Hair Loss in African American Women

Hair loss in black women is quite common, yet most of these women don’t seek treatment. In a 2016 study on 5,594 African American women, 47.6% reported hair loss on the crown or top of the scalp. African-American women may have a genetic predisposition to hair loss, but the situation is made worse by damaging styling practices. Many black women braid, weave, and use chemical relaxers to straighten hair on a frequent and long-term basis. While chemical relaxers are super effective at straightening hair, they can reduce its strength, leading to breakage and hair loss. The negative effects of chemical relaxers are compounded by flat irons and blow dryers. Several different types of conditions are associated with hair loss in black women.


Central Centrifugal Cicatricial Alopecia (CCCA) 

The number one cause of hair loss in the 2016 study, CCCA is caused by inflammation which can lead to scarring alopecia if left untreated. Scar tissue can cause permanent loss of functioning hair follicles. Once known as Hot Comb Alopecia, the condition was thought to be linked to oils applied to the hair that were then heated with a hot comb. Later, it was shown that many people developed CCCA even though they didn’t use hot oil and combs. CCCA can occur with other hair loss conditions such as traction alopecia.

A large-scale study analyzing four years of data on 487,000 adult black women revealed a connection between CCCA and uterine fibroids. Nearly 14% of women with CCCA also had fibroids. From this data, researchers established that black women with CCCA have a fivefold risk of developing fibroids. It’s a well-known fact that black women are more prone to conditions that cause scarring, which may explain the co-occurrence of both conditions, but the connection is still unclear. Based on these findings, the recommendation is that black women with abnormal hair loss should be screened for CCCA, especially if they are suffering from heavy bleeding and pelvic pain associated with fibroids.


Traction Alopecia 

Traction alopecia is caused by inflammation of the hair follicles. This occurs when hair is pulled too taut over a long duration, in styles such as tight braids and ponytails, cornrows, hair extensions, or weaves. Hair that is naturally curly is fragile, preventing the natural protectant sebum from traveling down the length of the hair shaft. Traction alopecia is self-inflicted, setting it apart from other hair loss conditions linked to genes, stress, illness, and unavoidable factors. It can be reversed if it is recognized and treated early, however, repeated tension caused by hair styles will lead to scars and permanent hair loss. Signs include small white dots at the sides of the scalp or in areas surrounding the hairline. Traction alopecia typically causes gradual, but noticeable hair loss on the edges of the scalp, including the back and the front parts of the hairline, behind the ears, and the temples.


Folliculitis Induced Alopecia

This condition, also called traction folliculitis, occurs when bacteria finds its way into the scalp. This causes inflammation of the hair follicles, destroying them and making it difficult for hair to grow back. Weaves are notorious for causing traction of the hair and inflammation of the follicle root. Scalp tenderness, pain, and little bumps around the follicle are signs of inflammation and possible infection.


Prevention Tips 

  • Use silicone creams instead of chemical relaxers to straighten each strand of hair
  • Choose hairstyles that don’t put extreme tension and pressure on hair strands
  • Allow hair to be completely natural in (e.g. an Afro style), which means no ties, slides, or clips
  • If you want to braid your hair, only tie loose, larger braids
  • Use a wide hair band made of fabric to hold back your hair loosely
  • Use castor, Jamaican black castor, olive, or unrefined and pure coconut oil to massage your scalp


Types of Treatment

Although hair loss is common among American-American women, many aren’t aware they should visit a healthcare professional for an evaluation. In fact, the 2016 study revealed 81.4% of participants never consulted a physician about hair loss. When hair loss is detected and treated early before scarring has taken place, it may be possible to reverse some of the damage. Seeking medical help from a dermatologist, trichologist (hair and scalp specialist), or a physician is key to identifying scalp damage or illnesses that may cause hair loss. Treatment includes high-strength minoxidil formulations, hair growth boosters, and medications applied directly to the scalp on a daily basis.

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