Hair: Keep physical, cultural differences in mind

Cleveland - Regardless of gender, race, or age, a healthy head of hair tops every patient's wish list. Attaining this goal requires dermatologists to keep physical and cultural differences in mind.

Caucasians of Northern European descent usually possess finer, cylindrical hair fibers that range from blonde to light brown. Caucasians from Mediterranean countries, on the other hand, tend to have dark, coarse, possibly curly, hair. Patients of African descent generally possess flat, ribbon-like, very curly hair. In Asians, hair types are usually dark, but hair fibers are oval-shaped.

Differences in hair loss patterns - and their causes - are perhaps more pronounced.

"In Caucasian and Asian patients," she says, "there's a tendency to have receding hairlines and central baldness, which are familial and usually considered unrelated to hair care practices. However, in the African-derived individuals, because of their hair type and perceived need to straighten their hair to look more like a Caucasian, the hair care, whether it be chemical or physical, produces some problems. Dermatologists who deal with hair loss believe that some of the hair care in that population group induces an inflammatory alopecia, which ultimately produces a scarring hair loss condition. Many members of this population notoriously shampoo every two weeks and continue to apply occlusive emollients to their hair and scalp. And they may or may not wear wigs, hair pieces, bandannas, or hats to keep their hair straight, which increases the surface heat and causes greater occlusion."

Early-onset genetic hair loss (also called diffuse central or androgenetic alopecia) often goes unrecognized in African-derived females because doctors mistake it for inflammatory scarring alopecia. Women in this population furthermore tend to experience menopausal or perimenopausal onset 10 years earlier than Caucasians, so occasionally they experience central hair loss earlier than do Caucasian females.

At the same time, all ethnic groups - especially Africans and Caucasians - are experiencing an increasein inflammatory acne related toandrogen excess and, in turn, tofollicular occlusion disease. The latter category includes occluded acne,folliculitis of the scalp, and hidra-denitis suppurativa (an inflammatory condition of the folded areas of the skin, predominantly the axilla and groin).

"This trend can also be associated with hair and body care products and practices," Dr. Bergfeld says.

Fortunately, patient counseling and newer, less occlusive hair care products can help combat patient-inflicted hair and scalp damage. Additionally, the North American Hair Research Society has convened a cicatricial alopecia study group to redefine classification and histology of this condition so researchers can develop better treatments for it.