A recent study from researchers at the Johns Hopkins School of Medicine offers evidence that not all hairstyles are created equally. According to a report from UPI, researchers have shown that women who pull their hair back tightly to make braids face a heightened risk of losing their hair later in life.

Scientists reviewed 19 studies and reported finding a strong association between hairstyles that pull the scalp and the onset of traction alopecia – gradual hair loss resulting from damage to the hair follicle. Traction alopecia is caused by prolonged and repeated tension on the hair root.

The study’s authors say traction alopecia is more common in African-American communities where tightly pulled hairstyles are popular – the study found that roughly one-third of African American women suffer from traction alopecia.

According to Dr. Crystal Aguh, an assistant dermatology professor at Johns Hopkins, “Hair is a cornerstone of self-esteem and identity for many people but ironically, some hair styles meant to improve our self-confidence actually lead to hair and scalp damage.” Hairstyles that can lead to traction alopecia include braids, tight ponytails, weaves, dreadlocks and extensions. Chemical treatments also influence the likelihood of traction alopecia.

But the news isn’t all bad – traction alopecia can be stopped and reversed if intervention comes soon enough. Researchers recommend alternating hairstyles between those that create tension on the hair root and those that ease the strain.

The study was published in the Journal of the American Academy of Dermatology. “We have to do better as care providers to offer our patients proper guidance to keep them healthy from head to toe,” said Aguh.

“Dermatologists need to be conscious of the fact that many high- and moderate-risk hairstyles greatly improve hair manageability, and simply telling patients to abandon them won’t work for everyone,” says Aguh. “Instead, physicians can educate themselves to speak with patients about making the best hairstyling choices to minimize preventable hair loss.”

A press release from Johns Hopkins describing the details of the study can be found here.