African american women, hair care, and health barriers.

OBJECTIVES: The objective of this study was to elucidate the prevalence of hair loss among African American women; explore the psychosocial impact of hair grooming difficulties; and examine both perceptions related to physician encounters in this group and the relationship between hair grooming, physical activity, and weight maintenance. DESIGN: An anonymous retrospective and qualitative survey, the Hair Care Assessment Survey, is an 18-question novel survey instrument designed at the Henry Ford Hospital Department of Dermatology Multicultural Dermatology Center. SETTING: The Hair Care Assessment Survey was distributed at church-related functions at predominantly African American metropolitan Detroit churches. PARTICIPANTS: Two hundred African American women from metropolitan Detroit, Michigan, aged 21 to 83. MEASUREMENTS: The Hair Care Assessment Survey collected data relating to hair loss and hair care, psychosocial experiences relating to hair loss, and hair care as it relates to exercise and body weight management. Data was collected on doctor-patient hair-related medical visits and experiences with commercially available ethnic hair care products. RESULTS: More than 50 percent reported excessive hair loss. Twenty-eight percent had visited a physician to discuss hair issues, but only 32 percent felt their physician understood African American hair. Forty-five percent reported avoiding exercise because of hair concerns, and 22 percent felt that their hair impeded maintaining healthy body weight. CONCLUSION: Hair loss affects a compelling number of African American women, and a significant number express dissatisfaction in hair-related physician encounters. Additionally, hair styling problems present a serious impediment to physical activity and weight management among this already high-risk population.

Hair care practices and their association with scalp and hair disorders in African American girls.

BACKGROUND: Few studies have extensively examined the prevalence of hair care practices and their association with scalp and hair conditions in African American girls. OBJECTIVES: We sought to determine the prevalence of hair care practices and their association with traction alopecia, seborrheic dermatitis (SD), and tinea capitis (TC). METHODS: A questionnaire was administered to caregivers of African American girls aged 1 to 15 years. Multivariate analyses were performed to determine the association of hair care practices with reported disorders. RESULTS: A total of 201 surveys were completed from dermatology (n = 98) and nondermatology (n = 103) clinics. Mean patient age was 9.8 ± 4.4 years. Essentially all respondents reported use of hair oils/grease (99%). Ponytails, braids, and cornrows were worn by 81%, 67%, and 49% of girls, respectively, within the past 12 months. In all, 61% reported hair washing every 2 weeks; 80% used hot combs; and 42% used chemical relaxers. Cornrows were significantly related to traction alopecia among respondents from nondermatology clinics only: adjusted odds ratio = 5.79 (95% CI 1.35-24.8, P = .018). Hair extensions and infrequent hair oil use were significantly related to SD: adjusted odds ratio = 2.37 (95% CI 1.03-5.47, P = .04) and 3.69 (95% CI 1.07-12.7, P = .039), respectively. No significant associations were observed for TC. LIMITATIONS: Small sample size and disorders reported by caregivers were limitations. CONCLUSIONS: Certain hair care practices were strongly associated with development of traction alopecia and SD. No association was found between hair washing frequency and SD or TC, or between hair grease use and TC. These results can be used to inform practitioners, advise parents, and adapt treatment regimens to accommodate cultural preferences.

Hair grooming practices and central centrifugal cicatricial alopecia.

BACKGROUND: The cause of central centrifugal cicatricial alopecia (CCCA) in African American women remains to be elucidated. OBJECTIVE: This study was designed to determine the hair-grooming practices in African American women with and without CCCA and to evaluate possible etiologic factors. METHODS: Utilizing a novel survey instrument, the Hair Grooming Assessment Survey, we performed a retrospective comparative survey of the hair-grooming practices of two populations of African American women seen and evaluated at the Department of Dermatology, Henry Ford Hospital in Detroit, MI, between 2000 and 2007. The case group were women with clinical and histologic diagnosis of CCCA, and the control group were those without a history of alopecia. RESULTS: All 101 surveys that were returned were analyzed (51 from the case group and 50 from the control group). A strong association was found between the use of both sewn-in hair weaving and cornrow or braided hairstyles with artificial hair extensions and CCCA (P < .04, P < .03, respectively). Similarly, women with CCCA were more likely to report a history of "damage", typically defined as uncomfortable pulling and tenderness, from both sewn-in and glued-in weaves, and from cornrow or braided hairstyles with artificial hair extensions (P < .001, P < .02, and P < .03, respectively). In contrast to previous anecdotal beliefs, no correlation was found between the use of either hot combing or hair relaxers and the development of CCCA. LIMITATIONS: Results are limited by patient recall of past hair grooming practices. Also, as hair grooming practices may vary by geographic region, these results may not be generalized to all women of African descent. CONCLUSION: There is a clear difference in both quantitative and qualitative hair grooming practices among African American women with CCCA.

Central centrifugal cicatricial alopecia: past, present, and future.

Clinical scarring alopecia in African American women has been recognized for years. The classification of this unique form of alopecia dates back to Lopresti, who first described the entity called "hot comb alopecia." More recently, the term "central centrifugal cicatricial alopecia" has been adopted to describe a progressive vertex-centered alopecia most common in women of African descent. While this form of hair loss is widely recognized, and may even be on the rise, the causes of central centrifugal cicatricial alopecia are a constant source of debate and remain to be elucidated. This review outlines the descriptive evolution of central centrifugal cicatricial alopecia and the historical controversies ascribed to its pathoetiology; it also examines African hair structure and discusses how hair structure along with common physical and chemical implements utilized by individuals with African hair type may play a causal role in the development of central centrifugal cicatricial alopecia.

Narrowband UVB phototherapy for early-stage mycosis fungoides.

BACKGROUND: Narrowband UVB (NB-UVB) phototherapy has been shown to be effective for the treatment of various dermatoses. OBJECTIVE: We evaluated the effect of NB-UVB in the treatment of early stage mycosis fungoides (MF). METHODS: The response of 24 patients (12 stage IA, 12 stage IB) with patch stage MF to thrice weekly NB-UVB was assessed. Twelve patients had skin phototypes I-III, and 12 had types IV-VI. Seven patients had hypopigmented MF. Mean follow-up period was 29.0 weeks. RESULTS: Thirteen patients (54.2%) had a complete response (CR), 7 (29.2%) had partial response (PR), and 4 (16.7%) had no response. Specimens from a repeat biopsy in 10 patients with CR showed histologic clearing in 9 of them. Upon discontinuation of treatment, 4 patients with CR relapsed, with a mean time to relapse of 12.5 weeks. CONCLUSION: NB-UVB is a viable, comparably safe, and easily administered alternative in the management of early stage MF.