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A trichologist explains why alopecia in black women isn’t as straightforward as you’d think

27 May 2019

Illustration by Niellah Arboine

As a trichologist, I have a special interest in hair research and regularly attend conferences and seminars both in the UK and across the world, to capture the work that is being carried out globally. It enables me to give relevant and evidence-based advice to my clients.

In March 2019, I attended the World Congress for Hair Research (WCHR) that took place in Barcelona. Hair specialists from all over the globe discussed and delivered the latest knowledge on conditions that affect the hair and scalp. It was the most amazing experience – I was meeting people that I had been reading about and admired their work for some time.  Scientists, biologists, dermatologists, surgeons, researchers and trichologists gathered together at the greatest scientific event in the world of hair research. And it was here that the ground-breaking discovery within hair loss in afro-textured hair was unveiled.

Afro hair is fragile due to the curly nature of the hair shaft which makes it prone to dryness and breakage. Yet, you often find that black women have some of the most high-risk hair practices – including chemical straightening, which weakens already fragile hair, making it prone to dryness and breakage, and hairstyles that pull on the hair, like tight braids and weaves which can cause a type of hair loss called “traction alopecia”.

These practices are due to a lack of awareness of safe styling techniques and the consequences if left unchecked. Sadly, a few of these practices have caused some of the common hair loss conditions seen in afro hair. But, not all hair loss in Afro hair is down to grooming; the importance of genetics in the development of hair and scalp disorders is just beginning to be understood.

“The importance of genetics in the development of hair and scalp disorders is just beginning to be understood”

In addition to traction alopecia, another condition that affects people of African-Caribbean descent is central centrifugal cicatricial alopecia (CCCA). Unlike traction alopecia caused by pulling and tight hairstyling, this type of hair loss starts in the crown (central) of the scalp and radiates outwards in a centrifugal (circular) pattern. CCCA causes the destruction of hair follicles and replaces them with scar tissue, leading to irreversible and permanent hair loss. It is also found in African men, but to a lesser degree.

In Barcelona, I had the pleasure of meeting Professor Ncoza Dlova, a South African dermatologist who is earning worldwide praise after discovering that it is the mutation of a gene called PADI3 (which is present in all skin types) that is a major cause of this permanent hair-loss condition amongst women of African descent. This discovery is probably the biggest breakthrough in hair loss in the history of afro-textured hair.

The condition was first noticed in the 1950s  and by 1968 it was documented by LoPresti that it was likely caused by the use of a hot iron comb in combination with hot petroleum jelly (hair grease) which would travel down the comb, onto the scalp and burn the hair follicle, causing irreversible damage and subsequent permanent hair loss. It became known as “hot comb alopecia”. It was recorded in 1992 by Leonard C. Sperling that not all the black women who had presented with this condition had a history of significant use of hot combing – it was then named “follicular degeneration syndrome”. As the years went on, many were now using relaxers and following some research by A.G Nicholson, the likely cause of the condition was attributed to the use of chemicals to the hair. So in 1993 it became known as “chemically induced scarring alopecia”. Then finally in 2001, the condition took on the name central centrifugal cicatricial alopecia.

“Unlike traction alopecia caused by pulling and tight hairstyling, this type of hair loss starts in the crown of the scalp”

Fast forward to 2019, and Professor Dlova reported that in her research she saw a young patient with CCCA who had no history of using a hot comb or relaxers. “It was then the penny dropped,” Professor Dlova told the World Congress. The condition could not only be linked to these causes, but there must also be other causes. It is through her extensive studies, in collaboration with her US counterparts that we now know that genetics plays an integral role in the development of this condition.  

Whilst, unfortunately, you cannot alter genetics, it’s clear that there is more research to be done as this current breakthrough paves the way for future therapies to be developed in order to manage the condition.

Currently, the advice will be to anyone who thinks they may be experiencing hair loss is to get an early diagnosis. You can visit your GP, a dermatologist or a trichologist. Treatment will vary according to the severity of the condition, however rapid progression of CCCA is associated with tight hairstyles and the use of chemicals, therefore gentle hair grooming is advised.