25-Apr, 00:07

14:31, April 02 103 0

2018-04-02 14:31:11
Skin Deep: What Black Women Need to Know About Hair Loss

When Jasmine Collins, a hairstylist in the Atlanta area, turns her clients around to face themselves in the mirror, it’s often the first time they have seen their own hair styled in years, maybe decades.

Ms. Collins has a niche clientele of women with hair loss that is caused primarily by traction alopecia: hair loss from the tension exerted by styles like braids, extensions (with the hair braided underneath) and wigs.

Ms. Collins is convinced that increased wig and weave wear since the early 2000s has caused widespread hair loss among black women. “Remember 20 years ago, when people were wearing their own hair with relaxers?” she said. “People had heads full of hair.”

“I am not anti-weave,” she said. “I’m just trying to spread the word about an issue.”

The topic is fraught for black women. Wigs and weaves give them styling versatility, and, when done well, can protect their own hair. But critics are quick to accuse extension wearers of submitting to the pressures of a Eurocentric society and its beauty standards. Another assault has a misogynistic slant — namely that wearers are trying to deceive men with hair that is not their own. Last year, Whoopi Goldberg added puzzling commentary when she conflated black women wearing straight blond extensions with cultural appropriation.

Amid the cacophony, change is brewing. As women let go of wigs and weaves, stylists like Ms. Collins have perfected hairstyles to hide hair loss, and doctors are helping women through the process of growing back their own hair.

“A lot of people think they’ll be in weaves for the rest of their life,” Ms. Collins said.

Traction alopecia is caused by inflammation of the follicle when the hair is being pulled too tight for too long. “It’s probably the most common form of hair loss we see in the black community,” said Crystal Aguh, an assistant professor of dermatology at Johns Hopkins University Hospital in Baltimore and an editor of the textbook “Fundamentals of Ethnic Hair: The Dermatologist’s Perspective.”

Hair that is naturally curly is also fragile. Because of bends in the hair, sebum from the scalp, a natural protectant, can’t travel down the length of the shaft. The bends themselves also make curly hair prone to breakage.

Hair loss happens in phases. Pain and little bumps around the follicle, called traction folliculitis, are the first signs that a style is too tight. Subsequent thinning, traction alopecia, can still be reversed. After that, when the follicle is put under repeated tension, it scars over and hair stops growing permanently. This is called scarring alopecia.

Braids, wigs and extensions can be worn safely and are not the direct cause of hair loss. But when they put too much tension on the hair or are worn constantly, the follicles inflame and hair breaks. Women may notice hair loss but feel trapped in a cycle of wearing extensions to cover it.

“Patients come into my office, and they don’t even want the nurses to see their hair,” said Michelle Henry, a dermatologist in Manhattan who specializes in hair-loss treatments. “These styles — braids, weaves — are so a part of our culture that people think their hair loss is hereditary.”

Ms. Collins started posting striking before-and-after photos on her Instagram account two years ago. When word got out, she was styling about 120 clients a week. (“I was running myself into the ground,” she said.) She has a lighter client load now that she has passed on her technique to the nine stylists at her salon, Razor Chic in Lithonia, Ga. Education is part of her broader mission.

“A lot of stylists don’t know how to camouflage someone’s hair,” Ms. Collins said. “That’s another reason I’m always teaching classes.” She teaches in-person and online styling seminars, streamed through her website, razorchic.com.

Ms. Collins attributes her work to an expertise in hairstyling fundamentals. Camouflaging hair loss comes down to giving each client the right haircut and color, then working with her face shape to conceal balding along the edges or at the crown (or both) with whatever hair is remaining.

Her chemical straightening strategy depends on hair texture and length. If someone has medium to long hair, she won’t put a full relaxer in it, “because I want the fullness and volume,” she said. “The only time I’ll do a bone-straight relaxer is if I have to go very short.” New clients spend around $500 for services and any maintenance products Ms. Collins recommends.

“I’m able to give a person a nice look so they can walk around confident enough to rock their own hair,” she said.

Dr. Henry balances empathy with an urgent message about the condition. “The conversation I have with my patients is you can stop wearing these styles now and save your hair, or you can continue and end up with permanent hair loss,” she said.

Because traction alopecia is caused by inflammation, Dr. Henry injects the scalp with steroids. “I also make a compound with minoxidil that helps growth, a steroid and a little bit of tretinoin to help it all penetrate,” she said. Platelet rich plasma therapy, in which growth factors from the patient’s own blood are injected into the scalp, can stimulate hair growth, too.

Dr. Aguh doesn’t ask her patients to go cold turkey on a hairstyle because such a regimen is too difficult to stick to. Instead, she requests smaller, consistent changes. Relaxed hair is more likely to break when it’s braided, so she asks patients who are wearing extensions and also use relaxers to space out chemical treatments, for at least 12 weeks, and eventually go natural.

“But if you’re really noticing a lot of thinning, you have to get a style that doesn’t include your broken hair at all,” she said.

Dr. Aguh also recommends essential oils including thyme, rosemary, cedar wood and peppermint to patients who aren’t pregnant, aren’t prone to seizures and don’t have heart conditions. “Essential oils are very strong so they must be diluted with inactive oils like grape seed, coconut or olive oil,” she said.

Once hair loss is permanent (a dermatologist can diagnose which phase the scalp is in), transplants are the only reliable treatment.

“But most people have nonscarring hair loss,” Dr. Aguh said. “They have the potential to get that hair back if they make styling changes and get treatment.”