Epidemiology, Behavioral Determinants, Symptom Burden, and Severity of Traction Alopecia Among Ghanaian Women: A Cross-Sectional Study

Traction alopecia (TA) is preventable, yet population-level data on cumulative exposures in African cohorts remain scarce. This study characterized the epidemiology of TA among Ghanaian women and evaluated a multi-behavioral risk-stratification early-screening framework.

We surveyed Ghanaian women in May 2026 using a structured questionnaire. Hairline status was classified using the Marginal Traction Alopecia Score (M-TAS). Associations between exposures and TA were evaluated using bivariable analyses and multivariable logistic regression. Model discrimination was assessed using the area under the receiver-operating characteristic curve (AUROC), and participants were stratified into risk tiers using predicted probabilities.

The mean age of the 197 respondents was 23.1 ± 4.3 years, and 40.6% (80/197) had hairline recession consistent with TA. In the regression model, each additional year of age was associated with an 8.0% increase in the odds of recession (aOR, 1.08; 95% CI, 1.00-1.16; p = 0.04). Keeping a single hairstyle for over 6 weeks showed a non-significant increase in estimated odds (aOR, 1.81; 95% CI, 0.59-5.60; p = 0.30) while > 2 high-frequency thermal styling sessions/month (aOR, 5.65; 95% CI, 1.35-23.62; p = 0.02) were associated with increased odds compared to unexposed individuals (AUROC, 0.68; 95% CI, 0.60-0.76). The proportion of participants with hairline recession consistent with TA increased from 27.7% in the lowest-risk group to 58.5% in the highest-risk group (p < 0.001).

TA risk scales non-linearly, driven heavily by prolonged installations and frequent heat exposure. Integrating these distinct exposures into a unified, model-predicted risk stratification framework could provide a well-calibrated backend architecture for consumer-facing digital health tools in Africa.