Welcome to It’s Textured, a column where we untangle the joy, trauma, confusion, and frustration that can come with Black hair. For this edition, associate beauty editor Annie Blay-Tettey speaks with three women about their journey with traction alopecia, and how hair loss ultimately helped them gain so much more.
That’s weird, thought 29-year-old Drea Okeke as she examined her new set of box braids. Getting a fresh set of braids was typically a liberating experience for the content creator, but in that moment, the relief of not having to do her hair for at least three weeks was replaced by a tinge of worry when she noticed some unusually large spaces—rather than even parts—between her box braids.
Like many Black women, this writer included, braids are a normal part of Okeke’s hair routine—at least, they were. As a first-generation Nigerian, getting her hair braided was practically a birthright. “My aunt has a hair braiding salon in Queens, so [in my teen years] I used to get my braids for free,” Okeke recalls. Since it was free, she’d get those braids often, going back and forth between box braids, sew-in weaves, and crochet styles (her favorite), all meant to be “protective” because they kept her strands tucked away.
During Okeke’s college years, weaves were the style du jour. “When I got a weave, I’d keep it in for as long as I could,” she says. But all that repetitive tension on the scalp proved harmful over time. Patches of her hair began to fall out, eventually revealing a humbling diagnosis: traction alopecia. “It started at the top of my head, mostly around the left side,” Okeke says. “It started with one patch, then grew to more and more.”
Traction alopecia (TA) is a form of hair loss caused by prolonged tension on the scalp. Symptoms include scalp tenderness and pain, and pimple-like bumps in the areas of highest tension. “Traction alopecia is caused by anything that pulls on the hair, ultimately damaging the root, and can lead to scarring and permanent hair loss,” board-certified dermatologist Doris Day, MD, previously told Allure. She added, “It’s a process that usually takes years.”
Typically, the condition starts at the hairline, but in certain cases it can begin on other parts of the head, as it did for Okeke. She first noticed the patches at the top of her hair in 2020, more than a decade after she started getting braids. “I thought it wasn’t a big deal at the time and that it would grow back,” Okeke says—a thought many Black women have mistakenly believed.
When Ashley Parker first noticed her edges thinning, she also thought nothing of it—because she was instructed to. “I was getting my hair done at the salon, they had just relaxed it and my edges were coming out in chunks,” recalls Parker (who is using a pseudonym for this story). “I was so worried, but the hairdresser was like, ‘Don't worry. It’ll grow back.’”
Just a few hours after getting the relaxer, Parker got box braids, a style the now 22-year-old architecture student had been getting since she was in boarding school in England, starting at age 10. “It’s difficult to maintain your natural hair while you’re in boarding school, so I would get my hair braided [in a style that lasted] for four weeks at a time,” Parker explains. When she removed the braids a few weeks after the relaxer and styling appointment, though, she realized her edges had gone from thin to nonexistent.
Traction alopecia can affect people of any ethnicity, but it is most commonly seen in Black women. Up to a third of us will have the condition at some point in our lives, according to a 2023 article published in the journal JAMA Dermatology. There’s been a recent increase in information and awareness about TA among dermatologists and hairstylists, but Black women dealing with the condition often do so in isolation, with feelings of shame and helplessness that can’t be improved in a doctor’s office or with different hairstyles.
Thinning edges are not normal
Traction alopecia at its most severe (large patches of hair falling out) would be terrifying to most, but the earliest sign of TA, thinning edges, is something Black women seem to be particularly attuned to. Crystal Aguh, MD, a board-certified dermatologist in Baltimore, says she believes most people are familiar with the concept of traction alopecia, even if they don’t know the medical term for the condition.
If you often got braids while you were growing up, you were probably advised to avoid getting them “too tight” or to “give your hair breaks” in between styles. But, Dr. Aguh says, these tips are more or less old wives’ tales and don’t guarantee you won’t lose your hair. “Hairstyles don't have to feel tight for you to develop traction alopecia,” she adds. In other words: Just because a style isn’t causing you physical pain doesn’t mean it isn’t taking a toll on your hair follicles.
The nomenclature used for these types of styles can make dealing with TA more confusing; for instance, it seems odd that something in the “protective” style category could be causing damage. If you’ve begun to experience hair loss due to tension, Dr. Aguh explains, any hairstyle (including glue-on wigs, sew-ins, and locs) that perpetuates tension over a prolonged period could lead to further hair loss.
“Part of the struggle is calling them ‘protective’ styles,” says Dr. Aguh. “Let's call them ‘styles of convenience,’ because that’s what they really are.” These styles may protect hair from the breakage that can come with constant manipulation, she confirms, but they can also introduce damage from tension on the scalp.
In treating her many Black patients who deal with traction alopecia, Dr. Aguh finds that one of the biggest barriers to understanding TA and treating it is a lack of education that she believes is directly related to the lack of diversity in dermatology. “Because of the limited literature on Black hairstyling methods, hair loss in this patient population can present a diagnostic and therapeutic challenge for dermatologists,” Dr. Aguh wrote in a review for the Journal of the American Academy of Dermatology. While a dermatologist of any race can understand the science behind traction alopecia, many lack the cultural awareness to empathize and sometimes properly treat the condition in Black women.
This is exactly what 23-year-old Nyana Martin faced. After two years of wearing locs (a decision she made because she thought it would help her hair grow), an area on the back of Martin’s head gave out from strenuous hairstyles. “I would do pinups a lot,” says Martin, referencing a style that involves gathering locs at the top of the head by twisting them from the bottom up. “It felt really tight from a mix of the twisted locs and bobby pins. I never kept the pinups in for long because they hurt,” she recalls. “I could give them, maybe, four or five days max because they would hurt that much.”
When Martin’s hair began to fall out in the back, it came out unevenly. The hair was slow to grow, and when the uneven growth began to “look all over the place,” Martin cut her hair in that area and rocked an undercut. Like Okeke and Parker, she wasn’t too concerned at first; she felt that wearing an undercut was an edgy fix. Says Martin, “I don’t think I really cared much about it until it wasn’t growing back.”
While the slow progress in her hair growth was frustrating, Martin recalls, finding a dermatologist who truly understood what she was going through was more troubling. “I remember there was one white dermatologist who asked if there were bumps in the area because, if so, there’s probably just hair stuck under my scalp,” says Martin. Another derm told her to “just take better care of your hair,” without giving any specific recommendations beyond moisturizing it more. On the advice of a dermatologist, Martin even underwent hormone testing to determine if it was a hormonal issue; it wasn’t.
When traction alopecia affects mental health
Going from one dermatologist to another, Martin felt gaslit—and not just by medical professionals. “Everyone around me was like, ‘Well, just stop touching it. Maybe it’s falling out because you keep touching it,’” says Martin.
It’s common in the Black community to pass down ancient hair traditions as modern-day fixes. After all, it worked for our grannies and their grandmothers, so it’s good enough for us. These solutions often include using “natural” ingredients like shea butter. There's been a recent boom in using botanical oils (castor and rosemary oil are the most popular), most of which have limited, if any, backing evidence that they actually work to reverse hair loss on their own.
There’s also the treatment my mother loved to use: “Just leave it alone.” Comments like these, which imply that women experiencing the issue are at fault, are, at best, extremely unhelpful. When women facing traction alopecia seek out the more involved treatments the condition typically requires, they’re often met with remarks that diminish their experience and amplify the shame they already feel. “My mother was in complete denial that there was anything wrong when my hair started falling out,” says Parker. “She thought that I just developed this complex overnight.”
In reality, effectively treating traction alopecia requires consistently using medication like minoxidil, a method Dr. Aguh advocates for. Parker started to self-treat her traction alopecia in November 2023 using botanical oils, but it wasn’t until June 2024 that she actually made a dermatology appointment. “I did a lot of intense research on dermatologists and trichologists, but I was mostly worried about—and I know it sounds ridiculous because it’s a doctor's job—getting judged,” says Parker.
When Parker started minoxidil on her dermatologist’s recommendation, her mother urged her to stop “putting that chemical on you.” It put a strain on their relationship, until Parker’s mother went with her to a derm appointment and began to understand what was required to treat TA.
Unlike other types of alopecia that are genetic or completely uncontrollable, traction alopecia is, in large part, due to a person’s hair practices, so it can bring about feelings of guilt. “I just kept asking myself, How did I let it get this bad? How did I not notice it on time? I felt like it was my fault, so I needed to fix it,” says Parker.
Another factor that kept Parker out of the doctor’s office for so long was how difficult it was to find a Black female dermatologist in London, where she lives. (Allure wasn’t able to confirm the exact number of Black female dermatologists in England, but if it’s anything like the US, the ratio is likely to be low.) Parker recalls, “I did not want to go to one that wasn’t a Black woman because I felt that they would not understand.”
Hair is so personal to Black women—especially when we’re losing it. Our strands are already scrutinized regularly and ridiculed, so much so that many Black women would rather avoid seeking treatment than risk being shamed by a medical professional who doesn’t understand their hair. Says Parker, “It’s more comforting to know that the person who’s treating me understands my hair.”
The same guilt and fear of judgment that kept Parker out of the dermatologist’s office for over a year also pushed her to hide her hair loss from people close to her. This isolation eventually drove her to depression.
Losing your hair can be mentally consuming, and Parker found it hard to focus on anything else. At the height of her traction alopecia, Parker’s studies for her master’s program and her social life took a hit. “There were some days I was so depressed about my hair, about not seeing progress, that I just didn’t want to do anything,” she recalls. “I didn’t have the motivation to do anything, go anywhere. I was so depressed about the state of it.” She tried wigs and different means of covering her natural hair, but nothing made her feel better.
Okeke also felt “embarrassed, awkward, and insecure.” When her hair loss was at its worst, in 2020, the content creator harnessed her ability to put on a cheery disposition, smiling and laughing her way through social interactions; internally, though, she was more self-conscious than ever. At one point, she had edgy black-and-red braids and tried wearing them in different styles to hide the patches, but the braids made her scalp so tender that doing anything other than leaving them down caused pain.
Healing through traction alopecia
For Okeke, Martin, and Parker, treating traction alopecia involved more than just growing their hair back. All three women say they had to face the root causes that drove them to constantly keep their hair in a protective style.
Many Black women love the look and ease of braids, locs, and weaves, and it is possible to wear these styles while still maintaining healthy natural hair. “Black women, in general, just love showing out,” says Okeke. “It’s a cultural thing. We need to look good, and our hairstyles are art. You can tell our personality from our hairstyle. If we got a bob, we’re feeling like a boss. If it’s a long, buss-down wig, we’re ready to go out.” Different hairstyles allow us to express ourselves.
On the darker flip side, many Black women turn to these styles as a way to hide a part of themself. Parker recalls thinking that her hair was a problem she had to deal with, often by way of protective styling. She says she thought of her hair as “something I have to get out of the way.”
Despite strides toward texture inclusivity made during natural hair movements in previous decades, there’s still an underlying sentiment that there’s good hair and bad hair—the latter being coarse, type 4 hair. I’ve always struggled to love my 4C hair. Very early in my hair journey, I latched onto the lie that my hair was tough, too hard to do, and ugly. Braids were not just a way to avoid having to do my hair, but to avoid having to look at it too.
Since I didn’t see my hair as beautiful, I didn’t value it enough to stop and wonder what constant protective styling was doing to it. “There's this societal perception that our hair, the way that it is, is just not cute,” says Okeke. “We push ourselves to these extremes. It’s like, Okay, yeah, my hair is thinning and falling out, but I’m still going to get braids.”
To grow their hair back, all three women I spoke with eventually cut out protective styles entirely. “I made a decision, like, Drea, you’ve got to take care of this,” says Okeke. The decision included a break from braids, working with a stylist who specializes in textured hair, and a change in diet.
“Before all this happened, I didn’t want to even look at my hair,” she adds. “Once I started looking at myself in the mirror with my natural hair, I was able to start loving my hair more. Now I care for my hair.… I love the way I look, wig or no wig.”
Some with traction alopecia may eventually be able to reincorporate protective styling into their routine. In March 2023, Okeke began experimenting with braids again, but this time she sought the help of braider Aicha Kamara in Elizabeth, New Jersey, who works to safely reintroduce protective styles for many clients who have alopecia.
Parker is still steering clear of protective styles during her treatment. She’s currently working with a dermatologist and is on a treatment plan that includes minoxidil, rosemary oil, a derma pen for deeper penetration, and platelet-rich plasma, or PRP, injections once every two months. “I went from not thinking about my hair at all to it being something that consumes my entire life,” says Parker. “It’s the first thing I think about when I wake up, the last thing before I go to bed. I’m taking progress pictures obsessively to track and see what’s going on.”
Parker’s biggest piece of advice to Black women in a similar position is: “Get diagnosed, and quickly. Don’t do what I did. Go to a dermatologist, find one you trust, and get diagnosed.”
Martin, whose hair loss was not as drastic as the other two women, has taken a more lax approach. “I’m not even focused on growth; I’m focused more on maintenance,” she says. This means getting braids less often. She recently got braids for the first time in almost two years and, when we spoke via Zoom in June 2024, she had twists—but says she told the braider to keep them “very loose” at the roots. Martin is also using caffeine oil and rice water in her hair-care routine and doing regular scalp massages to promote stimulation and blood circulation.
Though treatment will likely involve many dermatologist visits and a tedious product routine, it seems the most laborious part of treating traction alopecia is tending to the internal wounds it exposes—and learning from them. “Practice radical self-acceptance,” says Parker. “It’s going to be really difficult at first, but I’m way better for it in the long run.”
After processing the stories of these women and thinking back on my own hair journey, these words from Parker ring loudest: “Listen to your hair. If it hurts, take it out. You’re not tender-headed. You don’t have to just suck it up.”
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