Under a microscope, African-American hair appears elliptical in cross-section and looks like a twisted rod — with frequent twists and random directional reversals.

But not only is African-American hair unique in appearance, its unique structure makes it especially fragile and prone to injury and damage.

African-American hair needs special care to avoid damage

In particular, styling practices can lead to serious hair and scalp diseases for some black women, says Henry Ford Hospital dermatologist Diane Jackson-Richards, MD.

“Hair is an extremely important aspect of an African-American woman’s appearance,” says Dr Jackson-Richards. In fact, the American Academy of Dermatology (AAD) notes that although African Americans only constitute 13 percent of the nation’s population, they account for at least 30 percent of all hair care expenditures.

Dr Jackson-Richards notes that despite their strong numbers, many women who have a hair or scalp disease do not feel their doctor takes them seriously, and adds, “physicians should become more familiar with the culturally-accepted treatments for these diseases.”

Says proper hair care can help prevent the onset of such diseases like seborrheic dermatitis and alopecia, she says, and that dermatologists need to become more sensitive to the hair and scalp plights of African Americans.

Hair and scalp diseases in women of African descent

Little research has been done about the prevalence and causes of hair and scalp diseases in African Americans. Dr Jackson-Richards says understanding the unique physiologic characteristics of African textured hair — for example, it grows slower and has a lower hair density than other ethnic groups — will assist dermatologists in prescribing treatment options.

African-American women are known to shampoo their hair less frequently than other ethnic groups, and an estimated 80 percent of them use chemical relaxers. Frequent use of blow dryers and hot combs, combined with popular hair styles like hair weaves, braids and dreadlocks, add physical stress to the hair and contribute to scalp diseases like alopecia, or hair loss.

Find out about Central centrifugal cicatricial alopecia/CCCA: When hairstyles cause hair loss

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“Hair loss is the fifth most common condition cited by patients when they visit their dermatologist,” Dr Jackson-Richards says. Fortunately, dermatologists can help, and offer these hair care tips to minimize damage.

Best practices & hair care tips

“Since African-American hair is very dry, it is important to add moisture to hair by using products that either preserve or add moisture and to avoid hair styling regimens that can remove moisture from the hair,” says Raechele Cochran Gathers, MD, FAAD, senior physician at the Multi-Cultural Dermatology Center of Henry Ford Hospital Department of Dermatology in Detroit.

Dr Gathers offers this hair care advice specifially for black women.

Washing African-American hair

  • Hair should be washed once a week or every other week to avoid build-up of hair care products, which can be drying to hair.
  • Conditioners should be used every time hair is washed. Special attention should be paid to the ends, which are the oldest and most fragile part of the hair.
  • If you work out regularly, it is a good idea to rinse the hair with water to remove sweat and salt buildup between washings. You can follow with a conditioner. Also, water is good for hair and adds moisture.

Products for African-American hair care

  • Dr Gathers recommends hair care products that contain natural ingredients, such as olive oil, shea butter, aloe vera juice or gel, or glycerin, because they help dry hair maintain moisture.
  • Shampoos that contain sulfates can be drying for some hair types, especially if hair is washed frequently.
  • Conditioners that contain wheat proteins, amino acids, hydrolyzed proteins or panthenol are recommended by Dr Gathers.
  • Hot oil treatments should be used twice per month to add additional moisture and elasticity to the hair.
  • Heat protectants should be used on hair after washing and before hair is heat styled to minimize heat damage.

Styling African-American hair

  • Relaxers should be applied by a professional hair stylist to ensure they are applied safely and to minimize hair damage.
  • Touch-ups with relaxers should not be done too frequently (every eight to 12 weeks to new hair growth is recommended), because they can cause hair breakage. Never apply relaxer to hair that already has been relaxed.
  • Ceramic combs or irons should be used when pressing (thermally straightening) hair. It is best to use heat no more than once weekly. (A straightening device with a dial temperature is preferred to ensure the device is not too hot.)
  • Braids, cornrows or weaves should not be too tight. If it hurts while hair is being styled, tell the stylist to stop and redo it. Pain equals damage.
  • Even the slightest bit of noticeable thinning can be the start of hair loss, so women should see a dermatologist immediately if they notice any changes in the texture or appearance of their hair.
More tips to protect your hair

Dr Jackson-Richards suggests these grooming tips to women to reduce their risk of developing a hair or scalp disease:

  • Allow two weeks between relaxing and coloring.
  • Limit use of blow dryers and hot combs and other heated hair styling products to once a week.
  • Wash braids or dreadlocks every two weeks.
  • Avoid wearing braids too tightly; and don’t wear them for any longer than three months.
  • To detangle hair, use a wide tooth comb while conditioner is still in the hair.

The AAD estimates that hair loss or balding is the fourth-most-common reason for African Americans to visit a dermatologist, so those physicians are often the first line of defense in helping African-American women with hair problems.

If you have questions or concerns about the health of your scalp or hair, be sure to consult a medical professional before the damage becomes severe.


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