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Losing Your Hair? Here’s How to Hold on to It

Breakage and thinning have various causes. Getting to the root of the problem is the first healing step.

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Black woman from the back showing her hair
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For many Black women, hair is a point of pride and a major part of our identities. So hair loss, though common, can be particularly devastating for us. Almost 50 percent of respondents in the Black Women’s Health Study said they’ve experienced hair loss, and the reasons can range from stress to severe medical issues.

The most important step to healing hair loss, regardless of its cause, is to see a dermatologist as soon as possible. But studies show most Black women don’t seek medical help. Rebecca Baxt, a board-certified dermatologist at Baxt CosMedical in Paramus, New Jersey, believes resources, time and embarrassment are to blame.

“There’s a lot of different causes [for hair loss]. They’re hard to determine and it’s going to be impossible to figure it out on your own,” she said. “There often is treatment and when people come in late, it’s harder to treat. It’s better to catch it early, whatever the problem is, and not wait for years. So seek medical attention.”

We talked to some top dermatologists to learn about the typical roots of hair loss and some possible solutions.

Tenderness, itching or burning
Hair loss can be gradual with few obvious symptoms, but lots of tenderness, itching or burning in the scalp may be a sign of central centrifugal cicatricial alopecia (CCCA).

“This is a form of hair loss that affects Black women almost exclusively. It’s considered a scarring alopecia, which means it’s permanent,” said dermatologist Crystal Aguh, an assistant professor of dermatology at the Johns Hopkins University School of Medicine and author of 90 Days to Beautiful Hair: 50 Dermatologist Approved Tips to Unlock the Hair of Your Dreams.

The earlier you see a medical professional at the onset of CCCA, the better. Treatments may include anti-inflammatory medications, injections and hair transplants.

Thinning edges
Loss around your hairline can be a sign of traction alopecia. Heat and chemically treated styles can exacerbate the condition because the hairline is normally the most fragile area of your hair and can easily suffer the most damage. Traction alopecia affects up to one-third of Black women who wear braids, dreadlocks, weaves and extensions because, although they’re beautiful styles, they continuously pull at the roots of your hair.

“We always recommend if you’re going to braid the hair, just don’t braid it too tight,” said Baxt. “Take breaks from braids. Don’t braid [your hair] 24/7/365 for years and years. Braid it and then unbraid it so that the hair doesn’t pull so much.”

If you believe your hair loss stems from wearing styles that strain your hairline, dermatologists recommend removing the weave and extensions after six to eight weeks, paying a professional to relax or dye your hair and dialing down your use of heat. Remember, no chemical services are fully safe for your hair, so going natural is always the better alternative if other solutions don’t seem to be working. If you have dreadlocks, try wearing an updo that doesn’t pull them too tight and places the weight of the hair on your head. Depending on the severity of the hair loss, a dermatologist may prescribe antibiotics or shampoos that can help.

Balding at the crown
While researchers are studying risk factors that may contribute to balding at the crown, they have yet to determine what those factors are. We do know that balding at the crown can be a sign of androgenetic alopecia, which can be caused by factors ranging from genetics to stress. Although other areas affected by balding can be easy to spot, the crown of the head is sometimes the hardest place to notice since we can’t easily see it in the mirror.

That said, the earlier androgenetic alopecia is detected, the better. There are medications and injections that can help restore the hair, but doctors may also recommend over-the-counter products that contain minoxidil, an ingredient that can help promote hair growth for some people.

Loss of volume coinciding with stress
According to the Mayo Clinic, in addition to stemming from chronic health issues, hair loss can sometimes be caused by a very stressful event. Ellen Grant, a licensed clinical social worker and Weiss Institute fellow, says she experienced alopecia two decades ago during a stressful period at work, challenges related to parenting and troubles in her marriage. “I went to the dermatologist because I couldn’t understand why my hair was falling out. I told her what was going on in my life and she said ‘well, that’s what’s really going on.’”

Concerned about side effects from recommended hair-loss drugs, Grant opted not to take them and focus instead on gentle styling and practices. She’s a believer in limiting the stress of brushing and in using silk scarves and pillowcases at night. More important, Grant, a former cochair of the Black Women’s Health Study, prioritized reducing stress. “I ended up getting a divorce and also changed jobs,” she recalls. “I started taking care of myself. You know, we women often are caretakers in so many ways. When we put ourselves last it can have detrimental effects.” Grant exercises daily and follows a vegetarian diet. She says lifestyle changes helped her manage her condition, and she never had to resort to wearing a wig.

According to the American Academy of Dermatology (AAD), stress-related shedding is often temporary and will resolve within six to nine months as the body adjusts. This may be the case after a weight loss of 20 pounds or more, childbirth, a high fever, surgery or going off oral contraceptives. Caring for a loved one who is ill, losing your job or experiencing divorce can lead to shedding. “If the stressor stays with you, however, hair shedding can be long lived,” notes the AAD website. “People who are constantly under a lot of stress can have long-term excessive hair shedding.”

Hair breakage
Just as it’s important to distinguish between permanent loss and shedding, you’ll also want to assess if your hair is breaking off along the shaft versus falling out at the roots. Shed hairs without a hair bulb at the base are considered broken hairs. You can read Sisters’ advice on stopping hair breakage here.