Medical and surgical therapies for alopecias in black women

Abstract

Hair loss is a common problem that challenges the patient and clinician with a host of cosmetic, psychological and medical issues. Alopecia occurs in both men and women, and in all racial and ethnic populations, but the etiology varies considerably from group to group. In black women, many forms of alopecia are associated with hair-care practices (e.g., traction alopecia, trichorrhexis nodosa, and central centrifugal cicatricial alopecia). The use of thermal or chemical hair straightening, and hair braiding or weaving are examples of styling techniques that place African American women at high risk for various "traumatic" alopecias. Although the exact cause of these alopecias is unknown, a multifactorial etiology including both genetic and environmental factors is suspected. A careful history and physical examination, together with an acute sensitivity to the patient's perceptions (e.g., self-esteem and social problems), are critical in determining the best therapy course. Therapeutic options for these patients range from alteration of current hair grooming practices or products, to use of specific medical treatments, to hair replacement surgery. Since early intervention is often a key to preventing irreversible alopecia, the purpose of the present article is to educate the dermatologist on all aspects of therapy for hair loss in black women--including not only a discussion of the main medical and surgical therapies but also an overview of ethnic hair cosmetics, specific suggestions for alterations of hair-care practices, and recommendations for patient education and compliance.

Hair and scalp disorders in women of African descent: an overview

“…Taking a detailed hair-grooming history is important as it guides how patients are counselled regarding minimizing their adverse hair care practices. 16 Examination Examination of the scalp should be undertaken in good lighting, and should also include complete physical examination of the rest of the integument, including skin, nails and mucosae.…”

“…16,53 Hair-grooming products (e.g. spritzes, gels and hair sprays) can also contribute to the problem.…”

“…Thus, current therapeutic strategies are based on anecdotal evidence. 16 They include avoidance of specific hair care products, such as hair gels, sprays and spritzes; and the use of antiseborrhoeic medicated shampoo. Agents such as zinc pyrithione are better because of their minimal drying effect on the hair shaft.…”

Trichotillomania and Traction Alopecia

“…Prevention is an integral part of management of TA, as appropriate measures to eliminate traction can stop hair loss before it becomes permanent [27,28,61]. It is important to recognize that TA most often originates during childhood and adolescence, suggesting that public education should primarily focus on these at-risk populations [27,43,44].…”

“…There is a paucity of evidence-based literature data with regard to the medical treatment of TA. Topical or intralesional corticosteroids and topical or systemic antibiotics may be utilized to suppress the inflammation in the early stages of the disease [61].Topical min-oxidil was described as effective in an anecdotal report [42] and recommended by some authors [27,43,61], although controlled trials are lacking. An interesting study demonstrated the protective effect of piloerection induced by topical phenylephrine against the development of TA, suggesting a potential role of α 1 -adrenergic receptor agonists in the treatment of TA [41].…”