Woman posing for portrait.
A black woman with braids. Credit: patronestaff / Adobe Stock

Researchers at Johns Hopkins say they can confirm a “strong association” between common African-American hairstyles and the development of traction alopecia, which is the gradual loss of hair loss caused by damage to the hair follicle.

Prolonged tension on the hair root can trigger the loss of hair. An estimated one-third of African-American women suffer from traction alopecia, making it the most common form of hair loss among that group.

In a report on their analysis, dermatologists are urged to better educate themselves about damaging hairstyles such as tight ponytails, braids, knots and buns, and are encouraged to advise patients of risks and alternatives.

“Hair is a cornerstone of self-esteem and identity for many people,” says Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, “but ironically, some hairstyles meant to improve our self-confidence actually lead to hair and scalp damage.”

Traction alopecia, she adds, is entirely preventable, and early intervention can stop or reverse it. ”We have to do better as care providers to offer our patients proper guidance to keep them healthy from head to toe,” she says.

Aguh and her colleagues categorize hair practices into low, moderate and high-risk styles. The highest-risk styles include braids, dreadlocks, weaves (glued or sew-in) and extensions, especially when applied to chemically straightened hair. These styles are popular among African-Americans because they are low maintenance and many consider them to be protective styles. Moderate risk styles include straightening the hair using heat, permanent waving and use of wigs.

Untreated and unprocessed hair, Aguh says, can withstand greater traction, pulling and brushing, and overall decreases the risk of traction alopecia, regardless of styling.

In their review, investigators recommend guidelines for dermatologists and haircare providers to prevent and manage hair loss from traction alopecia, The first tip, hair therapy. They also offer up alternate styles to allow follicles to recover from stress.

“Dermatologists need to be conscious of the fact that many high-and moderate-risk hairstyles greatly improve hair manageability, and simply telling patients to abandon them won’t work for everyone,” says Aguh. “Instead, physicians can educate themselves to speak with patients about making the best hair styling choices to minimize preventable hair loss.”