Black women and hair loss: the causes, the remedies, the prevention

GLORIA Hearns, 49, a project manager in Naperville, Ill., woke up one morning, looked in the mirror and cringed. The hairline around her fragile, relaxed hairstyle was thinning. During the past few years, Hearns had noticed hairs floating across the bathroom floor, but she dismissed it as normal shedding.

The visible hair loss convinced Hearns to stop using hot combs and relaxers to create the hairstyles she preferred since she was a teenager. It was then that she experimented with braids before turning to hair weaves and hairstyles that did not require chemicals, hot curlers or hot combs to maintain. These days, Hearns sometimes wears a wig to give her hair a break. "It ]hair thinning] bothers me, but I try not to let it ruin my whole life," Hearns says.

Hearns is among thousands of Black women who experience hair loss due to uncontrollable factors such as age, heredity, hormonal changes and alopecia (the medical term for hair loss). But there are other factors that can be controlled. For instance, women put themselves under too much stress, don't eat properly and overprocess their hair by coloring and straightening it at the same time. Some women wear weaves and hairstyles that pull the hair too tightly. These all are situations that may result in temporary or permanent hair loss.

Hair thinning and hair loss affects as many as two-thirds of African-American women by age 50, according to R. Martin Earles, M.D., a renowned Chicago dermatologist who specializes in hair-loss treatment. "It just has become rampant" he says. "I see as many as three to five women patients a day suffering from permanent hair loss."

In Dr. Earles' office is a collection of shocking photographs of patients with severe hair loss problems. They reveal many Black women of all ages with large areas of permanent baldness and horrific scalp damage. One of the patients is Cynthia Alston, M.D., of Chicago, who suffered from a form of hair loss known as traction alopecia around her hairline and scalp due to wearing braids too tightly as a child 20 years ago.

Traction alopecia affects thousands of Black women each year. Continuous pulling of the hair that occurs from tight cornrows, braids, weaves, ponytails and curlers is often the culprit. If you have difficulty moving your forehead or experience headaches and scalp soreness, these may be signs that your hair is styled too tightly. Over time, bald spots may develop along the hairline and above the ears. The hairline gradually recedes significantly. If the problem is not treated, a permanent condition called scarring alopecia may result.

It was Dr. Earles who later performed transplant surgery to rotate hair-bearing scalp from one section of Alston's head to balding areas to create new hairlines. "It was well worth it," says Dr. Alston, an internist, who enjoys styling her natural long hair in dreadlocks these days. "Now I have lots of flexibility to wear all kinds of styles and pull it up in a ponytail." Hereditary hair loss remains visible on large areas of Dr. Alston's scalp and appears to be increasing with age, a trait of her mother's, she says. Dr. Earles advised that she consider another hair transplant in the future.

For Black women, the most common type of hair loss falls into the category of traumatic alopecia. Caused by destructive habits that are often avoidable, dermatologists say traumatic alopecia results from the following: 1) improper use of products that chemically alter the natural hair texture, 2) excessive hot-pressing, curling or blow-drying, 3) gluing hair in during the weave process, 4) applying new relaxers over previously relaxed hair, 5) chemical or heat burns to the scalp, and 6) combining permanent color with other chemical hair treatments.

Another common type of hair loss among Black women is hot comb alopecia or central centrifugal cicatricial alopecia, which begins at the central portion of the scalp and progresses rapidly. Eventually, it causes severe damage to hair follicles.

Some dermatologists theorize that applying hot hair oil during hair pressing may contribute to the problem. Once the hair follicles are destroyed and scar tissue forms, hair will not grow again. (Madam C.J. Walker, the first Black woman millionaire, experienced hair loss after the painful use of processes to straighten her hair. The experience inspired Walker to develop special products to nurture Black hair.)

Last year, Joi Basley, a Chicago juvenile probation officer, was diagnosed with female-pattern baldness at the top of her head and along her hairline; the medical condition often is caused by hormones, aging and genetics. Basley maintained a positive attitude and took action. She stopped applying chemical relaxers to her hair and consulted hairstylist Karin Lemon at Rhani Flowers' Van Cleef Salon in Chicago for treatments to stimulate hair growth and for alternative hairstyles.

"When I have a client who has a hair-loss issue, I do a background analysis that looks at everything from diet and exercise to lifestyle, and I try to determine a remedy," Lemon says.