Traction alopecia is commonly seen in patients with ethnic hair.
"Many ethnic patients who come to the dermatologists with hair and scalp problems are African-American women," Dr. McMichael said at the 57th Annual Meeting of the Pacific Dermatology Association here. "No matter what their other concerns are about their scalp, they probably have a good case of seborrheic dermatitis, which must be dealt with first. It is important to treat a healthy scalp."
"One of the reasons for this is that African-American women tend to not wash their hair as frequently as other ethnic or racial groups. It is very difficult to style thick, coarse hair. So once they get it into a style they like, it is easy to keep it that way for a while rather than washing and having the style go away," Dr. McMichael explains.
Hair breakage is another common problem.
"Because the hair is so thick and curly, many women use heat and/or chemical relaxers to allow ease of styling. As a result, bonds of the hair shaft are broken to restructure it, and that takes away some of the strength of the hair shaft, so there is more likelihood of hair breakage from even mild trauma," she says.
When dermatologists see hair breakage, they have to take time to explain to patients that this is an "outside job."
"People may think they are taking the wrong vitamins. However, very rarely is one of these hair shaft disorders secondary to a nutritional problem. About 95 percent of the time it is secondary to something that has been done from the outside. Patients do not understand that these problems are cumulative," she says.
Traction alopecia is commonly seen in patients with ethnic hair. Typically, the hair loss is seen in front of the ears and on the very frontal edge of the scalp.
"We know that it occurs secondary to any significant tension that is put on the hair over a long period of time," Dr. McMichael explains. "This causes an inflammatory reaction around the hair bulb and release of those hairs. Oftentimes this allows enough inflammation and pulling on the hair shaft itself that it causes permanent scarring."
Many black women note that they have had it all their lives, but it has worsened. Dr. McMichael explains to patients that they probably have it from hair practices that were performed as a child, which most likely weakened the area.
"It is a cumulative process, so if they continue to pull the hair back tightly or use a lot of gels, it is going to worsen," she tells Dermatology Times.
Start at the beginning
Treatment begins with asking about the patient's current hair care practices.
Dermatologists should make sure patients are not wearing heavy, tight braids; not using products that are damaging around the hair shaft; and are not manipulating the hair or pulling it tight.
Stopping the process or slowing it down can be difficult. If patients have active disease, Dr. McMichael will reduce inflammation with topical steroid agents used for a month to two months. Two courses of intralesional corticosteroid injections will be used and then minoxidil 2 percent applied in an ongoing fashion. The off-label use of minoxidil 2 percent stimulates less increased hair growth around the face - which can be an unwanted side effect - than does the 5 percent version, she says.