Hair grooming practices, such as braids and weaves, as well as inflammation in the form of bacterial infection, may be contributing to the development of scarring hair loss in African American women, according to a report posted online today that will appear in the August print issue of Archives of Dermatology, one of the JAMA/Archives journals.

"Central centrifugal cicatricial alopecia (CCCA) is a term coined by the North American Hair Research Society to describe a scarring hair loss, centered on the vertex of the scalp, that spreads peripherally," the authors write as background information in the article. "It is thought to be the most common pattern of scarring hair loss seen in African American women, yet so little is known about its true prevalence among them."

Angela Kyei, M.D., M.P.H., and colleagues at the Cleveland Clinic, Cleveland, Ohio, conducted a study to investigate medical and environmental risk factors for CCCA. A total of 326 African American women answered questionnaires at two African American churches and a health fair in Cleveland. The researchers analyzed data on the study participants' demographics, family and medical history, hormonally driven conditions, and methods of hair grooming.

The study results suggest there is a high prevalence of central hair loss among African American women. "Advanced central hair loss with clinical signs of scarring was seen in 59 percent of these respondents and was interpreted as clinically consistent with CCCA," the authors report. "Diabetes mellitus type 2 was significantly higher in those with CCCA, as were bacterial scalp infections and hair styles associated with traction (e.g., from braids and weaves)."

The increase in type 2 diabetes among women with CCCA is in line with recent theory that cicatricial alopecia may be a manifestation of metabolic dysregulation.

"The results of this study suggest that hair grooming practices that cause traction, such as weaves and braids, may be contributing to the development of CCCA because these styles are more commonly used in those with the most severe central hair loss to increase hair style versatility while camouflaging hair loss," the authors write. "Given the fact that many African American women pay hundreds of dollars to have their hair braided and weaved, they often maintain these hair styles for weeks to months at a time to justify the money spent. The resulting prolonged traction can produce chronic folliculitis, which can eventually lead to scarring."

Source: JAMA and Archives Journals