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Is caused by excessive pulling forces, leading to mechanical damage of the hair follicles. This can eventually lead to inflammation and scarring of the scalp. In its early stages is it reversible and presents with bumps, "puss" bumps, mild thinning and hair breakage.  In its late stages, it presents with scarred balding of the scalp.  It is one of the most common causes of hair loss in women of African descent.  It may be managed by avoiding potentially tension producing hairstyles  (i.e. tight ponytails, extensions, braids, etc.), steroids, (topical/ injection), minoxidil, scalp camouflage (scalp micropigmentation, hair fibers, wigs),  platelet rich plasma, hair transplantation.

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References: 

- Callender VD, et al. Medical and surgical therapies for alopecias in black women. Dermatol Ther. 2004;17(2):164–176.

- Aguh C, Okoye G, eds. Fundamentals of Ethnic Hair: The Dermatologist's Perspective. Cham: Springer, 2017

- Billero V, Miteva M. Clin Cosmet Investig Dermatol.  Traction alopecia: the root of the problem  2018 Apr 6;11:149-159