Traction alopecia is caused by inadvertent prolonged traction on the scalp by the physical pressure of hair styling . There is often a cultural element, such as braiding in African American girls or the “topknot” in Sikh boys. The distribution of hair loss reflects that of maximal traction, but is most commonly seen at the scalp margins. Although potentially reversible in its early stages, loss of hair follicles leads to permanent hair loss if the traction is unrelenting over months to years