When hairstyles cause hair loss

Hair styles may contribute to scarring hair loss in African-American women

A frequent form of permanent hair loss seen among African-American women is thought to be associated with excessive pulling of the hair, particularly with braided hairstyles.
When hairstyles cause hair loss

“Central centrifugal cicatricial alopecia (CCCA) is a term coined by the North American Hair Research Society to describe a scarring hair loss, centered on the vertex of the scalp, that spreads peripherally,” researchers wrote in a report in the August 2011 issue of Archives of Dermatology, one of the JAMA/Archives journals. “It is thought to be the most common pattern of scarring hair loss seen in African American women, yet so little is known about its true prevalence among them.”

When hairstyles can lead to hair lossCertain hairstyles cause hair loss, such as braids and weaves, while inflammation in the form of bacterial infection may also be contributing to the development of scarring hair loss in women of African descent.

The key: Catch and treat hair loss early

Raechele Cochran Gathers, MD, FAAD, senior physician at the Multi-Cultural Dermatology Center of Henry Ford Hospital Department of Dermatology in Detroit, said in 2012 that if not treated early, CCCA can be disfiguring and permanent, as the hair follicles are replaced by scar tissue.

Fortunately, there are steps you can take that should keep the damage from getting worse. Styling the hair differently and avoiding harsh styling techniques sometimes can help slow or reverse the progression of the disorder. In addition, anti-inflammatory medications, such as intralesional coricicosteroid injections or topical corticosteroids, often are used in combination to treat CCCA.

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Certain chemicals applied to the hair also may play a role in the development of CCCA, but a study conducted by Dr Gathers found no association between the chemicals used in relaxers and hair loss.

Although there is no conclusive evidence showing that relaxers can contribute to hair loss, Dr Gathers notes that most dermatologists would err on the side of caution and recommend that women stop using relaxers — or at least limit their use — if they are being treated for CCCA.

Medical research on central centrifugal cicatricial alopecia

Angela Kyei, MD, MPH, and colleagues at the Cleveland Clinic, Cleveland, Ohio, conducted the study reported in 2011 to investigate medical and environmental risk factors for CCCA.

A total of 326 black women answered questionnaires at two African American churches and a health fair in Cleveland. The researchers analyzed data on the study participants’ demographics, family and medical history, hormonally-driven conditions, and methods of hair grooming.

>> Also see: A little TLC: African-American hair needs special care

The study results suggest there is a high prevalence of central hair loss among African American women. “Advanced central hair loss with clinical signs of scarring was seen in 59 percent of these respondents and was interpreted as clinically consistent with CCCA,” the authors report. “Diabetes mellitus type 2 was significantly higher in those with CCCA, as were bacterial scalp infections and hair styles associated with traction (e.g., from braids and weaves).”

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The increase in type 2 diabetes among women with CCCA is in line with recent theory that cicatricial alopecia may be a manifestation of metabolic dysregulation.

“The results of this study suggest that hair grooming practices that cause traction, such as weaves and braids, may be contributing to the development of CCCA because these styles are more commonly used in those with the most severe central hair loss to increase hair style versatility while camouflaging hair loss,” the authors write.

“Given the fact that many African American women pay hundreds of dollars to have their hair braided and weaved, they often maintain these hair styles for weeks to months at a time to justify the money spent. The resulting prolonged traction can produce chronic folliculitis, which can eventually lead to scarring.”

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