Bad Hairstyling Practice

High Risk Hairstyling Practices for Traction Alopecia

  • Frequent use of tight buns or ponytails

  • Applications of weaves and/ or braids to relaxed hair

  • Hair extensions applied to relaxed hair

  • Tight braids, cornrows, locs (frequent and tight re-twisting/ “palm rolling”)

  • Tight scarves worn during the day or at night to bed

  • Any style causing any symptoms such as pain, inflamed red skin, stinging, crusting, tenting, or pimples

Moderate Risk Hairstyling Practices for Traction Alopecia

  • Loosening of braids/ cornrows/ locks

  • Weaves and braids applied to natural hair

  • Hair extensions applied to natural hair

  • Wigs worn with cotton or nylon wig caps

  • Permanent weaving

Good Hairstyling Practice

Low Risk Hairstyling Practices for Traction Alopecia

  • Loose, low hanging ponytails and buns

  • Wigs worn loosely with satin caps

  • Natural unprocessed hair

  • Very loose twists and braids

General Hairstyling Recommendations

  • Braid extensions

    • Loose application of braids

      • Braids should be looser at the hair line, also consider leaving part of the hairline out around the scalp

    • Avoid braiding hair down to scalp

      • Try to start braiding hair leaving at least 1/2 cm of base hair

    • Opt for larger diameter braids

    • Avoid using an increased amount of heavy extension hair to braid a small amount of your own hair

    • Avoid braid styles that cause pain, pimples and hair breakage after as this may eventually cause permanent hair loss.

    • Avoid updos and pulling hair back while braid extensions are installed

    • Use extensions sparingly and for short periods of time and remove immediately if they cause pain or irritation

    • Don’t leave braids styles in for more than 4-6 weeks at a time

    • Give breaks between braid styles at least 8-12 weeks where your own hair is worn.

  • Chemical Straightening

    • Make sure scalp is based with petrolatum product at lead 20 minutes prior to relaxer.

    • If the scalp starts to burn or tingle then ask for the chemical to be washed out as your scalp is signaling to you that there may be damage and inflammation deeper in the scalp that can lead to hair breakage and baldness.

    • Relax the hair no more than once every 2-3 months.

    • Make sure that ends of hair are protected with petrolatum based product and that ONLY "new growth" get the relaxer.

    • Get relaxers done by trained professionals.

  • Heat Straightening

    • Try to avoid daily heat styling

      • Try to minimize heat to once per week if hair must be straightened

    • Decrease use of thermal straightening on chemically relaxed hair

      • Avoid thermal straightening and styling at least 1-2 weeks after chemical relaxing

    • Use lower heat settings on flat irons and blow dryers

    • Use heat protectants when styling the hair

    • If hair is natural, try to air dry the hair

  • Locks

    • Avoid tight and repeated re-twisting

    • Allow “new growth” to remain

      • If re-twisting, leave at least 1cm of hair before twisting

    • Avoid updos

  • Weaves

    • Avoid tightly braiding hair under weaves

    • Opt for loosely sewn-in weaves instead of bonding glues

      • Bonding glues can cause skin allergies

    • Don’t leave weaves in for more than 4-6 weeks at a time

    • Give breaks between weave styles at least 8-12 weeks where your own hair is worn.

  • Wigs:

    • Should not create too much tension on the frontal scalp

    • Wear a silk or satin cap

    • Be careful of glues on the scalp


    • Avoid use of tight scarves or “hair/ head tie” during the day or while sleeping

    • Avoid tension hair styles with relaxers

    • Alternate hairstyles when possible

    • Avoid styling in “up-dos”

    • Get regular trims to remove split ends

    • Give hair a break from all styling practices by adopting a “natural hairstyle”

    • Recurrent pain and pimples and hair breakage after any hairstyle hair will eventually cause permanent hair loss. Prevention is better than cure

    • Keep children’s hair natural hair, and in loose styles otherwise, they may have traction alopecia by the time they are teenagers.

    • Try to avoid products heavy, greases on the hair (petrolatum, lanolin, mineral oil) and stubborn silicones that can weigh down the hair down and build up on the hair and eventually lead to breakage

    • Protect the hair, particularly the ends, from environmental damage.

      • Caution with many harsh materials on the hair (wool. cotton, etc)

      • Try to sleep with silk or satin scarf and or pillow.

  • Pay attention to and avoid any side effects from all hair grooming practices

Adapted From

  1. Brochure by Dr. Ncoza Dlova MBshB FCDerm. PhD)

  2. Aguh C, Okoye G, eds. Fundamentals of Ethnic Hair: The Dermatologist's Perspective. Cham: Springer, 2016

  3. Ogunleye TA, McMichael A, Olsen EA. Central centrifugal cicatricial alopecia: what has been achieved, current clues for future research. Dermatol Clin 2014;32:173e81.