While the aftershock of Sunday’s Oscars controversy continues to unfold, the enduring impact of the event has pushed the autoimmune disease, alopecia areata, to the forefront of health discussions.
According to John Hopkins Medicine, “almost half of Black women experience some form of hair loss,” leaving individuals with this common condition to navigate difficult stigmas and shame surrounding their experience — from coping with their changing appearance to adjusting to shifts in their self-confidence and esteem. The process to produce more informed perspectives on hair loss comes through proper self-education and guided insight.
For the answers, ESSENCE tapped Dr. Isfahan Chambers, Ph.D. Biomedical Scientist and Trichologist, and founder of Alodia Hair Care, and board-certified dermatologist, Dr. Meena Singh, for the top facts about alopecia in general, how it occurs, and what Black women experiencing hair loss should know about their treatment options and managing their symptoms.
ESSENCE: For the record, what is alopecia?
Dr. Isfahan Chambers: Alopecia is defined as a partial or complete absence of hair from the areas of the body where it normally grows. It is important to note that alopecia is not a diagnosis but a symptom of hair loss. I hear the phrase “I was diagnosed with alopecia” often but it’s important to know the forms of alopecia. There are over 10 different types and even more subtypes of alopecia.
Could you share why and how alopecia areata occurs?
Dr. Chambers: Alopecia areata (AA) is an autoimmune form of hair loss in which the immune system attacks the hair follicles. It occurs mainly in four forms: isolated bands of hair loss, circular patches, total hair loss on the scalp and total hair loss all over the entire body (eyebrows, eyelashes, etc.). Depending on the form, it can happen in young children, adults, as well as men and women.
Like any autoimmune condition, it can be triggered by stress, diet, other autoimmune diseases such as lupus or sarcoidosis for example, or hair care practices like coloring the hair or different chemical treatments, etc.
Dr. Singh, what is the difference between alopecia areata and traction alopecia?
Dr. Meena Singh: Traction alopecia is caused by tight, tension-inducing hairstyles usually along the frontotemporal hairline. It is typically a gradual form of hair loss that occurs when the hairstyle is repeated. It starts with the shortening of hairs in the area and then over time can lead to thinning and smoother bald areas.
Alopecia areata is an autoimmune condition in which the hair can fall out rapidly and lead to smooth bald areas in short periods of time. Traction alopecia and alopecia areata can both cause loss of hair along the hairline. However, traction alopecia tends to leave a fringe of hair intact at the periphery.
Are their treatment options available? Is alopecia reversible?
Dr. Singh: Yes, both forms of hair loss are treatable. In both cases, the earlier treatment leads to improved outcomes. Alopecia areata is typically treated with anti-inflammatory medications, including topical/intralesional/oral steroids. We can also treat with platelet-rich plasma. There is a new class of medications called JAK inhibitors that interfere with certain inflammatory cascades. We have seen very promising results with these treatments.
Traction alopecia is entirely preventable and can be treated with cessation of the hairstyles that cause it, anti-inflammatory treatments such as topical/intralesional steroids, minoxidil compounds, and/or platelet-rich plasma. If the hair loss is reversible and the hair has lost the ability to regrow, I surgically restore the hairline with hair transplantation surgery.
How do traditional Black hairstyles such as braids, relaxers, and wigs contribute to hair loss?
Dr. Singh: Black women are known for our versatility in hairstyles. They look bold, beautiful, and creative. However, many can lead to hair loss because of tension in the hair follicles. In addition, once we start noticing our hair thin along the hairline, we use these hairstyles to mask our hair loss which can further compound the problem.
These hairstyles include braids, locs, wigs, rollers, wrapping the hair with tight scarves, tight ponytails, and styles with bobby pins close against the scalp, in addition to others. Having a relaxer with these hairstyles also increases the risk for traction alopecia.
What’s something about hair loss that you wish more people knew?
Dr. Singh: Early diagnosis is the key to restoring hair follicles that are thinning or not growing. Dermatologists depend on stylists to help recognize these conditions early so that we can address the root causes and get started with therapy.
What advice would you both give to Black women with hair loss who may be struggling to embrace the change in their appearance?
Dr. Singh: Our hair is an extension of our persona and helps shape how the world perceives us. Over 50 percent of Black women state they are experiencing some form of hair loss, which is a disproportionate number. I empathize with my Black female patients because our forms of hair loss are different than other demographics and can be much more severe and disfiguring.
Black women have received untoward commentary about our hair texture, our hairstyle choices, and our hair loss for a very long time now. We are fortunate to have such versatile choices with our hairstyling to help mask our hair loss; however, we often internalize the pain that we may be enduring because of the hair loss. I believe that having a strong support system and knowing that they are not suffering alone can help them adjust to the experience of enduring hair loss.
Dr. Chambers: I really empathize with these women because it is a traumatic experience. It breaks my heart when I hear that they have lost their self-esteem after losing their hair. I try to let them know that there are options out there like combless wigs, which are great for allowing you to switch up your look. I also let them know that they are beautiful as they are and can wear their bald or shaven head when they are ready.
This conversation has been edited for length and clarity.