Hair Loss in Women with Skin of Color:

Expert Tips from AAD 2023

It’s known that hair loss in women can be emotionally devastating and may detrimentally impact quality of life, but new research suggests that it can also be associated with having other common medical conditions, such as diabetes, acne, and breast cancer. Early evaluation of hair loss in women may be key to preventing progression of hair loss and can  lead to diagnosis of other medical conditions that can be linked to hair loss with the proper workup.

Speaking at the 2023 Annual Meeting of the American Academy of Dermatology, dermatologist Valerie D. Callender, MD, FAAD, professor of dermatology at Howard University College of Medicine, said, “By recognizing the signs of hair loss and seeing your dermatologist as soon as possible, you may be able to limit the progression, hold on to the hair you have, and discover any other underlying medical conditions you may have.”

Central centrifugal cicatricial alopecia (CCCA) is estimated to affect nearly 15% of Black women and is the most common type of hair loss seen in women with dark skin tones. Conditions such as breast cancer, high cholesterol, diabetes, and high blood pressure are common among Black women with CCCA, says Dr. Callender.

Another common type of hair loss‑-female pattern hair loss–affects millions of women of all skin tones. In female pattern hair loss, the hair thins mainly on the top of the scalp, usually presenting initially as widening of the center hair part. Many women who have female pattern hair loss also have acne due to an increase in specific hormones, says Dr. Callender. While acne is more common in the early stages of female pattern hair loss, menopause and high blood pressure are common as female pattern hair loss progresses.

Treatments for female pattern hair loss are available, including minoxidil, which has been shown to reduce hair loss, stimulate hair growth, and strengthen existing strands of hair. “When treatments are not effective to prevent hair loss, a permanent solution is to consider a hair transplant, which creates natural-looking results,” says Dr. Callender. “Hair transplants are most effective in patients with traction alopecia and female pattern hair loss. While patients with CCCA aren’t always ideal candidates for a hair transplant due to scarring, it is possible for them to have success. A board-certified dermatologist can determine if a hair transplant is the right option.”

Dr. Callender also notes the importance of hairstyling, especially styles that tightly pull the hair, and product use. Styles such as braids, a tight ponytail, or an updo can cause traction alopecia, which is a common type of hair loss in women with dark skin tones due to hair styling.

“One of the first things I ask my patients who have a history of braids is if it hurts when their hair is braided,” says Dr. Callender. “Getting your hair done shouldn’t hurt, so if they have pain, it’s an indicator that they could be developing traction alopecia.”

Loosening up the hairstyle, reducing the frequency of wearing hairstyles that pull on the hair, and changing hairstyles can all help prevent traction alopecia.

Women with any type of hair loss must pay attention to the ingredients in the hair care products they use, according to Dr. Callender. Because women with dark skin tones, particularly those of African descent, have hair that tends to be coarse, dry, and fragile, some shampoos for dandruff and other scalp disorders can further dry out hair, leading to breakage. Patients with dark skin tones are advised to use shampoos and hair products with ingredients that moisturize their hair, such as vitamins A and E, jojoba oil, and shea butter.