaves on top of that weakened structure speeds up follicular damage. Dermatological guidance specifically cites concurrent relaxer use as a compounding risk factor for progression from reversible to scarring traction alopecia.

What should I expect at a dermatology appointment for traction alopecia scarring?

Expect a detailed styling history intake, a close clinical exam of the scalp and hairline, and likely dermoscopy. A biopsy may be recommended if scarring is suspected or the diagnosis is unclear. Bring photos of your hairline from earlier years if you have them, and prepare a timeline of your styling. If the diagnosis is confirmed as scarring alopecia, the dermatologist will discuss anti-inflammatory options and whether a transplant referral makes sense.

Sources

1. American Academy of Dermatology, Hair Loss: Traction Alopecia: The AAD identifies tight hairstyles as a primary cause of traction alopecia and recommends wearing looser styles as a preventive measure; also describes early clinical signs including pustules, missing baby hairs, and receding frontal/temporal hairline.
2. American Academy of Dermatology, Clinical Guidelines: Traction Alopecia Management: The AAD classifies traction alopecia with scarring as a primary cicatricial alopecia; recommends avoiding all tight styles and chemical relaxers as first-line management; notes that topical and intralesional corticosteroids are used to manage residual inflammation.
3. Dermatologic Clinics, Cicatricial Alopecias Including Traction Alopecia (Elsevier): Systematic review estimated traction alopecia prevalence at 17 to 33 percent in African and African-American women; discussed co-occurrence with frontal fibrosing alopecia and biopsy histology findings including fibrous tract replacement and lymphocytic infiltrate.
4. Journal of the American Academy of Dermatology, Marginal Traction Alopecia Grading Scale (M-TAGS): The M-TAGS grading scale scores traction alopecia severity from 0 to 4; grades 3 and 4 represent extensive follicular dropout consistent with scarring; dermoscopy findings including perifollicular fibrosis and the lonely hair sign are used in grading.
5. Aguh C et al., Journal of the American Academy of Dermatology, Prevalence of and Risk Factors for Traction Alopecia, 2016: Cross-sectional study of 326 Black women found traction alopecia prevalence of 31.7 percent, identifying it as the most common form of hair loss in that population; tight braids, weaves, and ponytails were the primary associated styles.
6. International Journal of Dermatology, Traction Alopecia: The Root of the Problem, 2017: Review noted that traction alopecia may first present in childhood or adolescence and that early onset correlates with more severe outcomes; identified concurrent chemical relaxer use as a compounding risk factor accelerating follicular destruction.
7. National Institutes of Health / PubMed, Koyama T et al., Standardized Scalp Massage Results in Increased Hair Thickness, Eplasty 2016: 24-week study of standardized 4-minute daily scalp massage found increased hair thickness in participants; proposed mechanism is increased blood flow and mechanical stretching of dermal papilla cells.
8. National Institutes of Health / NIH Office of Dietary Supplements, Iron Fact Sheet for Health Professionals: Iron deficiency, identified by serum ferritin levels below approximately 30 ng/mL, is associated with increased hair shedding and can compound hair loss from other causes including follicular damage.
9. British Journal of Dermatology, Cicatricial Alopecia Review including Traction Subtypes, 2019: Review of cicatricial alopecias reported that traction alopecia accounts for up to 3.4 percent of dermatology visits in predominantly African American populations; noted hair transplant graft survival in well-selected traction alopecia scarring candidates reported at 70 to 90 percent in case series and that active inflammation must be resolved before transplant surgery.
10. American Academy of Dermatology, Frontal Fibrosing Alopecia: The AAD distinguishes frontal fibrosing alopecia from traction alopecia as an autoimmune-mediated cicatricial alopecia; notes they can co-occur and may require biopsy to distinguish; treatment algorithms differ between the two conditions.