African American Hair & Hair Loss Treatments

A Black woman staring at a comb full of broken hair strands

Hair loss: It’s one of those things that none of us want to experience and yet, the reality is that many of us will. Reportedly, 53 percent of men will experience moderate to extreme hair loss as they continue to age. (1) Meanwhile, as much as 50 percent of women will lose a noticeable amount of hair over the course of their lifetime too. (2) Most of these people are affected by a condition known as androgenetic alopecia, also known as pattern hair loss.

Many different types of alopecia are common — but some types affect Black men and women more than other individuals. Black men and women can experience androgenic alopecia, the most common form of hair loss. But they’re also likely to be affected by scarring alopecias, which are caused by scalp inflammation, traction alopecia, which occurs when hair is subjected to repeated tension or friction, and hair follicle disorders. (3,4)   

In order to find an effective treatment option, you’ll need to get a professional diagnosis from your doctor. Based on the root cause of your condition, they may prescribe a certain type of medication, like Rogaine or Propecia, or even recommend immunotherapy or a hair transplant. (4,5) But not all hair loss is the same. Some people may simply need to change the way they care for their hair. 

What Makes African American Hair Unique?

African Americans are known to have the curliest texture of all ethnicities – which is sometimes referred to as “coily” hair. Both curly and coily hair can be affected by shrinkage. Shrinkage simply speaks to the fact that when African American hair is in its natural state, its tight curls can make tresses appear much shorter than they are when stretched out. But these aren’t the only things that make Black hair unique. 

Humans have an average of 100,000 hairs on their heads – each of which sprouts from a hair follicle. Every day, most people shed 50-100 of those hairs, and every month, experience between a third to half an inch (0.9 to 1.3 centimeters) of hair growth. (3,6)

Compared to people of European descent, Black men and women have fewer hair follicles and a lower hair density. Their hair also grows slower than Caucasian hair, and suffers from more knots and breakages compared to both Caucasian and Asian individuals. (6) 

These issues are due to asymmetrical hair follicles, which make the hair strands that grow from them more prone to damage. And to add to that, African American hair tends to be more fragile and brittle. Interestingly enough, the reason it’s drier than other hair types is because its coiled shape makes it difficult for scalp oils to make their way from the roots to the tips. (6)

While these may all sound like negatives, Black hair has huge advantages, particularly in hot climates. It’s particularly helpful at providing protection from the sun and supporting the body’s ability to thermoregulate. 

Regardless of the pros and cons, these factors require African Americans to be hypervigilant about keeping their hair healthy. Black hair will always be more prone to physical and chemical damage than other hair types, but you can encourage healthy hair growth by (7,8):

  • Deep conditioning your hair
  • Regularly applying a leave-in conditioner
  • Using very little heat
  • Not applying tension or pressure when styling hair
  • Eating a healthy diet 
  • Staying hydrated and well-rested

What Causes African American Hair to Fall Out?

Like every other ethnicity, several different types of hair loss can affect African Americans. African Americans are less likely to experience the most common form of hair loss, androgenetic alopecia, but are more prone to suffer from brittle hair conditions, scarring alopecias, and hair follicle disorders. (6,9)

1. Androgenic Alopecia 

Commonly known as pattern hair loss, androgenic alopecia, or androgenetic alopecia, this condition is the most common cause of balding. It’s mainly caused by a mixture of genetics and hormones. (10)

2. Alopecia Areata 

Alopecia areata is an autoimmune disorder that can result in hair coming out in clumps (usually around the size of a quarter) instead of simply shedding. It can also cause complete baldness or hair loss all over the body. (15)

3. Telogen Effluvium

Telogen effluvium is a condition that’s tied to either physical or mental stress. It’s a temporary hair loss issue that results in excessive shedding. It gets its name from the telogen phase of the hair growth cycle, which is the resting phase of hair growth. (16)

4. Acquired Proximal Trichorrhexis Nodosa 

Acquired Proximal Trichorrhexis Nodosa is a type of hair loss that’s common among African Americans. It occurs when chemical relaxers cause nodes along the hair shaft, causing hair strands to get weak, which results in hair breakage. (6)

5. Short Anagen Syndrome

Short anagen syndrome occurs when hair is prevented from gaining significant length due to the fact that it has a shorter anagen (the active stage of hair growth) phase.(6)

6. Central Centrifugal Cicatricial Alopecia 

Central centrifugal cicatricial alopecia is another hair loss condition known to affect African American women. It causes permanent hair loss around the crown. It often causes inflammation and scalp scarring, too. (4)

7. Lichen Planopilaris 

Lichen planopilaris is a rare inflammatory condition that affects the skin and sometimes, the mucous membranes. It results in patchy, permanent hair loss. (6)

8. Traction Alopecia 

Also common among African American women, traction alopecia occurs when hair experiences too much pressure from protective styles (like braids and twists). This type of hair loss can also occur due to damage from chemical relaxers or excessive amounts of heat. (4,6)

9. Lupus of the Scalp

The autoimmune disorder lupus can sometimes cause lesions on the scalp which result in hair loss. Sometimes lupus of the scalp can cause hair along the hairline to become fragile and easily break off, too. (16)

10. Dermatosis Papulosa Nigra 

Dermatosis papulosa nigra is a skin condition that affects one-third of African Americans. It leads to small dark bumps across the face and can affect facial hair. (4)

11. Pseudofolliculitis Barbae 

Approximately 60 percent of African American men deal with pseudofolliculitis barbae. It mostly affects hair follicles around their beards. Pseudofolliculitis barbae is also known as “razor bumps”, which are ingrown hairs that can occur after shaving curly hair textures. (4)

12. Acne Keloidalis Nuchae

Acne keloidalis nuchae look like keloids. This common chronic disorder causes inflammation and scarring of hair follicles. It occurs heavily on the scalp and neck and can result in hair loss around these regions. (4)

What Causes Hair Loss in Black Males?

Although all of these types of hair loss can affect both men and women, the two that perhaps affect Black men the most are androgenic alopecia and pseudofolliculitis barbae.

Male Androgenic Alopecia

Androgenic alopecia is the leading cause of receding hairlines in Black men. Researchers believe it’s connected to androgens – a type of sex hormone in men. It’s also believed to be tied to genetics. This type of hair loss is progressive and symptoms increase with age. (7)

Although nothing can be done about one’s DNA or what can happen over the course of time, there are hair loss treatments for androgenic alopecia, like minoxidil, finasteride, and laser hair therapy. Also, reducing stress and avoiding hairstyles that put a lot of pressure on the hairline can help reduce the speed at which hair loss progresses. (17)

Pseudofolliculitis Barbae in Men

Whenever you see a cluster of bumps come up after shaving, you’re likely seeing pseudofolliculitis barbae. Curly hairs can find themselves growing back into the skin, which can cause ingrown hairs and inflammation. These bumps can be quite visible and painful to the touch (similar to a hard pimple). Applying warm compresses and not shaving against the grain can help reduce these types of bumps. (8)

What Causes Hair Loss in Black Women?

As with Black men, there are certain kinds of hair loss that are more common among Black women. Acquired proximal trichorrhexis nodosa, central centrifugal cicatricial alopecia, and traction alopecia all top this list. (6)

Female Androgenic Alopecia

Androgenic alopecia is the most common form of hair loss in both men and women. Like with men, this form of alopecia is due to a combination of hormones and genetics. (7) The FDA has approved two hair loss treatments for women with this condition: minoxidil and laser hair therapy.

Acquired Proximal Trichorrhexis Nodosa

Trichorrhexis nodosa can be a type of inherited hair loss that is connected to health issues like iron deficiencies and hypothyroidism. However, acquired proximal trichorrhexis nodosa is what happens when hair weakens from excessive use of chemicals and oftentimes heat. Going natural is one way to keep this type of hair loss from becoming an issue.(6)

Central Centrifugal Cicatricial Alopecia

Central centrifugal cicatricial alopecia symptoms affect many Black women over the age of 30. Some of the symptoms include a burning, itchy scalp, along with bumps that resemble acne. Initially, hair loss occurs at the crown, making it look like hair that is thinning. However, as it continues to spread, its appearance is similar to male pattern baldness. Bacterial and fungal infections are involved in this form of hair loss, too. (6)

Traction Alopecia

Hair is not designed to experience a lot of tension or friction. Traction alopecia is what happens when it experiences too much pressure and strain. Braids and twists that are too tight, extensions, and sometimes even a wig’s positioning can create this kind of hair loss. Some of the symptoms of traction alopecia include redness, an itchy scalp, and short broken hairs. (6)

African American Hair Loss Treatment Options

Now that you’re aware of some of the different types of hair loss that affect the African American community, you might be wondering what hair loss products are available for Black hair. More specifically, how can Black men and Black women prevent hair loss? The good news is that there are a variety of treatments available.

Androgenic Alopecia Treatments

Topical minoxidil is an FDA-approved medicine that has helped to improve hair growth in men and women with pattern hair loss symptoms. This medication, also known as Rogaine, works by opening up blood vessels, allowing more oxygen and nutrients to reach the scalp. The alternative medication, finasteride, is an oral pill that’s only FDA-approved for use in men. This drug, which is commonly known as Propecia, works as a hormone blocker. (9)

In addition to these medications, there is also laser hair therapy, which can help to stimulate hair follicles. Low-level laser therapy devices are thought to be able to prevent and treat pattern hair loss. People with androgenic alopecia may also want to consider alternative options, like hair transplants or clinic-based hair loss treatments, like microneedling and platelet-rich plasma therapy. (17)

Pseudofolliculitis Barbae Treatments

Black males dealing with pseudofolliculitis barbae don’t usually need a hair loss treatment. It’s more about finding the kind of medications that reduce inflammation and help prevent razor bumps from occurring in the first place. Some of those include hydrocortisone (which reduces mild inflammation). Another product worth considering is topical eflornithine hydrochloride cream. Sometimes it can slow down hair growth, allowing shaving to occur less often. (10)

Acquired Proximal Trichorrhexis Nodosa Treatments

The necessary treatment for acquired proximal trichorrhexis nodosa is not really found on a shelf in a store. Instead, since this type of hair loss is the result of too much chemical or heat usage, it’s all about taking the “less is more” approach. Taking off a season to let one’s natural texture grow and opting to use as few heat treatments as possible is the most effective treatment for this particular type of hair loss. 

Central Centrifugal Cicatricial Alopecia Treatments

Central centrifugal cicatricial alopecia can be permanent. But sometimes, this kind of hair loss can be reversed, so long as there isn’t any scarring on the hair follicles.

Topical steroid medication is commonly prescribed to people with central centrifugal cicatricial alopecia. If the condition is chronic, sometimes this treatment will be combined with local corticosteroid injections. Injections are administered to the scalp for a period of 4 to 8 weeks. (6) 

Traction Alopecia Treatments

As with acquired proximal trichorrhexis nodosa, traction alopecia requires lifestyle changes to resolve. You first need to stop styling your hair in ways that cause pressure or strain and allow it to grow. Based on traction alopecia’s severity, topical antibiotics and corticosteroids may sometimes be used to decrease scalp tenderness and inflammation. Minoxidil is sometimes used off-label to treat traction alopecia, too. (6)

Alopecia Areata Treatments

Autoimmune-related hair loss issues like alopecia areata are often treated with corticosteroids. More recently, doctors have started applying medications like anthralin and diphenylcyclopropenone onto the scalp. Over a series of visits, this can trigger a mild allergic reaction that can potentially help to heal the scalp. Minoxidil is also sometimes used off-label to treat this type of hair loss. (12)

Alopecia and African American Hair Loss Products

Hair loss within the Black community is prevalent. The good news is that there are a variety of options that can help prevent hair loss, several which can help heal the scalp and hair follicles. While not all hair loss is reversible, in most cases, at least some hair can be restored. It’s all about getting the proper diagnosis and following your physician’s recommendations.

If you’re new to starting a hair loss treatment, be aware that they won’t work their magic on their own. You’ll also need to reduce your stress levels, eat a balanced diet, and be gentle with your hair. When you combine a hair loss treatment with these positive lifestyle changes, you may be able to restore hair growth. Unfortunately, with scarring alopecias, there’s a much lower chance that lost hair can be restored.

References

  1. Rhodes, T., Girman, C.J., Savin, R.C., Kaufman, K.D., Guo, S., Lilly, F.R., Siervogel, R.M. and Chumlea, W.C. (1998). Prevalence of male pattern hair loss in 18-49 year old men. Dermatologic surgery, 24(12), pp.1330-1332.
  2. Cleveland Clinic. (2022). Hair Loss in Women.
  3. NYU Langone Health. (2022). Types of Hair Loss. Patient Care at NYU Langone Health. 
  4. Kundu, R. V., & Patterson, S. (2013). Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color. American family physician, 87(12), 859-865.
  5. Mayo Foundation for Medical Education and Research. (2022, March 26). Hair Loss. Mayo Clinic.
  6. Tanus, A., Oliveira, C.C.C., Villarreal, D.J.V., Sanchez, F.A.V. and Dias, M.F.R.G. (2015). Black women’s hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity. Anais brasileiros de dermatologia, 90, pp.450-465.
  7. American Academy of Dermatology. (n.d.). Black hair: Tips for everyday care. American Academy of Dermatology.
  8. Aguh, C. U. (2021, December 1). Hair loss in black women: Tips from an expert. Johns Hopkins Medicine. 
  9. Cranwell, W. & Sinclair, R. (2015). Male androgenetic alopecia. National Library of Medicine.
  10. Hoss, E. (2021, April 14) Male Pattern Baldness. Penn Medicine.
  11. American Osteopathic College of Dermatology. Pseudofolliculitis Barbae. (n.d.) American Osteopathic College of Dermatology.
  12. Kelly, Y., Blanco, A., & Tosti, A. (2016). Androgenetic alopecia: an update of treatment options. Drugs, 76(14), 1349-1364.
  13. Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology, 12, 241.
  14. Cardoso, C. O., Tolentino, S., Gratieri, T., Cunha-Filho, M., Lopez, R. F., & Gelfuso, G. M. (2021). Topical treatment for scarring and non-scarring alopecia: An overview of the current evidence. Clinical, Cosmetic and Investigational Dermatology, 14, 485.
  15. American Academy of Dermatology Association. (2022). Hair Loss Types: Alopecia Areata Diagnosis and Treatment. American Academy of Dermatology Association.
  16. Barbosa, V. (2022) Hair Loss (Alopecia) Prevention and Treatment for Women. UChicago Medicine.
  17. York, K., Meah, N., Bhoyrul, B., & Sinclair, R. (2020). A review of the treatment of male pattern hair loss. Expert opinion on pharmacotherapy, 21(5), 603-612.
Published on November 30, 2023

Last updated November 2023

Latest articles