Caring for African-American hair

Hair disorders are an important concern for especially African-American women, according to Amy McMichael, M.D., dermatology professor and chairwoman, Wake Forest Baptist Health, Winston-Salem, N.C.

Dr. McMichael and colleagues published a national study in the April 2012 issue of Journal of Drugs and Dermatology looking why people of color go to dermatologists.

 “The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or eczema, seborrheic dermatitis, atopic dermatitis and dyschromia. For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis and seborrheic keratosis,” the researchers found. “By contrast, in Caucasian patients, the top five were actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer. In Hispanic patients of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin, and viral warts.”

African-Americans were the only group in which hair made it to the top 10 diagnoses, at number seven, according to Dr. McMichael (Davis SA, et al. J Drugs Dermatol. 2012; 11:466-473).

The dermatologist looked further into the problem of hair issues among African-American women.

“Many of my patients who were coming in were overweight and having issues with diabetes or prediabetes. And it just dawned on me that they were not exercising and, probably, hair care and hair concerns were a reason for that,” she says. “So, we did a small study looking at just over 100 women and asked them if they exercise less because of their hair are issues. Almost 40 percent of our population said yes.”

Harsh haircare products

Part of the problem is African-Americans have extremely fragile hair. Add the haircare practices common among African-Americans, including heat, chemical relaxers and tight braiding, and you have a perfect storm for hair issues.

“We were able to look at this population of women … and almost 50 percent had hair breakage, scalp itching, scalp flaking,” Dr. McMichael says. “We found out in this population of women who were coming in for other dermatologic issues, they not only didn’t exercise because of their hair but they also had underlying issues with their scalp.”

The findings underscore the importance of addressing hair issues with African-American dermatology patients, especially if they are women, according to Dr. McMichael. Dermatologists can treat hair breakage by recommending that patients stop harmful practices, including color, chemicals and relaxers, as well as hair traction hairstyles that might pull or break hair.

“Part of the problem is that we all have a certain look that we want to achieve. There are ways to try to improve your appearance but also the health of the hair shaft,” she says.

One way to minimize damage to the hair shaft is with a layering, moisturizing regimen. Rather than stopping at shampoo and conditioner, patients should layer a leave-in conditioner and silicone coating agent onto the hair shaft, according to Dr. McMichael.

Next: Treating hair loss

Addressing hair loss

Certain forms of hair loss are prevalent among African-Americans, though good prevalence data is lacking, according to Dr. McMichael. Central centrifugal cicatricial alopecia (CCCA) occurs typically in women of African descent and causes scars and hair loss, Dr. McMichael says.

“It’s associated with symptoms such as itching, burning, stinging or pain,” she says. “We try to address the symptoms with topical corticosteroids…. We also use injection techniques of corticosteroids right to the area. At times, we use other anti-inflammatory treatments including oral antibiotics. But our goal is really to take down inflammation. What we have found is that white blood cells are attacking the hair follicles. And there is suggestion of a genetic component to the process.”

A hair-related condition that Dr. McMichael says is on the rise among African-Americans is frontal fibrosing alopecia.

“In the past, we thought it affected mostly middle-aged Caucasian women,” she says. “Recently, we’ve seen African-American women with this, as well, and the reason it might stump some dermatologists is we’ve always thought of frontal hairline changes in African-American women as traction alopecia.”

Treating frontal fibrosing alopecia is different than treating traction alopecia, according to the dermatologist. Doctors should pay attention to differentiating signs. In traction alopecia, patients typically have a lot of fine hairs in the area where the traction has been prominent. But in frontal fibrosing alopecia, dermatologists often find very few hairs, if any, and none of those fine hairs leading up to the receding hairline. Other frontal fibrosing alopecia clues: hyperpigmentation on the face and loss of eyebrows.

Treatment for the condition is the same what dermatologists would use for scarring alopecia of all kinds.

“We treat it, oftentimes, with topical corticosteroids or intralesional corticosteroids. We also use a number of oral antiinflammatory medications that we would not use with CCCA, such as Plaquenil (hydroxychloroquine) or methotrexate,” Dr. McMichael says.

Disclosures: Dr. McMichael is a consultant for Allergan, Galderma, Guthy-Renker, Procter & Gamble and Johnson & Johnson. She also is a researcher for Allergan and Procter & Gamble.