More education needed on hair disorders in skin of color

September 1, 2005

There are hair disorders that occur in disproportionate numbers, or almost exclusively, in the black population such as central centrifugal scarring alopecia, dissecting cellulitis, pseudofolliculitis barbae (PFB), and acne keloiditis.

Chicago - Physicians need to educate themselves about the hair disorders that are more prevalent in people of color, as well as the products and styles that their patients use, so they can offer them alternatives that will prevent future hair disorders, according to Victoria Holloway Barbosa, M.D., vice-president of research and development at L'Oréal USA.

"For instance if someone develops grooming-induced alopecia, the physician can counsel a patient on proper use of products, such as only using them every six to eight weeks," Dr. Holloway Barbosa explains. "Individuals need to be told to space out their use of relaxers and permanent hair color, by at least two weeks, and should be encouraged to use deep conditioners twice a month. There are excellent conditioners available in a variety of price ranges."

A survey that Dr. Holloway Barbosa conducted found that 60 percent of black women questioned said they experience hair breakage. The majority of female black survey respondents (56 percent) also said they experience a dry scalp.

"Largely, the dry scalp occurs because of some of the hair products that are used," she says. "Many of the hair sprays, gels, and sheens contain alcohol and can be very drying to the hair and scalp. Remember that some of these products are being used everyday or every-other-day. Many African-American women may be washing their hair every week or every other week, so dryness of scalp should not be surprising."

Dr. Holloway Barbosa says that the nature of black hair is inherently more fragile than hair of Asian, Caucasian or Latino women. Compounding hair's fragile texture is repeated use of chemical processes to achieve particular hairstyles, as well as the use of extremely hot styling appliances to achieve particular hairstyles. More than half of black women say they use hair relaxers, a chemical process.

"It adds up to a lot of wear and tear on the hair," she says.

There are hair disorders that occur in disproportionate numbers, or almost exclusively, in the black population such as central centrifugal scarring alopecia, dissecting cellulitis, pseudofolliculitis barbae (PFB), and acne keloiditis. Treatments for each of the conditions vary.

"They are conditions that physicians see, but they tend to be frustrating problems because they can be difficult to treat," Dr. Holloway Barbosa says. "For many of these conditions, there isn't a lot of data. The etiology is not clear and the treatment options are not always successful, so they can be very frustrating for the patient and the physician."

With a condition such as PFB, it presents mainly as mild to moderate disease. If men can find the right shaving method, it can help keep the disease to a minimum, she explains.

In a survey of black men with PFB, respondents cited use of electric clippers, triple-bladed razor, or use of a depilatory as the best ways to prevent PFB, Dr. Holloway Barbosa notes.

"Doctors can help find the shaving regimen that will minimize disease," she says. "In addition, many doctors have reported success with using lasers for hair removal. Eliminating the hair will eliminate the bumps."

Acne keloiditis, or bumps on the back of the neck, can be treated with topical steroids and antibiotics if it presents as mild to moderate disease. In more severe cases, excision may be necessary.

For a condition such as central centrifugal scarring alopecia, a frequent treatment is topical steroids alone or in combination with oral antibiotics.