Dear Ms McDaniel,

I saw your article in The Gleaner about dandruff and thought that maybe I could get some advice on the reasons why women experience hair loss especially on the sides of the head. Over the last two months, I realised that my hair has been falling out by the roots. The shedding is mostly from the left and right sides of my hair (hair line). I also realised that, in recent times, the thinning has been moving further inwards where I can almost see my scalp. There are times when that area feels somewhat tender and if you pull at the hair it pops out from the root.

I have tried treating my hair with various types of hair treatment and I have taken biotin tablets and so on. I used to use curling irons and have stopped; I also occasionally wear hair extensions. I am really distressed about this and would like to know what I can do to stop the thinning and maybe a recommendation on how to get my hair growing again.

Dear Reader,

Thank you for your questions which are always welcome. Regarding the loss of your hair, I can appreciate your distress. Alopecia is the medical term used to describe excessive or abnormal hair loss or baldness. Alopecia is mistakenly thought to be a strictly male condition but in some countries close to 40 per cent of women have it.

Forms of alopecia

There are different forms of alopecia, diagnosed according to its appearance, symptoms experienced and varied underlying factors such as gender, heredity medication intake, diseases, hairstyling practices, hormonal imbalance, stress, pregnancy, and so on.

At first glance at your situation, I believe that you are having traction alopecia. Traction alopecia, as the name suggests, is caused by localised damage and trauma to the hair follicles due to wearing hairstyles, over a long period, which have high tension and constantly pull at the hair. The most common styling causing this condition are tight ponytails, corn rows (or cane rows), braiding and weaving the hair.

Traction alopecia is very common amongst us Black women who braid our hair too tightly and in children and young adults. Hair loss is often at the front and side regions of the head as you have described. In people who wear corn rows or braids, the most affected areas are those immediately alongside the braids. Interestingly, I met an Afro-Caribbean man recently who told me that each time he goes to the hairdresser to have his hair corn rowed, he takes two painkilling tablets before and after. But he keeps going back, since his hair looks so tight and neat, and the rows well-defined.

Excessive heat

Traction alopecia can also happen due to using excessive heat, as you have described (curling iron), or chemically treating the hair with dyes, bleaches or hair relaxers. Hair glues used to install hair pieces are another factor. Some hairdressers place more emphasis on the hairline when they apply straightening techniques (hot-pressing or relaxing) since these areas are the first to show new growth of natural hair. These practices set us up for traction alopecia, since they disrupt the structure of the hair protein keratin, making the hair shaft weak. Combing or brushing this hair may then result in heavy falling out.

Unfortunately, some women who recognise the heavy falling out of hair choose the solution of weaving the hair to give it a break. In many cases this 'therapeutic' weave places excessive tension on the weak hair shaft causing more hair loss with the hair line being eroded farther and farther inwards.

Treatment

The first rule of treating alopecia is getting the correct diagnosis. This is best done by a skin specialist (dermatologist). If there is an underlying physical problem it would be corrected first. The good news is that traction alopecia is reversible if it is diagnosed early. Hairstyles would need to be changed for looser, gentler styling. The dermatologist may advise about whether or how to continue chemical processing based on the extent of the alopecia.

Late-stage traction alopecia cannot be corrected easily since the hair-loss is permanent by then. A surgical procedure called hair transplanting is possible. Androgenetic alopecia, a common form of alopecia, and its treatment will be addressed in a future article.