Traction Alopecia vs Trichotillomania

Hair loss caused by repeated tension on hair follicles. Hair-pulling disorder causing hair loss through recurrent pulling.

Research updated 2026-10-23

AI-generated educational illustration: Hair thinning and broken hairs along the frontotemporal margins next to tight braids, representing traction alopecia.

AI-generated educational illustration: A scalp patch with hairs broken at varying lengths and scattered stubble, representing trichotillomania.

Key differences What is it?What it looks like Diagrams When it starts Triggers Daily Care Treatment Outlook Complications When to get help Questions

Key differences

The same eight facts on every condition comparison.

Usual age

Any age

9 to 13

Where

Hairline, temples

Scalp, brows, lashes

Main sign

Thinning where hair is pulled

Patches of broken hairs of different lengths

Itch or pain

Tender when styled tight

Neither

Contagious

Long term

Reversible early, permanent late

Long-term without help

Scars

Late stage

Rarely

Who gets it

Tight braids, ponytails, extensions

Children and teens; more often girls

What is it?

Traction Alopecia

Trichotillomania

What is it?

What it is
Hair loss caused by repeated tension on hair follicles.

What it is
Hair-pulling disorder causing hair loss through recurrent pulling.

What it looks like

Traction Alopecia

Braided hair with thinning at the temple and front hairline.

Traction Alopecia The temples show reduced hair density beside tightly pulled braids.

Trichotillomania

The side of a head with an irregular thinning patch and short remaining hairs.

Trichotillomania A patch near the temple contains sparse hair of uneven lengths.

Skin tones

In the skin

Repeated pulling places stress on hair follicles and can disrupt hair growth. Early injury may recover, but longstanding traction can destroy follicles and leave scarring.

Recurrent pulling mechanically damages hair shafts and can injure follicles. The resulting hair loss comes from pulling behavior rather than ordinary shedding alone.

When it usually starts

010203040506070+

Traction Alopecia. Can start at any age with repeated tension.

Trichotillomania. Often begins in childhood or adolescence.

Causes and triggers

Causes

Chronic traction injures follicles; early damage can be reversible but longstanding damage can scar.

A recurrent urge or habit leads to hair pulling; it is not simply hair shedding.

Risk factors

Tight braids or ponytails, Heavy extensions

Habit and urge patterns, Stress or anxiety

Trigger

● Traction Alopecia

● Trichotillomania

Repeated hairstyle tension

Can contribute

Not listed

Stress

Not listed

Can contribute

Habit cues

Not listed

Can contribute

Daily Care

Traction Alopecia

Trichotillomania

Daily care

Habits that help

Loosen any hairstyle that pulls or hurts
Stop tension early; persistent pulling can permanently damage follicles.
Choose loose styles and lighter extensions
Give affected edges and part lines a break from repeated tension.
Handle thinning areas gently when washing and detangling
Use a gentle routine rather than vigorous brushing or scalp massage.
Protect exposed scalp from the sun
Use a comfortable hat that does not pull the hair or sunscreen on exposed skin.
Discuss hair-loss assessment
Active inflammation or uncertain diagnosis needs a dermatologist’s plan before adding medicines.

Avoid

Avoid: Tight braids, ponytails or heavy extensions
Pain, bumps and tenderness mean a style is too tight.
Avoid: Repeated heat or chemical processing on fragile hair
Seek assessment for ongoing loss, scalp inflammation or smooth scarred areas.

Habits that help

Notice situations that trigger pulling without blame
Short notes can identify activities, feelings or settings linked to the urge.
Use replacement actions from a habit-reversal plan
A trained therapist can help choose practical competing responses.
Keep useful hand activities nearby
A fidget object or other agreed strategy may help during high-risk situations.
Handle affected scalp and hair gently
Protect exposed skin from sun and avoid adding traction or chemical damage.
Seek specialist help if pulling persists or hair is swallowed
Swallowed hair can cause serious digestive complications and needs medical assessment.

Avoid

Avoid: Punishment, shame or repeatedly checking the hair
These responses can increase distress rather than support recovery.

Treatment differences

Evidence labels come from each condition’s own treatment list.

Treatment

● Traction Alopecia

● Trichotillomania

Treatment approach

Remove the pulling force by changing tight or heavy hairstyles. Early assessment can identify inflammation or permanent follicle damage and guide any additional treatment.

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Procedures

None listed

Mental-health support

Listed

Associated distress or anxiety may need treatment; swallowing hair must be discussed because it can cause complications.

Outlook

Long term

Early traction-related loss may regrow after pulling stops. Long-standing tension can destroy follicles and leave permanent loss, so continuing thinning or scalp inflammation deserves early assessment.

Hair can regrow if pulling stops and follicles remain intact. The urge to pull can recur, so ongoing behavioral support may be helpful; prolonged injury can sometimes cause lasting loss.