By Dr. Hope Mitchell, MD
The Truth Contributor
For many, it starts slowly. First, more strands than usual. Then, a little too much hair in the comb. Next, breakage around the edges or top of the scalp. The part that used to be full now looks thinner and wider. A small, soft spot near the temple where the braids had once pulled too tight or now hair thinning on the crown like that seen in your grandmother, mother or father has you wondering; “do I have alopecia?”
When you finally make the appointment, it has been almost a year or two since you first noticed the changes. Perhaps it was fear of the unknown – how much longer will this continue? Maybe tired of covering up the condition, or simply wanting to get to the root of the issue that brought you to the dermatologist. Regardless, you are not alone.
With my many years of experience as a dermatologist who has seen this many times before, I understand your concern when you say: “My hair is falling out and I am concerned.”
The comprehensive hair loss appointment starts with a thorough history which includes questions about styling habits, diet, stress, medications, surgical procedures and family history. You should remember to arrive without a confined hairstyle, regardless if you are only concerned with your edges, so that your entire scalp can be examined with ease.
You did not realize the itching, burning, tingling, or crawling feeling in your scalp is common in Black women with hair loss and that it could be tied to the inflammation that I can see in the scalp with my dermatoscope. As with the inflammation that attacks the joints and causes arthritis, inflammation can attack the hair follicles and cause hair loss.
The scalp exam may also reveal miniaturized follicles seen in male or female pattern genetic hair loss or unfortunately, there may be irreversible scarring noted. Everyone is born with all the hair follicles she or he will have in a lifetime; therefore, time is of the essence when experiencing hair thinning and loss, as we cannot make new follicle units.
What you’re experiencing is likely a combination of traction alopecia and chronic telogen effluvium, with some early signs of central centrifugal cicatricial alopecia—or CCCA. These are all common types of hair loss in Black women, but they’re often misdiagnosed or ignored until they’ve progressed. Yes, often more than one form of hair loss is documented during the appointment.
“Is it permanent?”
“It depends. “With traction alopecia, the good news is that if we catch it early, hair often grows back once the stress on the edges or crown from tight hairstyles is removed. But if there’s been long-term tension—tight braids, ponytails, or extensions over years—some follicles may be permanently damaged.”
“And the breakage?”
It is often due to dryness, over-processing, heat damage or harsh styling techniques. Many women think their hair ‘isn’t growing,’ when in reality, it’s growing but breaking off at the same rate.”
“And CCCA, I think I have heard of that.”
Yes, that is possible because it is the most common cause of scarring hair loss in Black women. It is not curable but has a good prognosis if caught early. Research in the last five years, has proven there to be a genetic defect in the hair shaft in about 25 percent of people, in addition to hair styling practices, that predispose to this type of hair loss.
“So what do I do?”
The first order of business is to get a diagnosis as there are nearly 15 different types of hair loss. A scalp biopsy may be necessary to confirm the type of alopecia or hair loss you have. Blood work may also be considered to correct any underlying systemic abnormalities that may be contributing to the hair loss.
I always sense a shift at the end of the appointment —maybe it is relief. Maybe for the first time, someone has been given hope, felt heard or understood their diagnosis. As a dermatologist, who treats all conditions of hair and skin, including eczema, acne, razor bumps, uneven skin tone, and hidradenitis suppurativa (HS), conditions in which African Americans carry the burden of disease, I understand how shared cultural background and experiences may lead to better communication and a feeling of being more fully heard and understood.
Final Thoughts from Dr. Mitchell
Time is follicles – See a board-certified dermatologist who is passionate about treating hair loss as soon as you notice thinning.
Scalp Care = Skin Care – Clean your scalp every 1-2 weeks. A healthy scalp is the foundation for healthy hair.
Partner with a stylist that will help you care for your hair. Avoid tight styles that pull at your edges and crown. Limit wigs and weaves and give your scalp breaks from those styles. Sleep with a silk pillowcase, preferably.
Address internal health with your primary care physician and recommended blood work at least yearly.
Be patient when undergoing treatment. Depending on your overall health, stress level and nutrition, it can take at least three months to reduce shedding, three to six months to notice new growth, and six to 12 months to notice visible length retention.
Join Dr. Hope Mitchell, board certified dermatologist and Joycelyn Dumfeh, PA-C, on Thursday, September 18th, 5:30-6:30, at Mitchell Dermatology, Perrysburg for Rooted in Truth, to learn more about hair loss. RSVP required as space is limited.