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In recent years the African American community has been taking a hard look at the hair practices we embrace and the long-term effects they have on our health, thanks to the natural hair movement. Now the medical community is taking note as well and quantifying the assertions we’ve made regarding damaging hairstyles.

Researchers at Johns Hopkins University have confirmed a “strong association” between certain scalp-pulling hairstyles and the development of traction alopecia, based on a review of 19 studies published in the Journal of the American Academy of Dermatology. Traction alopecia is a gradual hair loss caused by damage to the hair follicle from prolonged or repeated tension on the hair root, and an estimated one-third of African-American women suffer from the condition, making it the most common form of hair loss in our demographic, a news release on the finding reported.

It’s for that reason that these researchers are urging dermatologists to better educate themselves about the damaging hairstyles that lead to this condition — tight ponytails, buns, knots, and braids — so they can offer proper advisement to their patients.

“Hair is a cornerstone of self-esteem and identity for many people,” said Crystal Aguh, MD, 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.” Noting that traction alopecia is entirely preventable and can be stopped or reversed with early intervention, she added, ”We have to do better as care providers to offer our patients proper guidance to keep them healthy from head to toe.”

As part of their research Aguh and her team categorized various hair practices as low, moderate, or high risk based on the degree to which follicles are exposed to tension, weight, heat and hair-altering chemicals, like relaxers.

High-Risk Styles

Braids, dreadlocks, weaves and extensions — especially when applied to chemically straightened hair, which weakens the hair shaft and can cause breakage on its own.  When it comes to weaves, the greatest risk is if extensions are applied with adhesive glue put directly on the scalp.

Moderate-Risk Styles

Thermal straightening, permanent waving and wigs.

“Temporary thermal or heat-related straightening of the hair, such as the use of flat irons and blow drying the hair — while not by itself significantly associated with traction alopecia — can weaken shafts, leading to ‘significant’ hair loss when traction is applied, the press release noted of the authors’ conclusion. “Permanent waves made with ammonium thioglycolate to create or alter curl pattern, together with added tension from chemical treatment, do the same. And wigs attached with clips and adhesives to keep them in place can cause significant breakage.”

Braids, dreadlocks, and weaves also pose moderate risk when applied to natural, unprocessed hair though it’s less likely to cause hair loss. Untreated and unprocessed hair can also withstand greater traction, pulling and brushing, and overall decreases the risk of traction alopecia, regardless of styling, Aguh noted.

Low-Risk Styles

Loose buns and loose-hanging styles, like wearing your hair down because they pose no tension to the scalp.


As for guidelines for dermatologists and other care providers to prevent and manage hair loss from traction alopecia, the researchers said the first line of therapy should be to loosen braids and other high-tension styles, noting braided hairstyles should be in place no longer than two to three months, and weaves and extensions just six to eight weeks. The second phase is recommending alternate hairstyles that will allow the hair follicles to recover from stress, which means reducing or avoiding updos.

“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,” Aguh said. “Instead, physicians can educate themselves to speak with patients about making the best hairstyling choices to minimize preventable hair loss.”

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