Hair grooming practices and central centrifugal cicatricial alopecia

Abstract

Background: The cause of central centrifugal cicatricial alopecia (CCCA) in African American women remains to be elucidated.

Objective: This study was designed to determine the hair-grooming practices in African American women with and without CCCA and to evaluate possible etiologic factors.

Methods: Utilizing a novel survey instrument, the Hair Grooming Assessment Survey, we performed a retrospective comparative survey of the hair-grooming practices of two populations of African American women seen and evaluated at the Department of Dermatology, Henry Ford Hospital in Detroit, MI, between 2000 and 2007. The case group were women with clinical and histologic diagnosis of CCCA, and the control group were those without a history of alopecia.

Results: All 101 surveys that were returned were analyzed (51 from the case group and 50 from the control group). A strong association was found between the use of both sewn-in hair weaving and cornrow or braided hairstyles with artificial hair extensions and CCCA (P < .04, P < .03, respectively). Similarly, women with CCCA were more likely to report a history of "damage", typically defined as uncomfortable pulling and tenderness, from both sewn-in and glued-in weaves, and from cornrow or braided hairstyles with artificial hair extensions (P < .001, P < .02, and P < .03, respectively). In contrast to previous anecdotal beliefs, no correlation was found between the use of either hot combing or hair relaxers and the development of CCCA.

Limitations: Results are limited by patient recall of past hair grooming practices. Also, as hair grooming practices may vary by geographic region, these results may not be generalized to all women of African descent.

Conclusion: There is a clear difference in both quantitative and qualitative hair grooming practices among African American women with CCCA.