Afro-textured hair: Styling, chemical use increase risks for breakage, loss

November 1, 2008

Women with afro-textured hair are at increased risk of hair breakage and hair loss due to endogenous and exogenous factors. Conditions such as central centrifugal cicatricial alopecia, discoid lupus erythematosus and androgenetic alopecia affect women with afro- textured hair.

Key Points

"Afro-textured hair is hair that is very tightly curled and includes a spiraled hair follicle," says Renee A. Beach, M.D., a second-year dermatology resident at the University of Ottawa in Ottawa.

"It is believed that every point of curvature is a point susceptible to breakage along the hair shaft," Dr. Beach says.

"The hair is difficult to comb in its natural state, and many women find that it is easier to comb when the curl is wet and slightly more relaxed," she says.

Afro-textured hair grows more slowly - at less than three-quarters the monthly rate - than hair that is not afro-textured, Dr. Beach says.

Hairstyles

Several hairstyles that black women may wear repetitively, such as cornrows, hair extensions or hair weaves, contribute to conditions that lead to hair breakage or hair loss, Dr. Beach tells Dermatology Times.

The primary issue with these hairstyles is consistent pulling and tension applied to the hair shaft at various points on the scalp.

Use of chemicals

In addition to this repeated traction, the repeated use of chemicals (such as hair relaxers) and extra heat in the form of hot combs and straightening irons also contribute to decreased quality of the hair shaft, making it more susceptible to breakage or loss.

"There is compounded stress on the hair if this is done on a daily basis," she says. "It can negatively affect the hair shaft and result in hair shedding."

It is estimated that 80 percent of black women use chemical relaxers, Dr. Beach says. "Unfortunately, these can be incorrectly applied to the scalp, rather than to only the new afro-textured hair growth," she says.

These women are then at risk for scalp burns from the chemical relaxer that can result in permanent alopecia if the hair follicle is destroyed. Irritant contact dermatitis can develop on the scalp due to frequent use of these hair products that have an elevated pH content.

"The relaxer products can be irritating to the scalp even if they don't cause burning," Dr. Beach says.

Other products

Moreover, many black women use other products, such as petrolatum-based pomades, ointments and other products that facilitate smoothing and straightening of frizzy, tightly-curled hair.

It is difficult for these products to course down the entire hair shaft, and they often build up on the scalp.

CCCA

One of the endogenous conditions that women with afro-textured hair can develop is central centrifugal cicatricial alopecia (CCCA). Of the reported cases, 95 percent occur in women with afro-textured hair.

"When the hair loss begins, it starts at the scalp and proceeds centrifugally," Dr. Beach says. "Often, these women present to the dermatologist at late stages of the condition, by which time hair loss is largely irreversible and fibrosis of hair follicles has occurred."

To combat CCCA, corticosteroids are one of the proposed therapeutic options. They can be administered topically, intralesionally and systemically, she says.

Discoid lupus erythematosus

Another condition that arises disproportionately in women with afro-textured hair is discoid lupus erythematosus (DLE), a chronic skin condition of sores with inflammation and plaques with scarring that can favor several sites on the body, including the face, ears and scalp.

A skin biopsy is needed to confirm the diagnosis of the condition because other conditions can resemble DLE.