Hair easy to pull out

Loose Anagen Syndrome, Overprocessing, Cuticle Stripping

Written by WebMD Editorial Contributors

In this Article

  • Loose anagen syndrome
  • Traction alopecia and trichotillomania
  • Monilethrix
  • Overprocessing, cuticle stripping, and bubble hair
  • Trichorrhexis Nodosa

There are many conditions where physical damage to the hair fiber results in hair loss. Sometimes hair fiber is damaged due to the hair being improperly formed by the hair follicles. These conditions are usually determined by genetic defects. There are also conditions where physical damage of the hair fiber is caused by something environmental, most often poor or inappropriate hair care.

Hair loss as a result of physical hair defects are rare compared to other causes of alopecia, but the most common ones are listed below.

Loose anagen syndrome

Loose anagen syndrome or loose hair syndrome involves exactly what the name suggests, growing hair that is "loose" and easily pulled out of the hair follicle. Loose anagen syndrome is most often first diagnosed in young children, more so in girls than boys. Their hair never seems to grow, they rarely need a hair cut, and the scalp hair is usually thin, especially at the back of the scalp.

That the hair is loose and easily pulled out helps explain why the back of the head is most affected. The repeated rubbing of a person's head on a pillow at night pulls out more of the hair on the back of the head, whereas the front of the scalp has less contact with the pillow and so the hair is more likely to remain in place. The remaining hair usually does not grow very long and it can be unruly and difficult to comb and style.

Blond-haired children ages 2 to 5 are most likely to be affected but loose anagen syndrome can appear later in life as well. The syndrome improves with age of its own accord in children, but development in older individuals indicates the hair loss will be more persistent.

Why the hair is loose is not known, but the root sheaths that normally surround and protect the hair shaft in the skin are not produced properly in people with loose anagen syndrome. As a result, there is a lack of adhesion between the hair shaft and the root sheath, and the hair fiber is poorly anchored in the follicle.

There may be a genetic problem behind the syndrome and the condition can run in families, but there are also many isolated case reports with no family history. There are no known effective treatments for loose anagen syndrome.

Traction alopecia and trichotillomania

In terms of the mechanical action behind hair loss, traction alopecia and trichotillomania are exactly the same. The hair is plucked out of the skin leaving clear bald patches or diffuse, thin hair.

Traction alopecia can be caused by tight hat bands, pulling the hair into a tight pony tail, cornrow hair styles, and anything else that pulls on the roots of the hair. If traction alopecia continues for a long time and the same hair is repeatedly pulled out, then the hair follicles in the skin can become so damaged that they stop growing hair permanently.

Trichotillomania occurs when an individual plucks out their own hair. Often the hair on the scalp is plucked to leave bald patches, but the individual may focus on the eyelashes, eyebrows, pubic hair, or any other hair-bearing region. There is much argument about whether trichotillomania is a habit like nail biting, or a more psychological problem. Either way, affected individuals are usually not aware that they are plucking their hair, and when they are made aware of it they often find it very hard to stop.

Some individuals who pluck their hair also then eat it, a condition called trichophagia. This is a very dangerous condition that needs to be treated with some urgency. Hair is not digestible in the stomach and can build up into a hair ball. This can severely irritate the stomach lining, leading to severe ulceration. It is possible to die from trichophagia. Treating trichotillomania is difficult; therapists can probably help more than dermatologists.


The condition monilethrix makes hair fiber look like a string of beads. Along the length of a hair fiber there are nodes and constrictions making the edge of the fiber undulate. The beading that happens with monilethrix weakens the fiber.

Seen under a microscope, the hair fibers have lost their cuticle covering over the nodes while the constrictions keep their cuticle. The brittle hair easily breaks once it is exposed above the skin and the fibers rarely grow very long as a result. Breakage occurs in the weak constriction points along the fiber.

People with monilethrix have diffuse hair loss. Most frequently the hair loss is at the back of the scalp and neck and can leave the front of the head relatively unaffected. Monilethrix can also affect hair in other regions of the body.

Monilethrix most often occurs in childhood but young adults can also develop it. It is a genetically inherited disease and can run in families, although family members may be affected to different degrees of severity. The severity of monilethrix can also change with the seasons. It is often worse in winter and improves in summer. Monilethrix may spontaneously improve, although many people have monilethrix all their lives.

Overprocessing, cuticle stripping, and bubble hair

Overprocessing the hair is by far the most common cause of physical hair damage. Perming, straightening, bleaching, and dyeing the hair all involve harsh chemicals that can significantly affect the integrity of hair fiber. Using these cosmetic approaches too frequently or inappropriately can lead to irreversible damage to the hair fiber. The more hair fiber is damaged by these processes, the weaker it will be and the more likely it will break off.

The hair cuticle is a very strong outer sleeve of dead and highly keratinized cells that overlap each other like fish scales along the length of the hair fiber. The cuticle helps protect the softer inner cortex structure of the hair fiber from damage. The overlapping scales of the cuticle may become damaged and "flake up" if they are exposed to too much processing.

For perms, straighteners, bleaches, and dyes to work the cuticle has to be opened up so that other chemicals can get to the hair cortex and either rearrange the chemical bonds in the hair structure, as with perms and straighteners, or to remove or add hair pigment, as with bleaching and dyeing. If the chemicals to open the cuticle are applied for too long, in an unsuitably high concentration, or too frequently, the cuticle may be irreversibly damaged and even stripped away completely.

When this happens the softer cortex is exposed to the environment. The cortex does not have the same properties of the cuticle. It has a rough surface, so at this stage the hair can look dull, dry, and frizzy. Chemicals in shampoos, water, and polluted air, combined with UV light exposure, can all contribute to further damage and weakening of the hair cortex. Eventually, the hair may become so weak that it splits or breaks off completely. More usually, this splitting and breakage occurs to old hair, that is, toward the end of the hair fiber.

However, if the chemical processing is very severe, it alone can do so much damage to the hair fiber that the fiber at the root is severely weakened. If this happens, the hair may break off at the skin surface. The result is called a diffuse alopecia.

As well as chemically-induced damage, physical processes can also harm the hair. Aggressive brushing, back combing, and other grooming techniques that put a lot of physical stress on the hair fiber can cause the cuticle to flake and strip away.

Inappropriate use of a hair dryer can also cause a lot of damage. When you wash your hair, some water gets under the cuticle and into the cortex. If you dry your hair with a high heat you heat up the water. This makes the water expand inside the hair and this literally pushes outward to leave spaces in the hair fiber. In severe cases the hair develops little bubbles inside, a condition called "bubble hair." These bubbles make the hair much weaker and likely to break off. If damaging physical processes are combined with damaging chemical processes then the problem is compounded.

Physical damage to the hair through overprocessing is difficult to treat. The best approach is to cut off as much damaged hair as possible, avoid further chemical processing, be gentle with your hair, and wait for new, undamaged hair to grow in. While there are cosmetic treatments to help "glue" damaged hair back together, they only work for a short time and have to be reapplied regularly. The end result is never as good as the original, undamaged hair.

Trichorrhexis Nodosa

One of the most common hair shaft defects a dermatologist encounters is trichorrhexis nodosa (also called trichonodosis). Trichorrhexis nodosa is a defect in the hair fiber. When observed under the microscope most of a hair shaft looks entirely normal. However, in isolated spots along the length of a fiber swelling and/or fraying can be seen. These focal defects develop where there is an absence of cuticle.

Causes of trichorrhexis nodosa can be congenital or acquired. The congenital form is very rare, but some people have naturally weak hair where the cuticle is not properly produced. Congenital trichorrhexis nodosa is usually hereditary, it runs in families, and first develops at a very young age. Abnormal production of irregular and brittle hair fibers can also occur in metabolic disorders such as those that involve abnormal urea synthesis, abnormal copper or zinc metabolism, or defective cysteine or sulfur incorporation into hair fiber (trichothiodystrophy).

Acquired trichorrhexis nodosa is much more common and develops as a result of excessive hair manipulation and overprocessing. Too much brushing, hairstyles that put constant stress on the hair, and excessive washing, dying, and perming may disrupt the cuticle in focal areas along a hair shaft. Trichorrhexis nodosa is particularly seen in people who overuse hot combs or permanent waves to style their hair. Once the cuticle is removed from hair fiber then the hair cortex swiftly breaks down.

Treatment depends on the cause of the focal defects. If the hair production is believed to be abnormal then treatment will focus on the hair follicle and improving the strength of hair fiber. Where the defect is the result of excessive grooming the obvious action is to reduce the amount of hair manipulation. People are encouraged to stop using brushes, avoid hair styling that involves chemicals, and use only very mild shampoos.

Published on March 1, 2010

Trichotillomania (Hair Pulling) (for Teens)

Trichotillomania is a strong habit that causes people to pull out their own hair. They may pull hairs from their scalp, eyebrows, eyelashes, or pubic area. People may pull out a few hairs at once or one strand at a time. Some may look at, play with, chew, or eat the hair after pulling it out.

Others may not understand why people who pull out their hair don’t just stop. But to people going through this, hair pulling can be a very hard habit to break. Even though they have tried to stop, hair pulling can feel impossible to control.

If you are dealing with hair pulling, you’re not alone. And there’s treatment that can help. It takes time, patience, and practice. But when they learn the right skills, people can overcome hair pulling.

What Is Trichotillomania (Hair Pulling)?

Trichotillomania is sometimes called TTM. It is also called tric or hair pulling.

Hair pulling is a type of body-focused repetitive behavior (BFRB for short). BFRBs are self-grooming behaviors that become strong, unwanted habits.

There are different forms of BFRBs. For example, some people bite or chew their nails, lips, or the inside of their cheeks. Some pick their skin or nails. Some pull out, break off, twist off, or chew their hair. All these habits are BFRBs if a person does them to extreme.

BFRBs are not a type of self-harm. But they can cause damage to the hair, skin, or nails.

Can Trichotillomania Cause Health Problems?

Hair pulling can leave bald patches or areas without hair, eyebrows, or eyelashes. It can cause the skin to become sore or infected. It can leave scars. If people chew or swallow hair, it can cause a ‘ball’ of hair to form. This can lead to stomach pain or other health problems.

What Causes Trichotillomania (Hair Pulling)?

It’s not clear why some people do hair pulling but others don’t. Experts think that genes, hormones, and habit learning all play a role.

Genes. People who do hair pulling may have genes that make it more likely.

Hormones. Puberty hormones and stress hormones may prompt hair pulling to start in those who have the genes for it.

Habit learning. Many people with trichotillomania feel an itch, tingling, or an urge to do it. When they pull hair, they get a brief sense of relief. To the brain, this relief is a reward. The brain releases reward hormones, such as dopamine. This links hair pulling with the reward. It causes a hair-pulling habit to form.

Each time the person pulls hair, the brain releases a small burst of reward hormone. The person feels ‘rewarded’ with a brief sense of relief. This makes the urge harder to resist. Doing the habit makes it stronger.

What’s It Like for Someone With Trichotillomania?

Most people who do hair pulling feel stuck in a habit they don’t want. They may feel frustrated that they can’t control it. They may feel nagged by people who don't understand what it’s like for them. Some are hard on themselves for not being able to stop. But hair pulling is not their fault.

They may feel upset about how hair pulling affects their looks. Some may try to cover bald patches with hats or make up. Hair pulling can affect the way they feel around others, too. Some try to hide the hair pulling, even from family or friends. They might avoid doing things that could let others notice it.

What Can Help People With Trichotillomania (Hair Pulling)?

Therapy can help people overcome trichotillomania. The most widely used type of therapy is called habit-reversal training (HRT). It's a type of cognitive behavioral therapy (CBT). In this therapy, people meet with a therapist to learn skills to help them reverse the hair pulling habit.

Habit reversal is based on the way the brain learns habits. The same principles can help people unlearn a habit they don’t want.

To unlearn hair pulling, people need to resist the urge to pull hair. When they resist the urge, the reward hormone doesn’t get released. This breaks the cycle of hair pulling. Without the reward, the habit can start to fade on its own.

This sounds simple. But it’s not easy at first. The urge to pull hair can feel strong. It can be very hard to resist. Therapy is a way for people to build the skills that make it possible. With the right guidance — and plenty of practice — it gets easier. For this to work, people need to resist the urge to pull every time they feel it.

Along with habit reversal, other forms of therapy work for hair pulling. They include ComB (comprehensive behavior therapy), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT). Each of these forms of therapy offers skills people can use to work on trichotillomania.

It takes time, patience, and practice. But with the right guidance and support, people can overcome hair pulling.

What Should I Do if I’m Dealing With Trichotillomania?

Talk to an adult. If you're pulling your hair, talk about it with a parent, doctor, mental health counselor, or an adult you trust. It can be hard to talk about. But it’s best to be open and honest so that you can get the help you need.

Have a visit with your doctor. They will ask questions, listen, and talk with you and your parent. They will check for other things that can cause hair pulling or hair loss. If they diagnose trichotillomania, they can refer you to a therapist for treatment that can help.

Go to visits with a therapist. Therapy can take many visits. It takes time and practice to get good at the skills you’ll need. But you’ll notice progress along the way.

Let others support you. Support from loved ones helps a lot when you’re going through something like hair pulling. When you want to, it can feel good to confide in someone you trust. You can also feel their support when they do simple acts that show they care — or just by spending time together.

Do things to manage your stress. Stress doesn’t cause hair pulling. But stress can make it worse in people who have it. Be sure to eat foods that are good for you. Exercise and be active. Take time to rest, relax, or meditate. Make time for things you enjoy. Show kindness and help others. Doing these simple things every day helps keep stress levels in check.

The TLC Foundation for Body-Focused Repetitive Behaviors is a good resource for learning more as well as getting help and support.

Reviewed by: D'Arcy Lyness, PhD

Date reviewed: November 2022

Hair pulling as a way to combat baldness

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Photo copyright, THINCKSTOCK

Photo caption,

It is not yet clear whether the results of the study can be applied to alopecia in humans. This is evidenced by data from an American study published in the scientific journal Cell.

The task of the scientists was to determine how the hair follicles interact with each other in case they need to perform "restoration work".

As scientists at the University of Southern California found, the body perceives a change in hair density as a kind of damage to health and reacts by actively trying to replace the lost hair.

A group of scientists managed to regenerate 1300 hairs in experimental mice in place of 200 pulled out.

According to experts, this was a very interesting experiment, but it is not yet clear whether this method can be applied to humans and thus combat baldness.

Half of the world's male population suffers from baldness or bald patches.

In a series of experiments, researchers plucked 200 hair follicles from a circular patch of skin from experimental mice. With a rare pulling out of individual hairs in a section with a diameter of 6 mm, no regeneration occurred.

However, if 200 hairs were removed in a 5 mm area, this resulted in 1300 new hairs.

But with more dense hair removal - the same amount, but in a smaller diameter area, 4 mm - 780 new hairs appeared.

Scientists also found that the level of inflammation in the subcutaneous layer depended on the level of damage done, and through chemical and immunological reactions, the body reacted to the process of hair regeneration.

According to scientists, each hair "votes" about what should happen next, and when a certain threshold - "quorum" is reached, the process of restoration starts. The California team called this concept "quorum response."

"This research has the potential to lead to new approaches in the treatment of alopecia, a form of hair loss," said research director Chen-Min Chong.

Image copyright, BBC World Service

Image caption,

Hair density increased after active plucking in the study area

"This is a really interesting study. The idea of ​​a 'quorum response' is very clever," commented the BBC. this is the discovery of professor Chris Mason, who practices restorative medicine at University College London (UCL).

However, whether this can help in the fight against baldness is still unknown.

"That's a million dollar question. I can't answer it. Previously, many experiments led to the fact that it was possible to restore hair production, but these were baby hairs - light, light, soft. In this new study, in all likelihood , they managed to get the hair of an adult, and this is already a step forward, "Prof Mason said.

How to get rid of body hair: effective methods of removal

There are two ways to get rid of hair: remove only the visible part or remove the hair from the root. Procedures that work according to the first principle are almost always painless, but the effect of them is short-lived: after a couple of days, the skin ceases to be smooth, because the hair grows back. In the second case, the effect lasts longer, and some types of such procedures allow you to get rid of hair forever.

In this article, we have collected all the popular ways to get rid of hair.


How it works: cuts hair at the root

What to do: moisten the skin with water, apply shaving cream or gel. Run the razor over the skin in the direction of hair growth, not against. It is best to shave after a shower when the skin is warm, damp and clean. There is a risk of cutting yourself

How much the effect is held: 1-2 days


Price: razor and gel - from 400 r per month

Cream for depilation

How it works: dissolves the visible part hair

What to do: such creams often cause an allergic reaction, so before the first use, conduct a test - apply a little product on the skin area, wait time according to the instructions and rinse. If the skin turns red and there is a burning sensation ahead of time, do not use it again. And if there was no reaction, then after 24-48 hours you can use a hair remover on large areas of the body

Cons : Allergies may occur. Strong smell

How much the effect is held: 1-2 days


Price: from 600 r per month

How it works: EXTS the hair with a root of

9000 9000 What to do: heat the wax to a comfortable temperature or leave it cold - depending on the instructions. Apply to the skin in the direction of hair growth and glue a strip on top. With a sharp movement against hair growth, remove the strip when the wax hardens or after the time in the instructions has expired. The longer the hair, the better the effect will be

Cons : at first it may not be possible to effectively remove hair, the procedure will have to be repeated. Hair can grow, and scars occasionally remain on the skin

how much the effect lasts: 3-4 weeks

BILL BEAM: 😿 😿 😿

Price: from 200 r per month


How it works: pulls out hair from the root

What to do: Sugaring works in the same way as wax. It is necessary to warm up ready-made or self-made sugar paste, apply to the skin and sharply tear it off with or without a strip. Sugar paste sticks to hair worse than wax. Therefore, in order to avoid breakage and ingrown hairs, it is recommended to pull the paste in the direction of their growth

Cons : you have to adapt, at first you may not be able to effectively remove hair and they can grow. If the paste is too hot, the burn may leave scars

How long the effect lasts: 3-4 weeks

Pain level: 😿 😿 😿 😿

strips per month


How it works: pulls out hair from the root

What to do: epilator is an electric device that pulls out several hairs at a time with mechanical movements. Bring the device perpendicular to the skin, but do not press. Slowly move the epilator in the direction of hair growth. If you move the epilator quickly, it will not have time to capture all the hairs under it

Cons : takes more time than other methods. Hair capture performance varies between brands

Lasts: 3-4 weeks

Pain level: 😿 😿 — 😿 😿 😿 😿
Depends on the brand of epilator. Some have functions that reduce pain

Price: from 2000 r for the


How it works: destroys the hair of the hair with an electric current with an electric current

What to do: Electric power is carried out in clinics and beauty salons. . It is not necessary to remove hair before the procedure: it will be more convenient for the specialist to insert the needle under the root

Cons : a course of procedures is needed to achieve the effect.

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