Black women's hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity

Abstract

Afro-ethnic hair is different from Caucasian and Asian hair and has unique features. Ethnic hair is more prone to certain conditions or diseases. Such diseases are not only related to the fragile inner structure of the hair, but also to the cultural habits of hairstyles that often exert traction forces upon the pilosebaceous follicle. Women with African hair subject their hair to chemical treatments such as hair straightening and relaxing, and thus modify the structure of their hair shaft, making it more susceptible to damage. For this reason, hair complaints are common among black women and represent a diagnostic challenge to the dermatologist, requiring a thorough clinical examination of the hair and scalp, and a detailed medical history of the patient. The purpose of this review is to warn of the potential side effects and sequelae related to hairstyles and hair treatments used by black women, and to highlight the major diseases that affect this ethnicity.

FIGURE 1

Traction alopecia. Observe the traction exerted by the hairpiece upon the hairs, resulting in the shortening of the hairs in the temporal region

FIGURE 2

The fringe sign: short tonsured hairs outlining the original frontotemporal line of implantation of the hair

FIGURE 3

Observe the hair casts in traction alopecia, representing follicular sheath cylinders which detach themselves due to the traction forces exerted upon the hairs and adhere themselves to the hairs

FIGURE 4

A. Cicatricial alopecia in the central scalp (CCCA). In this case, the differential diagnosis was made with androgenetic alopecia in black women B. LED of the scalp. Because it shows central involvement, it is important to remember the differential diagnosis with CCCA in melanodermic patients

FIGURE 5

LPP

FIGURE 6

In melanodermic patients with LPP, we can observe a blue-greyish perifollicular pigmentation in a “targetlike pattern”, in addition to the characteristic features of perifollicular desquamation and erythema

FIGURE 7

Frontal fi brosing alopecia: notice the retraction of frontotemporal hair line and thinning of the eyebrow

FIGURE 8

Lonely hair sign: presence of isolated and dispersed terminal hairs in the area of alopecia

FIGURE 9

Note the intense perifollicular desquamation which mainly affects the hairs of the frontotemporal region and eyebrows

FIGURE 10

Androgenetic alopecia

FIGURE 11

The line used to tie the hairpice, shown in more detail