When I lecture to groups of dermatologists, I often say that hair loss is epidemic among black women. In the twenty years that I have been in practice, I have gone from seeing five women with hair loss each week to seeing 25 or more. No one knows for sure if African-American women are experiencing more hair loss or if more are visiting the dermatologist to find out why they having hair loss.
Hair loss can be absolutely devastating, particularly for women. Hair is so strongly tied to our beauty, sense of worth and self-confidence. Often when we loose our hair, we attempt to camouflage the loss but frequently utilize hairstyles that make the problem worse. Sadly, we wait too long to see the dermatologist.
Most women have no idea that there are many causes of hair loss. Some think that hair loss is a normal part of aging. Others do not realize that their hair care practices may lead to or contribute to their hair loss. Still others do not realize that something can be done to stop the hair loss. Since hair loss is such a major problem for our community and it has such devastating consequences, I have decided to devote three blog posts to this extremely important subject.
Over the next few weeks, please read about the different types of hair loss that black women typically experience. I think that it is very important for you to comment and share your experiences with hair loss. Comment after each hair loss blog post and tell me if you have, had or currently have the type of hair loss discussed and what your personal story is. Remember, you are not alone. Your dermatologist may be able to help you. You won't know if you don't go. If we are unable to help you grow new hair, we may be able to stop the progressive loss, allowing you to keep the hair that you have. Finally, there are hair loss support groups available where you can share your story in more detail and truly understand that you are not alone.
In order to understand hair loss, it is important to begin with a quick vocabulary lesson, so that we are all speaking the same language.
Hair Loss Vocabulary
Alopecia simply means hair loss. If you have hair loss, then you have alopecia. However, it is important to realize that there are many different types of hair loss or alopecia. Alopecia may occur in different locations on the scalp. There are different causes of alopecia. Some types are reversible and others are not. As you would expect, there are different treatments for alopecia depending upon the type.
Traumatic Alopecia (Hair Breakage) means that the hair strand has become shorter than it was before because of trauma or injury to the hair strand. An example is hair that previously touched your shoulders that may have broken off and now only touched the top of your ears. There are also many reasons for hair breakage. Your dermatologist and hair stylist may help you identify your specific reason.
Anterior Hairline is the growth of hair closest to your forehead, which is also called the edges.
Posterior Hairline is the growth of hair closest to the back of your neck, which is also called the kitchen.
Vertex is the crown or the top of your head.
Traction means pulling. There are many hairstyles and hair implements that can cause pulling of the hair.
Traction Alopecia is hair loss from pulling.
Central Centrifugal Cicatrical Alopecia is a type of hair loss that begins in the central portion of the scalp, spreads in an outward or centrifugal pattern and causes scarring or cicatrix of the hair follicles.
Scalp Biopsy is a procedure where a small area of the scalp is numbed with Novocain or lidocaine and a piece of the scalp is removed. A stitch is placed to close the area so that you will not have a patch of missing scalp. The small piece of scalp is sent to the laboratory to be analyzed under the microscope.
Fungal Culture is a procedure where several strands of hair are cut close to the scalp and sent to the laboratory to determine if the hair is infected with fungus (sometimes called ringworm)
Although there are many causes of hair loss that I will discuss, the three most common causes of hair loss that I see in my black female patients are:
Traumatic Alopecia (Hair breakage)
Central Centrifugal Cicatrical Alopecia
I would like to begin with hair breakage because that is the easiest to recognize and to reverse. It is often a matter of altering the way that you treat your hair.
Traumatic Alopecia (Hair Breakage) can occur at any location on the head and it is directly related to trauma or injury of the strands of hair. There are some women who report that they have a "weak" spot where the hair will break, re-grown and break again in that same area. Others will experience hair breakage infrequently and once the hair re-grows it will not break again. When the hair breaks you will not see the white hair bulb at the end of the hair. A broken hair is usually very short but it can be of any length. Sometimes you will see the short broken hairs in the sink or on the pillow. Other times you won't notice the breakage when it occurs. Your scalp will feel normal. The breakage may be sudden and unexpected or slow and gradual. Since there are many causes of trauma to the hair strand, there are many causes of breakage and I will highlight a few of the most common.
Common Causes of Traumatic Alopecia (Hair Breakage):
- Excessive Chemical Use: Relaxers, dyes or the combination of both relaxers and dyes
- Excessive Heat: Curling irons, flat irons, hot rollers, hot combs, blow dryers, hooded dryers
- Frictional forces: Rubber bands, excessive brushing or combing
Some women tell me that after a relaxer (perhaps one that was left on too long or one that was too strong) they noticed that their hair is suddenly shorter. In this case the trauma was because of the relaxer. Other women who have used peroxide containing hair dye and then immediately relax their hair have noticed breakage. In this case the trauma was from the combination of two chemicals applied to the hair.
Still others will report that they are doing nothing different in regard to their hair care practices (they have always relaxed, blow dried and flat ironed their hair every two weeks). Often we can identify the cause of the breakage, as in the above examples, but not always.
What can you do if you notice hair breakage? There are several simple measures that can be done to stop and reverse your hair breakage.
- Recognize that your hair is breaking and take action. By that I mean, sometimes we find it difficult to recognize or even admit that our hair is breaking. The experience can be very traumatic. If you suspect breakage, ask your hair stylist or a family member to take a look at your hair to determine if there are areas that are shorter than others. If that is the case, it is time to take action (see below).
- If you have relaxer in your hair, analyze how often you get a touch up. Ask yourself if you could be getting touch-ups too often. For some women, using relaxers too often can damage and weaken the hair shaft and cause breakage. Generally, touch-ups are performed every six to eigh weeks. Determine if you can possibly space your relaxer out to every eight or ten weeks or longer, particularly during the winter months when there is little to no humidity and you hair is less likely to revert. Can you use moisturizers more consistently to smooth and "tame" the new growth until it is time for a touch up? Can you use a wide-tooth comb to gently comb the hair, beginning at the ends and working up towards the root to minimize breakage? Can you avoid pulling and tugging the hair when combing new growth?
- Combining two chemical processes such as permanent hair dyes or highlights, containing hydrogen peroxide, with relaxers can lead to damaged hair shafts and breakage. I generally suggest picking one or the other chemical treatment and avoid using both chemical treatments on your hair. However, if you do use both chemicals, do not have them done at the same time but rather, wait several weeks after applying one to your hair before applying the other. Additionally, condition your hair regularly and minimize heat from blow dryers and curling or flat irons if you have both chemicals in your hair.
- Excessive heat may also damage the hair and produce hair breakage. This may be from hot combs, curling irons, flat irons, blow dryers, hooded dryers, or hot rollers. Do not use these implements more that once a week. See if you can decrease the heat that is generated from them by turning the setting down. Roll, pin curl or wrap your hair at night so that you do not have to apply heat in the form of curling irons or flat irons each morning.
- The hair of many black women is very fragile and studies have demonstrated that normal brushing and combing the hair can result in breakage. Brushing your hair 100-times a day is a no-no for our hair. Only comb and brush your hair to style it. Also avoid rubber bands or other implements that can physically cut into and break the hair shaft.
- Natural hairstyles are not immune to the possibility of hair breakage. If twists or locks are twisted too tightly, hair breakage may occur. Have you experienced a twist, lock or braid snapping off?
- Hair care practices that you could once tolerate (relaxers, blow drying, flat ironing) may result in breakage at another time in your life. Just like your body, your hair changes. If hair begins to break, ask your stylist what you can do differently. You might wear a wig for a period of time or smooth your hair back in a loose ponytail.
- Trim the damaged ends of the hair, wash and condition the hair every two weeks.
What should you do if you think that you may have hair loss? First, call your dermatologist today! If you don't have one, visit the "Find a Doctor" portion of the website of the American Academy of Dermatology: www.AAD.org. Secondly, when you visit your dermatologist, have a list of your medications, allergies, medical conditions and your hair care practices (for example: relaxers for 20 years, hot combs for 10 years, no weaves, braids with extensions for two years and natural styles for the last 5 years). Do not be afraid if your doctor suggests blood test, a scalp biopsy or culture. These procedures are recommended so that the doctor can determine the type of hair loss that you have and treatment can be started.
This is the first installment of a three part series on hair loss.
Susan C. Taylor, MD