Alopecia is no laughing matter for millions of black women

The slap that overshadowed the Academy Awards ceremony was sparked by a joke about Jada Pinkett Smith’s lack of hair, with husband Will Smith objecting violently to comedian Chris Rock mocking the actress’ shaved head.

Away from the recriminations over what could be perceived as a mean-spirited jibe and a disproportionate response, many people will sympathise with Pinkett Smith. As millions of women in the US and around the globe will attest, hair loss is no laughing matter.

The Conversation asked dermatologist Danita Peoples of Wayne State University’s School of Medicine about alopecia and why certain forms of it can disproportionately affect black women.

1. What is alopecia?

Alopecia is a medical word that refers to hair loss generally. There are descriptors added which can refer to where the hair loss is occurring, or to the cause of it. Traction alopecia, for example, is hair loss from trauma or chronic inflammatory changes to the hair follicles.

2. What causes alopecia?

Traction alopecia happens when there is trauma to the scalp, where the hair is being pulled or rubbed on a regular basis, causing inflammation around the hair follicles. This can lead to hair loss or thinning.

Alopecia areata describes hair loss to a particular area. It has different levels of severity so there might be just a coin-sized area of hair loss on the scalp, or it could affect large areas. It can occur any place on the body.

It might result in complete hair loss on the scalp, which is alopecia totalis. Some people lose eyebrows or see thinning of their eyelashes.

People can also have alopecia universalis, which is a loss of hair on the entire body.

Alopecia areata is considered an “immune-mediated” type of hair loss. The immune system is attacking the hair follicles. It has to do with T-cells, the important white blood cells in the immune system.

Other autoimmune disorders can have alopecia associated with them. This is the form of alopecia Pinkett Smith has said she has.

Lupus is an autoimmune disorder that can lead to hair loss. One type is systemic lupus erythematosus. Another type, discoid lupus erythematosus, primarily affects the skin and can cause hair loss with scarring on the scalp.

Thyroid abnormalities can also be related to hair loss. When patients come to me with hair loss, the first test I may order is a thyroid study.

3. Who does it affect?

Anyone can get alopecia. Alopecia areata can show up at any age, from children to adults, and in both men and women. However, it’s more likely to affect African-Americans than white or Asian-Americans. About one million people in the US have alopecia areata.

Traction alopecia can affect people in certain professions, like ballerinas, who wear their hair up in buns all the time. The pressure and friction from sports headgear, such as helmets and baseball caps, can also cause hair loss. In some parts of northern Europe, where it is common for people to pull back their hair back on a regular basis, there are higher rates of traction alopecia. Traction alopecia affects one-third of women of African descent, making it the most common type of alopecia affecting black women.

4. Why is traction alopecia so common among black women?

That is due to certain hair styling practices black women use —wearing tight weaves and extensions, straightening with heat, that sort of thing. Hair is a big deal among African-American women in a way it isn’t for others. When I was growing up, my older relatives told girls our hair was our “crowning glory”. They made a big deal about us keeping our hair looking stylish and well-groomed, and that usually meant straightening it.

I believe there’s less pressure than there used to be for black women to keep our hair straightened, in the workplace and elsewhere.

5. How is alopecia treated?

It depends on the cause. There are injected or topical corticosteroids for alopecia areata. If it’s due to a nutritional deficiency, like iron or protein, obviously you simply need to correct the deficiencies with supplements or by changing your diet. When it is caused by traction or discoid lupus, if you don’t treat the inflammation on the scalp soon enough, the hair loss can become permanent.

When it comes to traction, it’s much more about eliminating the practices that cause the problem in the first place. What’s happening is more people are aware of the downsides of chemical and heat applications to straighten hair and are using those damaging processes less.

One thing that may help is the CROWN Act, legislation introduced last year, which the US House passed on March 18 2022. That would make it illegal to discriminate against people wearing natural styles, such as Afros and braids, so I am hopeful it will contribute to a lot less traction alopecia in the future.

• Danita Peoples: clinical associate professor of dermatology, Wayne State University

This article was first published by The Conversation.