Paris Rollins began noticing patches of missing hair on top of her scalp in middle school.

“There’s been a lot of times where I’ve just cried because I don’t feel pretty,” Rollins said. She described the hair loss as the source of teasing from her classmates.

Over time, the patches became more “severe” and noticeable.

As Rollins’ hair continued to lose volume, her classmates’ teasing increased. 

 “That’s when the real bullying started. When I couldn’t put my hair in a ponytail anymore,” Rollins said. “It was embarrassing.” 

Rollins is one of many Black women who has alopecia, partial or total absence of the hair.

Why it matters: Some healthcare professionals believe that around a third of Black women will experience alopecia in their lifetime.

Paris Rollins. Photo courtesy of Paris Rollins. 

Common causes in Black women 

Black women can suffer from multiple types of hair loss, Dr. Amy McMichael, dermatologist, hair loss researcher and professor at Wake Forest School of Medicine said.

“There’s not just a certain group or forms of hair loss that happen in Black people. There are some that happen with more frequency.” 

One type of alopecia that can be common in Black women is traction alopecia, Dr. McMichael said. Traction alopecia is a form of hair loss that affects the frontal hairline. 

One known cause for traction alopecia is tension from tight hairstyles on the frontal hairline, from wearing certain hairstyles like tight braids or wigs. It can also come from using heat and applying chemicals to the hair, Dr. McMichael told QCity Metro. 

Athletes who wear helmets often may also suffer from this type of hair loss, Shawaunna Middleton, owner of Eunette Hair Essentials, a local hair salon in Charlotte and scalp specialist, said.

Shawaunna Middleton, owner of Eunette Hair Essentials. Photo courtesy of Shawaunna Middleton.  

Dr. McMichael said Black women are taught to keep their hair “neat” from a young age, which can increase the likelihood of traction alopecia. 

“​​From a very young age, the focus is often the hair looking neat,” Dr. McMichael said. “Pull it back, gel it down, make sure that there are no flyways, no wispiness.”

Female pattern hair loss is also a common type of hair loss in Black women, according to Dr. McMichael, where thinning occurs on the top and crown of the head.

Alopecia areata, patchy circles of loss in the scalp that can progress to total scalp or body hair loss, is more likely to occur in Black women, Dr. McMichael said.

This form of hair loss can be caused due to stress and genetics.

Trichologist and owner of Studio Glamour, Kari Evans. (Destiniee Jaram / QCity Metro). 

Genetics and diseases, such as autoimmune disorders, can also play a role in hair loss. Some are even directly linked to hair loss, like polycystic ovary syndrome (PCOS).

PCOS, according to the National Institute of Health, can cause male pattern balding – hair thinning and even total loss at the top of the head and at the front hairline– and disproportionately affects Black women.

Because many diseases like PCOS often go overlooked or improperly diagnosed in women of color due to medical bias and stigma, some women cannot identify the causes of hair loss until nearly irreversible damage is done.

Terza Lima-Neves, who teaches at Johnson C. Smith University, noticed a lesion that later turned into a bald spot in 2005 that prompted her to see a dermatologist. 

Lima-Neves was later diagnosed with discoid lupus, an autoimmune disorder that affects the skin. Triggers like stress cause flare-ups and inflammation in her scalp, causing hair loss. 

She told QCity Metro the diagnosis and the possibility of hair loss was difficult to accept.

“I was sad and concerned at first,” Lima-Neves said. “Emotionally, it was difficult because for Black women, let’s keep it all the way real, hair is the most important thing. For me to hear that potentially I could lose my hair was traumatic.” 

Emotional toll 

Jaren Doby, a licensed therapist at Novant Health, said hair loss is often an emotionally painful process.

“It’s an adjustment that can cause different emotional responses.” 

The emotional impact of hair loss can include anxiety, low mood, decreased pleasure or interest in doing things, sleep and appetite disturbance and fatigue.

Rollins, who began losing her hair in sixth grade, said that her severe hair breakage lead to other students teasing her and it negatively impacting her self-esteem. 

For women experiencing negative self-esteem due to hair loss, Doby recommends personalized affirmations kept in a place that can be seen daily. 

Treatment options 

Treatment for hair loss varies and depends on the cause.

Lima-Neves, who has balding due to an autoimmune disorder, said she maintains a healthy diet, exercises regularly, and avoids direct sunlight. She also uses a topical solution during flare-ups. 

Evans offers consultations for customers like Lima-Neeves that take a holistic approach. The consultation includes testing blood pressure and pH levels, checking one’s blood type and reviewing clients’ diets to make recommendations beyond the scalp.

For women in particular, alopecia can be embarrassing.

“You have to produce hair internally. You are what you eat. Hair is made up of protein and dead cells and all that. So once you give your body what it needs, it will reproduce,” Evans said. 

Lima-Neves is looking at her hair under a microscope. (Destiniee Jaram / QCity Metro). 

Evans also looks at the client’s scalp under a microscope and analyzes its strength and general makeup before recommending direct hair treatments like special shampoos or topical creams.

Other topical treatments, like essential oils, are another way to care for hair loss.

Middleton said essential oils like peppermint, lavender and Jamaican black castor oil can aid in hair regrowth by improving blood flow in the scalp, according to Middleton. 

These oils should not be applied directly to the scalp, according to Middleton, as they can become an irritant.

“You want to have some type of carrier oil, so olive oil or avocado oil,” Middleton said.

The mixture of carrier and essential oils can be applied to the scalp or the hair shaft by misting the hair with a spray bottle. 

Another effective treatment option is a transplant, a medical procedure that allows surgical hair restoration, Dr. McMichael said.

“You take the hair from the posterior scalp where you don’t have affected hair, fat hair follicles, and you place them into the affected area,” she told QCity Metro.

Dr. McMichael said that having a surgeon who specifically understands how to do that in people of color and how to transplant Afro-textured hair is important. 

“It does take some skills that are different from [operating on a] straighter-haired population,” Dr. McMichael said. “I think we definitely need to train more of our dermatologists to do this.” 

But, these treatments could be inaccessible to some due to price.

For example, a hair transplant can cost anywhere from $6,000 to $20,000 and require multiple rounds of treatment, Dr. McMichael.

“The average person may not be able to afford that,” Dr. McMichael said. 

Treatments can last up to nine months to a year, according to Evans. 

“Normal hair restoration takes about nine months, just the same as a baby,” Evans said.

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