What black women need to know about their hair loss

In December 2019, United States Congresswoman Ayanna Pressley revealed that she has alopecia areata, a condition that causes patches of hair loss and sometimes can lead to baldness. Pressley is not alone in her condition. Estimates are that anywhere from a third to a half of all black women experience some hair loss in their life time. But not all hair loss is permanent. If diagnosed and treated early, hair loss can be prevented but often stigma, lack of information and embarrassment have prevented many women from seeking help.

Causes of hair loss

If you’ve been told that your hairstyle “isn’t right if it isn’t tight” then you may be styling yourself bald. Although genetics can play a part in hair loss, many hairstyles and hair care practices are significant contributors to hair loss.

Black women (and men) are more prone to three specific types of alopecia:

• Central centrifugal cicatricial alopecia (CCCA)
• Traction alopecia
• Breakage

CCCA is caused by repeated use of braids, weaves, corn rows, chemical relaxers, hot combs and other hair care practices. These can cause inflammation in the hair follicles, and if these practices continue it can lead to permanent hair loss. Look for balding/hair loss in the crown of the head that radiates outward in a circular pattern. Tenderness is often a common symptom associated with CCCA. Treatment includes topical or injected corticosteroids and antibiotics to treat the inflammation. If left untreated, it can lead to scarring and permanent hair loss.

Traction alopecia is caused by long-term of tight hair styles, such as cornrows, dreadlocks, twists, braids and weaves that pull at the hair root causing inflammation. Over time, this can lead to scarring and permanent hair loss. Traction alopecia often appears as thinning at the hairline but can also occur anywhere the hair is constantly pulled. Most of my patients report that they experience pain during the styling process and for days and weeks after but the truth is, your scalp should not hurt, ever!

Breakage is damage of the hair itself rather than the follicle. With this damage, the hair shaft becomes weak and breaks off. Causes are excessive heat from flat irons and hot combs or from chemicals used to straighten or color the fragile naturally curly black hair. Treatment is primarily avoidance of hair care practices that cause breakage and topical medications.

How to prevent hair loss

• Go natural. Try to accept your beautiful hair and stop trying to make it do something it is not capable of doing without harsh chemicals or extreme heat
• Loosen or avoid braids, weaves, extensions, cornrows. Talk to your stylist about a looser style.
• Minimize heat styling and use the lowest heat setting.
• Wear the right size wig, choose one with an open cap and be sure to wash it regularly.
• Try to go two to three months between chemical relaxing treatments, and if your hair breaks or sheds, then stop applying chemicals.

There are many other types and causes of hair loss that occur in all populations. Some can be related to a health condition, such as thyroid disease, anemia or lupus. Others may be genetic. Either way it is important to seek help if you notice your hair is thinning or coming out in clumps. Many of my patients wait decades before they seek help and by then much of the damage is permanent.