Why hair loss and thinning hair are so common in Black and African American women, the types of alopecia behind most of it, and what to do about each one. Much of it can be slowed, and some of it can be reversed when it is caught early.
If your part has widened or your edges have thinned, you are in very large company, and you are right to take it seriously.
For many Black women, hair is woven into a whole life. It is Saturday mornings between your mother's knees while she braided, long afternoons in a stylist's chair, the silk press you saved for, the twists you finally learned to do yourself. So when it starts to thin, it can shake something deeper than a hairstyle. That is not vanity. You are allowed to care.
47.6%
of 5,594 African American women surveyed reported hair loss on the crown or top of the scalp.1 Almost half, and yet it is rarely talked about, and most women never mention it to a doctor.
Too many women have also been told, one way or another, that they did this to themselves. Often that is not true. There are several kinds of hair loss, most of them have nothing to do with how you wear your hair, and many can be slowed or treated when they are caught early.
We have fitted women with hair loss since 1995. We do not diagnose; a dermatologist does that. What we can do is help you make sense of what you are seeing, know what to ask for, and find something to wear in the meantime that is kind to your hair. Three things matter most:
Find out what kind of hair loss it is.
Where your hair is thinning is an important first clue.
See a dermatologist who understands your hair.
The earlier you go, the more there may be to preserve.
Care for what you have, and cover it your way.
Small changes first, and a wig whenever you want one.
With some kinds of hair loss, time matters. Some causes, including CCCA and long-standing traction alopecia, can permanently damage the follicle if they continue untreated, and a scarred follicle does not grow hair again. Caught early, they can often be slowed or brought under control. When to see a dermatologist →
1
what is happening to my hair?
breakage, hair loss, or both
Start with one question: is your hair breaking, or is it falling out at the root? Breakage happens along the strand. You see short hairs, uneven lengths, ends that snap before your hair reaches the length it used to. Hair loss happens at the follicle. You see less fullness, a wider part, a hairline moving back, scalp showing through where it did not before. You can have both.
The difference matters, because conditioner can protect a strand that is breaking, but it cannot reach inflammation at the follicle underneath. And one thing is especially important for Black women: breakage that stays in one place at the center of your scalp can be the very first sign of CCCA, before any thin spot appears. Afro hair breaks easily, so breakage is easy to shrug off. If it keeps happening in the same place, take it seriously.
why it is so common
Some Black women inherit a tendency toward hair loss, and years of relaxers, tight braids, weaves, flat irons and blow dryers can add to it. Chemical relaxers are super effective at straightening hair, but they weaken it, and heat on top makes it weaker still.
2
what it might be
the common types of alopecia, in plain words
Where your hair is thinning can be an important first clue. This is not a diagnosis. It gives you words for what you have noticed, so you can walk into the appointment and describe it.
edges and temples
often traction alopecia
the part
often female pattern hair loss
the crown
often CCCA
Where thinning hair shows up in Black women and what it often is
where you see it
what it can point to
the crown or center of the scalp
CCCA, or female pattern hair loss
a part that keeps widening
Female pattern hair loss
edges, temples, behind the ears
Traction alopecia
the front hairline, with thinning eyebrows
Frontal fibrosing alopecia
smooth, round patches
Alopecia areata
all over, with heavy shedding
Telogen effluvium
short, broken hairs anywhere
Breakage (traumatic alopecia); at the crown, possibly early CCCA
scaly, lighter or darker patches that scar
Discoid lupus
More than one can happen at once: CCCA with traction alopecia, for instance, or CCCA with female pattern hair loss. So if you loosen your braids and your edges come back but your crown keeps thinning, that usually means two things are going on at once, not that you did something wrong. The crown needs its own answer, and a biopsy can find the second cause.
We wrote this for women, because women are who we fit, but CCCA, traction alopecia and alopecia areata affect Black men too, and a dermatologist is their first step as well. For female pattern hair loss and shedding after illness, stress or childbirth, see female pattern hair loss and help! my hair is falling out.
thinning that starts at the crown (CCCA)
Central centrifugal cicatricial alopecia, usually just called CCCA, was the most common cause of hair loss in the 2016 survey. CCCA is an inflammatory scarring alopecia that damages hair follicles and can cause permanent hair loss. It usually begins at the crown and spreads outward.2, 3 Some women feel burning, itching or tenderness. Many feel nothing at all, which is part of why it goes unnoticed. In that same survey, 40.9% of the women described hair loss that matched CCCA, but only 8.8% had ever been diagnosed with it.1
A follicle that has scarred does not grow hair again. Treated early, it can often be slowed or brought under control, and sometimes some hair returns. If your thinning starts at the crown, ask your dermatologist specifically about CCCA.
Many women blame themselves for CCCA. For years it was blamed on hot combs and relaxers, and it was once even called hot comb alopecia. Then women who had never used a hot comb developed it too. The exact cause is still not fully understood. Researchers now think genes, inflammation and hair care may each play a part, with hair-care practices a possible contributor rather than a proven single cause. How you have worn your hair is not the whole story.
more on CCCA: treatment and research
There is still no cure, and CCCA has no single established standard treatment, but the options have grown. In a 2024 consensus, dermatologists who specialize in hair agreed strongly on steroid creams and injections to calm the inflammation, oral antibiotics used for their anti-inflammatory effect, topical or low-dose oral minoxidil, and hair transplantation once the condition has been quiet for a while.4 In one retrospective study at a single hospital, patients who took low-dose doxycycline along with steroid treatment were more likely to show regrowth than those treated with steroids alone; because the study looked back at records rather than testing the drug directly, more research is needed.5 Newer anti-inflammatory drugs called JAK inhibitors are being tried in women who do not respond, so far only in individual case reports.
Minoxidil on its own does not treat the inflammation, so for active CCCA it belongs alongside an anti-inflammatory treatment, not in place of one. Some people also shed a little more for the first few weeks on it, and its label warns of that. Ask your dermatologist what to expect, so a normal early shed does not send you looking for a different treatment.
A gene called PADI3 has been linked to CCCA.6 One retrospective study found that women with CCCA had higher odds of also having uterine fibroids, although later studies have not consistently confirmed the association.7 Women with CCCA who also have heavy periods, pelvic pressure, or pelvic pain should discuss those symptoms with their doctor.
thinning at your edges and hairline (traction alopecia)
Every hairline is different. Yours might be straight, rounded, peaked or uneven, and soft baby hairs along the edge are normal. What matters is change: edges thinner than they used to be, temples moving back, a hairline that no longer grows as far forward.
Most often, the cause is tension. Traction alopecia is acquired hair loss caused by prolonged or repeated tension on the hair, often from tight braids, cornrows, ponytails, extensions, or weaves.8 It can occur at any age and is especially important to catch early because hair can regrow before scarring develops. It affects up to a third of women of African descent.9 Naturally curly hair is fragile to begin with, partly because the scalp's own oil has a harder time traveling down a coiled strand to protect it.
Because traction alopecia comes from tension rather than genes or illness, it is the one you can do the most about. Glued lace counts as tension too.
Watch for soreness after a style goes in, small bumps or small white dots along the hairline, and broken hairs at the temples. Dermatologists also look for the fringe sign: a thin line of short hairs left along the very front, with thinning just behind it.10 Loosen the styles at your hairline first. If your edges keep receding after that, or your eyebrows are thinning too, see a dermatologist, because a scarring condition can look similar at first.
While your edges recover, a lace front wig worn without glue, a soft headwrap or a scarf covers the hairline without pulling on it.
breakage (traumatic alopecia)
Traumatic alopecia is basically a fancy term for hair breakage: hair-shaft breakage caused by repeated chemical, heat, or styling damage. The follicle is fine; the strand itself is damaged, so it snaps before it can grow long. Afro-textured hair can be especially prone to dryness and breakage, because of the shape of the fiber and how hard it is for the scalp's own oil to travel along a tightly curved strand. Dyeing, chemical straightening and heat tools such as flat irons all add to it. Because the follicle is not damaged, hair grows back once the damage stops.
tender bumps around the follicles (traction folliculitis)
Traction folliculitis is inflammation around hair follicles caused by excessive or repeated pulling from tight hairstyles. It can cause redness, tenderness, and small bumps or pustules. Infection can sometimes occur secondarily. If bumps keep recurring, crusting develops, or hair loss appears, see a dermatologist because some inflammatory scalp conditions can scar the follicle and need prescription treatment.
other types of alopecia in Black women
Each of these points to a different answer, so it helps to know what each one looks like.
A part that keeps getting wider. Female pattern hair loss thins the top while the front hairline usually stays. It is the most common hair loss in women overall, and treatment can slow it. Not every thinning crown is CCCA.
Smooth, round patches that appear quickly. Alopecia areata is autoimmune, and it has nothing to do with braids, relaxers or heat. In two large studies of US nurses, Black women reported it roughly three to five times as often as White women.11 Since 2022 the FDA has approved three oral medications for severe cases (baricitinib, ritlecitinib and deuruxolitinib), so a sudden patch is a reason to see a dermatologist rather than to change your hair routine.
Shedding from all over. Telogen effluvium is temporary shedding that tends to start a few months after an illness, surgery, childbirth, a medication change or a hard stretch of stress. By the time it starts, the cause can feel long past. Your own doctor can check whether blood work, such as iron or thyroid, makes sense.
A front hairline moving back, with eyebrows thinning. Frontal fibrosing alopecia is a scarring hair loss that is less common in Black women than CCCA, but in Black women it tends to start younger, often before menopause, with less itching and redness. It is easily mistaken for traction alopecia, and speckled darker pigment around the follicles at the hairline can be a clue. Mention both the hairline and the brows when you book.12, 13
Scaly patches that turn lighter or darker. Discoid lupus is an autoimmune skin condition that is more common in Black women. On the scalp it can leave discolored patches and permanent bald spots, and in one US study Black patients were more likely to have it on the scalp and to scar there.14, 15 A dermatologist diagnoses it, usually with a biopsy, and will check for lupus elsewhere in the body.
3
the right appointment
the earlier, the more can be saved
You should not have to defend your hairstyle before someone looks at your scalp. And yet most women with hair loss never get as far as the appointment.
81.4%
of the women in the 2016 survey had never consulted a physician about their hair loss.1
When hair loss is found and treated early, before scarring sets in, some of the damage can often be reversed. A dermatologist is the best clinician to evaluate unexplained or scarring hair loss and determine whether treatment is needed. Look for a board-certified dermatologist, ideally one who lists hair loss or skin of color among her interests. A trichologist, a hair and scalp specialist, can help with care, but she is not a medical doctor, so anything that might scar needs a dermatologist. If you would rather start with blood work, your own doctor can check for anemia, low vitamin D and thyroid problems, all of which can affect hair.16
what to ask for
CCCA is easy to mistake for traction alopecia. A 2025 survey of more than 1,000 people with scarring hair loss found CCCA took an average of 5.7 years from first symptoms to diagnosis, about twice as long as the other common scarring types.17 You can shorten that by asking plainly:
Could this be CCCA? Say where the thinning started, and whether your scalp ever burns, itches or feels tender, even if only sometimes.
Will you look closely at my scalp? Dermatologists often examine the scalp under magnification, and take a small biopsy when it is not clear.18, 19 Research in Black women with hair loss has found a biopsy can change both the diagnosis and the treatment.20
How will we know it is working? Ask what to watch for, and when to come back.
If what you hear does not match what you are living with, or you leave feeling dismissed, a second opinion is reasonable.
Often a stylist or loctician spots the change first, because she can see your crown and you cannot. Take what she saw to a dermatologist rather than waiting to see if it settles. And with a diagnosis, a wig prescribed as a cranial prosthesis may be covered by insurance; our guide to wig insurance coverage gives the exact words to use.
"My loctician says it is just the weight of my locs."
Heavy locs can pull, so she may be partly right. But thinning at the crown needs a dermatologist's eye either way, because CCCA starts there and can look like ordinary breakage at first. Take what she has seen to the appointment, and let the dermatologist rule it out.
when to book the appointment
Thinning at the crown that seems to be spreading, a wider part or a thinner ponytail, a scalp that burns, itches or feels tender, bumps or pus around the hair follicles, scaly patches that turn lighter or darker, or edges that have not grown back after you stopped wearing tight styles.
why hair loss can feel different for Black women
what else is going on when hair thins
For a lot of women the hardest part is not the thinning itself. It is giving up a style you have worn for twenty years, or finding that the braids you love now hurt at your edges, or that the wash day routine you finally figured out no longer works. Some women shrug it off. Many do not: in research with Black women living with CCCA, most said their hair loss left them embarrassed, frustrated or self-conscious.21
there can be a work layer too
Black women have had to think about their hair at work in ways many women never have. In a set of four studies published in 2020, Black women with natural hairstyles were rated less professional and less competent, and were less likely to be recommended for a job interview, than Black women with straightened hair.22 So when hair starts to thin, the question is rarely only how to cover a spot. It can also be whether a new style will feel right at work, or whether you are about to have another conversation about your hair that you never wanted to have.
guilt that does not belong to you
Many Black women with hair loss have spent years hearing that relaxers, braids, weaves or heat must be the reason. Sometimes tension really is part of it; traction alopecia is real. But CCCA is an inflammatory condition, female pattern hair loss is inherited, alopecia areata is autoimmune, and shedding can follow illness, childbirth or stress. Women with CCCA often blame themselves, partly because it was blamed on hairstyling for so long.21 In one survey of Black women, only about a third who had seen a doctor about their hair felt the doctor understood African American hair.23 So choose your doctor carefully.
The first question is “what kind of hair loss is this?”, not “what did I do wrong?”
missing your hair
You can know that hair is not the most important thing in your life and still be deeply upset about losing it. Some women feel better the minute they put a wig on. Some would rather wear their own hair, thin spots and all. We have fitted both, and neither one is wrong. Some days you will want to treat it, cover it, cut it short or change your braids, and some days you will not want to think about it at all.
It may still bother you. What you do about it is your decision.
4
how to care for thinning Afro hair
gentle habits that protect what you have
Afro hair can be especially prone to dryness and breakage, and thinning hair is more fragile still. These habits protect the hair you have and give an irritated scalp the best chance to recover.
Should you grease your scalp every day?
Not if it is itchy, flaky, tender or bumpy. Heavy oils on the scalp may feed the yeast behind seborrheic dermatitis, which many women take for dry scalp and treat with more oil. Put the oil on your lengths and ends, and ask your dermatologist about the scalp itself. The habit lasts because it is how so many women were taught.
Do wigs make hair loss worse?
Only when they are worn badly. A wig that is too small, glued to a fragile hairline or worn over a tight braid-down can cause breakage. One in your size, over loose cornrows or a soft cap and taken off at night, lets your own hair rest.
make your straightened hair last longer
Chemical relaxers are damaging to the hair and scalp. If you wear your hair relaxed, it is important not to overuse them. Wait at least the recommended eight weeks, and longer if you can: the American Academy of Dermatology suggests every two to three months, applied by a professional to new growth only.24 Less relaxer means healthier hair and less breakage. In between, keep your hair moisturized with deep conditioning, and when you want a break from it altogether, wigs, scarves and headwraps let you go longer between relaxers.
relaxers and your health: what the research says
Relaxers have also been studied for reasons that have nothing to do with hair. In the National Institutes of Health Sister Study, which followed more than 33,000 women for almost 11 years, women who used chemical straighteners more than four times a year were about twice as likely to develop uterine cancer: an estimated 4.05% by age 70, compared with 1.64% for women who never used them.25 Uterine cancer is uncommon, and the study shows a link, not proof that relaxers cause it. A 2023 analysis from the Black Women's Health Study found a similar pattern in postmenopausal women who had used relaxers for many years.26
The FDA announced in 2023 that it planned to ban formaldehyde and formaldehyde-releasing chemicals in hair straightening products. As of September 2026 it has not yet issued the proposed rule; its regulatory agenda now lists the proposal for November 2026.27, 28 If you relax your hair, or did for years, mention it to your gynecologist; she can tell you what it means for you.
let your protective styles protect
Braids, twists, locs, cornrows, weaves and extensions are not the problem. Tension is what causes the damage. A style that goes in without pain, sits loosely at the hairline and comes out on time is far less likely to cause traction damage. If it hurts while it is going in, ask your stylist to stop and redo it. Dermatologists put it in three words: pain equals damage.24
Give your scalp time to recover between styles that pull on your hair. How long depends on the style and on your own scalp, but pain, tenderness, bumps or thinning are signs to take a style down rather than stretch out its wear time. The American Academy of Dermatology suggests keeping braids in no longer than two to three months and loosening them around the hairline,29 and Johns Hopkins dermatologist Crystal Aguh suggests taking a weave or extensions out after about eight weeks.16 Go lighter on the weight and length of added hair, and change up your styles so the same spots are not pulled the same way every time.
How long to keep a style in. Braids: no more than two to three months. Weaves and extensions: about eight weeks. Relaxer touch-ups: every two to three months, on new growth only. And sooner than any of those, the day it starts to hurt.
wash, condition and oil the ends
Castor, Jamaican black castor, olive and unrefined coconut oil all belong on the lengths and ends, the oldest and most fragile part of your hair. The link between scalp oils and seborrheic dermatitis rests mostly on laboratory evidence so far, so the advice is to go lightly on the scalp itself.30
Wash once a week or every other week so product does not build up, condition every time, and use masks and deep conditioning to keep your hair moisturized.24 Always use a heat protectant before heat tools. And a balanced diet supports your hair as it does the rest of you: foods rich in vitamins and healthy fats, such as salmon, avocados, seeds, nuts, and plenty of fruits and veggies.
handle your hair less
Wearing your hair natural, with no weaves, chemical straighteners or dyes, can cut out chemicals and repeated heat, although a natural style pulled tight still puts tension on your follicles. But relaxed hair, braids, locs and wigs can all be cared for gently too. What protects your hair is less repeated heat, fewer chemicals, less tension and less handling, whatever style you love.
more everyday habits
Go easy on tension. Choose hairstyles that do not put extreme tension and pressure on the hair.
Give it days off. Let your hair be completely natural, which means no ties, slides, or clips.
Braid bigger. If you braid, choose looser, larger braids.
Hold it back softly. A wide fabric band holds your hair back without pulling.
Protect it at night. Wrap your hair in a silk scarf to protect your hair and scalp while you sleep. If your scalp is bare, silk and satin slide off in the night; a cotton or bamboo sleep cap stays put.
Add length without the pull. A properly fitted full wig gives you length and a new style without attaching added hair to fragile strands. Clip-in extensions put their weight on your own hair, so skip them where your hair is thinning.
Watch the clock. Be aware of how long you leave tight hairstyles in. If your scalp keeps feeling uncomfortable, have the style taken out.
5
toppers, wigs and head coverings
from small changes to full coverage
You do not have to wait until the thinning is severe before you try a topper, a scarf or a wig.
You can treat your hair loss and cover it at the same time. A wig or a wrap gives fragile hair a rest from daily heat and styling while treatment does its work. The rule for all of it is the same: if it pulls, pinches or hurts, change it. And if your scalp is inflamed or you are being treated for a scarring condition, your dermatologist's advice comes before ours.
You do not have to go straight to a wig. Start where you are:
thinning at the part or crown
A root touch-up powder in your shade softens the contrast between hair and scalp. A wide, soft headband pulls your hair back over a widening part, and in our experience Nioxin gives thinning hair a fuller look. For more coverage on top, a hair topper adds hair just where you want it.
nothing on your hair at all
Scarves, headwraps and hats ask nothing of your hair, and on a hot day a breathable headwrap is cooler than a wig on a tender scalp. A hat with hair is the quick answer for a walk or a grocery run.
whenever you want it
A full wig gives you almost any style you like and, fitted and secured gently, puts no added tension on fragile areas.
hair toppers for thinning hair
A hair topper is a partial hairpiece that clips into your own hair to cover thinning at the crown or along the part. Your own hair falls over and around it, so it blends, and it goes on and off in a minute. When the thinning is on top, from female pattern hair loss or from CCCA that is being treated, a topper is often the first step before a wig.
Cover all of it. The most common mistake we see is a base that is too small, because choosing a bigger one can feel like admitting how much has changed. Measure the whole thinning area and choose a topper that covers all of it, not just the worst of it.
Clip into strong hair. The clips need healthy hair around the thin area to hold on to. Never clip onto the thinning spot itself, and if a clip pinches or pulls, move it. If there is not enough strong hair to anchor it, a larger piece or a wig is gentler.
It covers the top, not the edges. A topper sits on the crown and part. Thinning at the hairline needs a different answer: loosen the styles pulling on it, and see a dermatologist if it keeps receding.
Match your texture. Most toppers are made in straight and wavy textures, so they blend most easily with relaxed, pressed or blown-out hair. Human hair toppers can be heat styled to match a press. If you wear your hair natural, call us before you buy, and we will tell you what will blend.
Ask first if your scalp is sore. If you are being treated for CCCA or your scalp is inflamed, check with your dermatologist before you clip anything near it.
With a first topper, we start with three things: how much it needs to cover, your texture, and where the clips can safely sit. Our hair topper buying guide walks through base sizes, clips and cap types.
covering thinning when you have textured hair
Covering a thin spot is only half the job. Whatever you choose also has to live with the hair around it, and that is where most general advice about toppers and wigs stops being useful to a Black woman.
Texture first, then color. If the hair around your crown is curly, coily or full, a straight topper may cover the scalp and still not look like yours. Curl pattern and density matter as much as base size and shade. When your own texture is natural, a curly wig or a wrap often looks more like you.
Find the strong hair before you choose. A topper expects healthy hair right around the thin spot. With CCCA or traction alopecia, your strongest hair may be at the sides or the back instead, and then a clip-in piece has nothing safe to hold. A full wig over a soft cap, or a wrap, puts no weight on the weak areas.
Braids and locs underneath change the fit. They add height and bulk under a wig or a scarf, so measure over the way you actually wear your hair.
Wraps work with everything.Headwraps and pre-tied scarves suit any texture and any amount of hair, and pull on nothing.
If you are not sure, call 1-800-264-4287 and describe your hair to us.
wear wigs properly
Wigs let you have any hairstyle instantly, including long, straight and colored hair, without tight weaves, chemicals or hair dyes, so you can change your look without processing or pulling on fragile hair. It is important to wear it the right way, though, because a wig worn improperly can cause hair breakage and affect hair growth.
Wear the right size. A wig that is too small rubs against your hair, and that friction causes breakage. Measure your head to find your size.
Use adhesive cautiously. Adhesives can irritate the scalp or cause contact dermatitis, especially on sensitive skin. Use the least adhesive needed and stop if the scalp becomes red, itchy, sore, or broken. Try any new adhesive on a small patch of skin first. Removing wig glue can also pull fragile hair at the hairline, so when your hairline is already fragile, a glue-free option such as a velour wig gripper may be the better choice.31
Keep the braids under it loose. A tight braid-down makes a wig lie flat, but it is tension too. Low-tension cornrows are gentler, including under a sewn-on unit.31
Put something soft underneath. A bamboo wig cap keeps a tender scalp off the lace and clips, and takes up sweat on hot days.
Choose a comfortable cap. Choose a comfortable, well-fitting cap construction with good ventilation if your scalp feels hot or sensitive, such as an open cap or a monofilament cap.
Too much hair is fixable. A wig that looks too full is too dense, not the wrong style. It can be thinned and the part plucked, so it sits the way your own hair would.
Match the warmth of your skin. Most wigs come in 15 to 20 colors, and the right one depends on your undertone as much as the shade; our guide to choosing a wig color walks through it.
Wash it regularly. About once every seven wears, or as the maker advises, to clear away sweat, oil and product buildup.
Take it off at night. Do not wear wigs overnight.
a few good places to start
Two caps with hair you can put on and go, and four wigs with light, open caps that let your scalp breathe.
An asymmetrical pixie, longer on one side, with wispy bangs. The fiber is heat-friendly, so you can smooth or curl it, and the open-wefted stretch cap lets air through.
Not sure which one is right for you? Call 1-800-264-4287 and a person will help you with size and cap.
questions women ask us
open only the one you need
why do so many Black women lose their hair?
Several causes overlap. CCCA, a scarring hair loss that starts at the crown, is seen mostly in women of African descent, and a gene has been linked to it. Traction alopecia comes from years of tension at the hairline. Alopecia areata appears to be more common in Black women too. Hair care can play a part, but it is rarely the whole story, and many causes have nothing to do with how you wore your hair. A dermatologist can tell you which one you have.
why is my hairline thinning?
Most often it is traction alopecia: years of tension from tight braids, ponytails, weaves, extensions or glued lace pulling at the edges. Caught early, the hairline often grows back once the styles loosen. If your front hairline keeps moving back after you have stopped tight styles, or your eyebrows are thinning at the same time, see a dermatologist, because scarring types of hair loss can look similar at first.
is thinning hair normal for Black women?
It is common, but it is not something you have to simply live with. Almost half of the Black women in a 2016 survey reported hair loss at the crown or top of the scalp. A wider part, a thinner ponytail or a spot at the crown that keeps spreading is a reason to see a dermatologist, because several of the causes can be slowed or treated when they are caught early.
what is the most common type of alopecia in Black women?
CCCA, the scarring hair loss that starts at the crown, was the most common cause in the 2016 survey of Black women. Traction alopecia is very common too, affecting up to a third of women of African descent, and female pattern hair loss and alopecia areata happen as well. Where your hair is thinning can be an important first clue to which one you have.
is alopecia areata more common in Black women?
It appears to be. In two large studies of US nurses, Black women reported alopecia areata roughly three to five times as often as White women. It is autoimmune, not caused by styling, and it shows up as smooth, round patches. Since 2022 the FDA has approved three oral medications for severe cases, so see a dermatologist as soon as a patch appears.
can Black women wear hair toppers?
Yes. A topper suits thinning at the crown or part when there is enough healthy hair around it to hold the clips. Most toppers come in straight and wavy textures, so they blend most easily with relaxed, pressed or blown-out hair; human hair toppers can be heat styled to match. Choose a base that covers the whole thinning area, clip into strong hair only, and remember a topper covers the top of the head, not thinning edges.
why do so many Black women wear wigs?
For lots of reasons, and many have nothing to do with hair loss. A wig lets you change your look without heat, chemicals or hours in a stylist's chair, and many women wear one to give their own hair a rest. Some women wear a wig because their hair is thinning, and it gives them a style they love while they find out what is happening. Whatever the reason, a wig that fits well and comes off at night is kind to your own hair.
does relaxing my hair cause CCCA?
Not on its own, as far as researchers can tell. CCCA looks like a condition with several causes working together, including genes and inflammation. Some studies link it to relaxers or tight styles and others do not. Gentle, low-tension hair care is still wise, but it is not accurate to say a woman gave herself CCCA by relaxing or styling her hair.
can hair lost to CCCA grow back?
Sometimes, when it is caught early. Treatment can let follicles that are inflamed but not yet scarred grow hair again. A follicle that has turned to scar tissue does not usually regrow, but treatment still matters, because it can slow the spread or bring it under control.
can traction alopecia grow back?
Early traction alopecia often grows back once the pulling stops. If the tension goes on for years and the follicles scar, the loss can become permanent, so soreness, broken hairs and thinning edges are the time to act, before the area turns smooth.
are braids and protective styles bad for your hair?
No, as long as they are not tight. Braids, twists, locs, cornrows, weaves and extensions can all be worn without hair loss when they go in without pain, sit loosely at the hairline and come out on time. If a style hurts, it is too tight.
should I use minoxidil for hair loss?
It depends on which hair loss you have. Dermatologists use it for female pattern hair loss, and alongside other treatment for CCCA, but on its own it does not treat the inflammation behind CCCA. Find out what you have before you rely on an over-the-counter product, and know that some people shed a little more for the first few weeks.
what kind of doctor treats hair loss in Black women?
A board-certified dermatologist, ideally one who lists hair loss or skin of color among her interests. Your own doctor can start with blood work for iron, vitamin D and thyroid. A trichologist can advise on hair and scalp care but is not a medical doctor, so anything that might scar needs a dermatologist.
what thirty-one years have taught me
a note from Danielle
My mother, Carol, was a hairstylist, and she knew how much hair can mean to a woman. In 1995, after her own breast cancer, she and I started Headcovers together. In the thirty-one years since, I have seen again and again how deeply hair loss can affect a woman.
Some of the women I talk with are saying out loud for the first time how much it hurts. You do not have to explain to us why your hair matters to you, or apologize for being upset about losing it.
If you have been blaming yourself, I want you to know that hair loss is not a personal failing. You deserve help understanding what is happening, without assumptions about your braids, your relaxers or how you have cared for your hair. If something about your hair care does need to change, that is only about helping you from here.
Helping you find something comfortable to wear is part of what we do. But if reading this helps you feel less alone, stop blaming yourself or walk into an appointment knowing what to ask, that matters to us just as much. We care how this turns out for you.
When you are ready, we are here.Browse at your own pace, or call 1-800-264-4287. A person answers, and they will get you to the right one.
Something we missed, or a question this guide did not answer? We want to hear from you: write to us through our contact page.
written byDanielle Galland-YatesPresident of Headcovers. Designing and fitting wigs and headwear for women with hair loss since 1995.page last updated October 2026
medically reviewed byDr. Ahsan Farooq Khan, MBBSSenior Clinical Fellow in Dermatology and Venereology. Reviewed this page for medical accuracy.reviewed October 2026
sources
Lenzy Y. and others, hair loss survey of Black Women's Health Study participants, presented at the American Academy of Dermatology Annual Meeting, March 2016 (AAD announcement). ↩
StatPearls, Central Centrifugal Cicatricial Alopecia, NCBI Bookshelf. ↩
Treatment for central centrifugal cicatricial alopecia: Delphi consensus recommendations, Journal of the American Academy of Dermatology, 2024 (ScienceDirect). ↩
Obi A. and others, Doxycycline for central centrifugal cicatricial alopecia: a single center retrospective analysis, Journal of the American Academy of Dermatology, 2024 (JAAD). ↩
Malki L. and others, Variant PADI3 in central centrifugal cicatricial alopecia, New England Journal of Medicine, 2019. ↩
Dina Y., Okoye G.A. and Aguh C., Association of uterine leiomyomas with central centrifugal cicatricial alopecia, JAMA Dermatology, 2018 (PMC5839278). ↩
Diagnostic clues to frontal fibrosing alopecia in patients of African descent, Journal of Clinical and Aesthetic Dermatology, 2016 (PubMed 27721910). ↩
Joseph A.K. and others, Discoid lupus erythematosus skin lesion distribution and characteristics in Black patients, Lupus Science & Medicine, 2021. ↩
Johns Hopkins Medicine, Hair loss in Black women: tips from an expert, with dermatologist Crystal Aguh, MD. ↩
Issa T. and others, Central centrifugal cicatricial alopecia is associated with longer time to diagnosis among scarring alopecias, JAAD International, 2025 (PMC12814682). ↩
DermNet, Central centrifugal cicatricial alopecia. ↩
Douglas A. and others, Scalp biopsy influences diagnostic accuracy and treatment in Black women with alopecia, Journal of the American Academy of Dermatology, 2023. ↩
Koval C.Z. and Rosette A.S., The natural hair bias in job recruitment, Social Psychological and Personality Science, 2020 (SAGE Journals). ↩
Gathers R.C. and Mahan M.G., African American women, hair care, and health barriers, Journal of Clinical and Aesthetic Dermatology, 2014 (PubMed 25276273). ↩
Dermatology Times, American Academy of Dermatology recommendations on traction alopecia. ↩
Hair oils may worsen seborrheic dermatitis in Black patients, Skin Appendage Disorders, 2023 (Karger). ↩
Considerations and recommendations on camouflage in alopecia in Black women, International Journal of Women's Dermatology, 2023 (PMC10550043). ↩
All sources last checked September 2026.
This guide is for informational purposes only and does not replace advice from your physician. Do not start or stop any treatment based on what you read here. Your care team knows your diagnosis, your medications, and your history.
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