Thin Hair in African American Female

/by William Rassman, M.D./1 /,

african american 40 yr old female. I have thin hair with approx 1 inch of traction alopecia around my hairline. Tiny visible thin hairs are present on the hairline, had little growth over five year period but they don’t seem to grow long or thicker. please help. I can’t afford a transplant. will it ever grow back since hair is present? a dermatologist told me it may grow.

Other than hair transplants or possibly a hairline lowering procedure, there is not much that can be offered to you. These types of surgeries will cost possibly around $10,000. I can’t be more specific on pricing averages without seeing you first. Wigs of varying types are often the solution used for many women in your situation.

My Hair Keeps Falling Out In the Same Spot

/by William Rassman, M.D./0 /,

I am a 21 year old African American Female. I started to relax my hair for the first time at about fourteen years old and after a couple months (maybe 6) the hair at the back of my head began to fall out. I then proceded to braid my hair for the next two years and relaxed it again at 16. Again, following a couple of months my hair began to fall out at the same place – the left corner of my head. I put it in braids again. I permed my hair for the last time when I was 18 and then decided that I was going to go natural. I braided my hair for the next two years to gradually grow out my natural hair. I now do not process my hair chemically (or hotcomb it) at all. However, last year after wearing my natural hair out for about 8-9mths my hair fell out in the same place again. Basically – My hair falls out repeatedly in the same place – the left corner in the back of my head. All the rest of my hair seems relatively fine. I usually put my hair in braids when this happens and the vast majority of the hair grows back (pretty quickly too). But after taking the braids out and leaving my hair out for a while, natural (no chemicals, or straightening products – just in a straight afro) it repeatedly breaks in that spot. HELP!! Do you have any hints into what is going on ?

Braiding will cause hair loss from constant pulling pressure, meaning Traction Alopecia. This is a known permanent cause of hair loss in the African American community. All of the things you discussed can cause permanent hair loss if you persist in doing them. I can not tell you if you are past the point of no return, but would strongly advise that to prevent further hair loss, you should avoid braiding and everything else you are doing to your hair. After a year or so, you will know what your new baseline is.

Many women in your situation find that if they put a stop to the things that they are doing to get the style they need to function on a daily basis, then I understand that the problem and the solution clash. Even the wigs used by some women can produce traction alopecia if they pull on the hair, so you have to find a balance between your social needs and the costs (in hair loss terms) between the things you do.

African American Dermatologist?

/by William Rassman, M.D./14 /,

Is there a way to find a national listing of African-American dermatologists? I am especially interested in those that deal with hair loss in the african-american female.

Thank you.

I don’t believe that you need to have an ‘ethnic’ doctor to understand the nuances of African-American hair loss. It will be far more valuable for you to indentify a good dermatologist or hair doctor who has a specific interest in hair loss. Some of these can be found on the physician search at ISHRS.org, or American Academy of Dermatology. There are many causes for female hair loss, such as braiding (dreadlocks), hypothyroidism, iron deficiency, malnutrition, stress, hormone imbalance, contraception, high blood pressure medication, warfarin, eczema, psoriasis and other inflammatory disease. These diagnoses and other causes for hair loss are general people/female problems, not specifically African-American ones.

Folliculitis Decalvans

/by William Rassman, M.D./3 /,

Hello Doctor,
I am a 22 yr old African American that has been diagnosed of folliculitis decalvans. I am losing my hair at my crown area at an ernomous pace through scarring. I have had this for several years (8yrs). I have been on several medications but they only seem to have an impact in the beginning. Please is there anyway of aggresively treating this disease as well as recovering my hair in the scarred regions. If you have any dermatologic recommendations around the Tri-state area i would be grateful. Thank you.

This is a difficult problem and you must find a doctor with a particular interest in this disese as well as the training to deal with it. Check with the American Academy of Dermatology for a referral channel for this problem. If the dermatologist is uncomfortable with this, then he/she should refer you to an appropriate expert.

FUE for African American Hair

/by William Rassman, M.D./0 /,

Question / Comments:
How effective is FUE on African-American hair? What are some of the challenges with African-American proceedures. I would like to have side-burns which I have minimum growth now. Is scarring more prevelant with darker skinned people?

Thanks for your responses.

FUE on African-American hair is very difficult to perform, but if you are serious, we can test your hair to find out how good a candidate you are. If your hair is kinky, you might not want kinky hair on the side burns. This is a real risk. Darker skinned people usually have more scarring risk, but this is not the case in the scalp as much as other parts of the body. As I have an office in San Jose and you indicated that you are there as well, you should come by for a visit. If, after the consultation you want to take the next step, then a biopsy would be indicated to determine your candidacy for FUE. Call my office at 800-NEW-HAIR to setup a free consultation.

Transplanting African American Women

/by William Rassman, M.D./0 /,


I am a 38 year old african american female. Like many other women of color, I began thinning in the top of my head as well as around my hairline. To make matters worse, my occupation requires me interact with many people in public places. Needless to say to go from beautiful hair to wearing a hair weave (to stop chemical processing) has damaged my self esteem(my hair is braided underneath a hair net). I am hiding my problem from family and friends and do not like being seen in public. I have acquired a biopsy and have been told that it’s probably due to genetics or stress. I have been to clinics that offer to match a hairpiece that is bonded with “medical glue” but the maintenance cost along with having to go back every six weeks for life did not appeal to me. I have not seen many photos of women of color with hair transplants; is this realistic? Please let me know if you perform this process; It is hard watching my self esteem deteriorate. Please help…

I am so glad you decided to write, because there is definitely hope for someone such as yourself and there is so little material available to TELL you that! You are correct – it is not generally advertised, but women of color do very well with hair transplant as a general rule. Because African-American hair is curly/kinky and because it matches the darker skin tones, you generally get good coverage and very nice results. You need to be careful if you do not have good donor areas, or if you have a history of keloids (abnormal scar healing), but for most cases you have a lot of options.

Clinics that offer glued attachments of hair to your head are not medical doctors and the products that they attached with the glues will accelerate hair loss and produce traction alopecia over time. Unless you plan on keeping this up, getting hair systems is not a wise choice.

The first thing you need to do is to meet with a respected hair doctor for a consultation. They may recommend a set of blood tests to rule out the many other causes of hair loss in women that can masquerade as genetic alopecia. You have had a scalp biopsy already, so you won’t have to do another (I’d bring those results to your doctor when you arrive for your appointment). Depending on your test results, there might be some drugs you can try before jumping straight into surgery.

In any case, please do not let this hurt your self-esteem. Studies show that women are especially impacted emotionally by hair loss, much more so than men and in more dramatic ways, even though men suffer it more commonly. Remember above all that there IS hope and treatments available. Go see your doctor! The fact that you have taken the time to write is an excellent first step.

DHT, Hair Lasers, Chemotherapy, and Finasteride

/by William Rassman, M.D./0 /, ,


I have a few questions about androgenic alopecia and I’d be very happy if you could answer them for me:

1. What is a bigger factor for hairloss the quantity of DHT in the serum or in the scalp? If the scalp had levels of DHT at 0% would this stop hairloss? If that is the case is there a topical drug like Rogaine with finasterid instead of minoxydil and would it decrease scalp DHT levels better than oral tablets?

2. What is your opinion on the Lasercomb device that uses lasers to improve blood circulation in the scalp? Since minoxydil also improves blood circulation and is supposedly ineffective on the frontal area of the head would this device have the same downside?

3. Father of a friend of mine had cancer and had to undergo chemotherapy. My friend told me that chemotherapy improved his hair and even made it grow darker than before. Could there be any truth in this?

4. With propecia losing its effect over time I often see that people increase the dosages of finasteride up to 5mg per day. Would these higher doses really help or are you just putting your health at risk?

This is not really a question just observation on my part: everytime I see the after and before pictures of hair transplants the comparisons aren’t realy fair since the before picture usualy has more intensive lighting and hair combed straight forward or back and is often greasy while after picture has less intensive lighting and different position of lights and hair is combed to the side and it looks like it has just been washed. It would be nice if all pictures would be made with people having wet hair combed straight forward or back so people could really see the difference.

Thank you for your time and answers.

Whew! You need a whole hour-long cosultation with a hair doctor to answer all of these questions, but I’ll try to give you some short answers in the meantime.

  1. DHT and genetics are the biggest factors in hair loss. DHT is a hormone that is present in your blood (which flows through the scalp but does not reside there). There are no topical formulations of Finasteride (the molecule is too big). Any topical medication for hair loss would need to be a small enough molecule to penetrate the skin and have an effect. Minixodil does penetrate – which is why it works. Rubbing Finasteride on your head will not help and it will waste the Finasteride.
  2. Do a search for “laser” here. To reiterate, there is no conclusive data on the effectiveness of laser therapy for hair growth.
  3. Chemotherapy can occasionally change the character (color, curliness, thickness, etc) of hair in addition to many other unusual side effects. However, the idea of taking chemotherapy just to improve your hair is ridiculous. Chemotherapy drugs can kill you, they are used when the alternative is death. Hair changes post chemotherapy are absolutely the truth, though.
  4. Propecia may lose its effectiveness over time (the data presently now goes out only 7 years), and some patients continue hair loss, hopefully at a slower rate. There is no evidence that higher doses will reverse this, but neither is there evidence that higher doses of finasteride pose an increased risk to health.

Finally, your observation is correct – there are methods of taking photos which will give the misleading impression of increased hair density/thickness/coverage. To really compare, similar photos need to be taken in similar lighting conditions with duplicated angles and styles. Wetting hair before and then showing dry hair after is an especially obvious tip-off that the comparison is invalid!

Hair Loss from Wigs

/by William Rassman, M.D./0 /, ,

Hi,

I am a 52 year old African American female, who has had the struggle of being bald most of my life. When I was 12 I had a severe case of chicken pox, and left me scarred all over. Fortunately, I recoved with the skin, but the disease left large bald spots all over my scalp. I have worn wigs .. seems like forever.

The problem is no one has ever been able to help me through the years, and the wigs that I always wore, are taking out the remaining hair I have left on my head.

Is there someone I can see, to help me with this problem. I have used medications, hair weaves, etc to no avail.

Thanks

Wearing a wig for many years can cause further hair loss as a result of the traction caused by the wigs. Traction Alopecia is common in wig wearers, those who wear turbins, and even in those women who pulled their hair into tight pony tails. Send your photos or if you are planning a trip to Los Angeles, visit my office so that I could better evaluate your situation. There are a few questions I need to answer, but can’t do so until I can see your hair loss. These questions include: What is your donor supply like? Is there enough hair for redistribution with hair transplants?

African American Hair Expert

/by William Rassman, M.D./7 /,

I’m an African American female and want to know which is better for my hair, pressing with a hot comb or using a non lye relaxer (like Precise). Also, I have hair loss and hair is very thin. I had a hair restoration in June 2005 by Bosley. Can you please recommend things I can do to improve my hair? Do you consider yourself an expert in dealing with African American hair?

I believe that I was the first person to place follicular units into an African American and started the trend that allowed for the use of small grafts in African hair types. As you may know, hair transplantation is a ‘peg in a hole’ surgery, but African hair is curly (like a cork screw) and therefore placing it into a round hole can be a difficult challenge to the inexperienced hair transplant surgeon. I guess that would make me an expert for transplants into African American hair types.

With regard to your other question, I am not an expert in the best ways to ‘relax’ hair, but I see problems with those individuals who have this done improperly. I am an expert in the complications of such treatments. I would have to examine you to make any recommendations.

Female Hair Loss from Diet Pills?

/by William Rassman, M.D./0 /,

I am getting bald in the top of my head and also on the left side of my head. Not sure what the problem. I was told that if you took a lot of diet pills in your younger days (of which I did) that would cause it. Please help me on this matter. It is very embrassing to go bald at the age of 42. Not that is matters but I am a black female.

Actually, race and sex do matter since certain backgrounds tend to produce certain types of hair loss. In your case, diet pills taken many years ago are not high on my list of causes for hair loss, although extreme diets and conditions such as anorexia and bulimia definitely do weaken hair and cause loss. For a final and accurate answer, you would really have to be examined and tested by a hair doctor (get your scalp mapped out for miniaturization) or a dermatologist, but I suspect you might want to review the many previous blog entries about Female Hair Loss to understand the various causes of hair loss that must be considered.

On a more positive note, hair loss in certain hair types (for example African-American hair or kinky/curly hair types) gets better results from replacement surgery and/or other treatments. Depending on what type of hair loss you have, you may still have many options for treatment, so don’t despair!

Pimples After Surgery Caused Skin Change

/by William Rassman, M.D./0 /, , ,

Dear dr. Rassman. Thank you for having time to answer questions concerning hair loss.

I am a black man. I had an FUE operation about 6 months ago. The donor area at the back of my head healed very well, but in the receiving area I got small pimples almost in every grafts incision (1000 grafts) in the front area of my head which looks different from the rest of the smooth skin. The hair is growing but it is not that dense to cover this area. These pimples are well seen especially from certain angles or according to the light reflection. I am really worried about if these skin changes will be permanent. What shall I do? Do you have any advice for me???

Pimples can be caused by sebum collections below the skin edge, but should have gone away within the first few months. FUE grafts should be trimmed, for if they are not trimmed and divided into their respective follicular unit, they will contain too much skin. The added skin will produce a skin deformity at the recipient site like the cobblestonning I talk much about in my published articles. The way light is reflected is an indication that too much skin may be have been left on the FUE graft or that the FUE graft was not separated into individual follicular units. Rarely, people with dark skin will tend to cause more scarring than those with very fair skin. Changes in the recipient area with a hair transplant do occur if you had atrophic skin (skin that lost much of the supportive infrastructure from blood vessels to glands, muscles and fat) or your hair is coarser, or if the surgical instrument used was large (by large I mean greater than 1mm, as a slit graft) or combinations of any of these factors. Today’s surgeons will use very small cutting instruments to minimize the skin wounds, hence the pitting or skin changes that could occur when the wounds are made too large. Skin deformities in the recipient area are rarely detected with small cutting instruments. Without seeing you directly, it would be hard to determine if any of these factors (or other factors) are playing a role here. I would expect that most people should not have this complaint, but just the other day I met a patient who had surgery from another medical practice with a similar complaint and I barely could see what was bothering him. This man had a body dysmorphic disorder. To determine your situation, either come in to my office (if you are in California) or at the least, send photos to the address on the Contact page.

Thinning Hairline in African-American Woman

/by William Rassman, M.D./2 /,

I am a 42 y/o black female. My hair started thinning around the hairline about 2 years ago. At first I thought it was some of the chemicals being used by my hair stylist. I have changed to another stylist, but the problem persits. I recently went to a dermatologist who started me on Rogaine. However, the site for Rogaine states that it is for hairloss in the top of the scalp. Is there any treatments that will help thinning hair around the hairline? I understand that this is uncommon for women? Please help, this has effected me emotionally.

There are a few important issues to address in your question. The first thing to note is that all salons use similar chemicals so you might want to stop chemically treating your hair altogether for several months to see if it recovers. The second issue is whether or not you have a tight braid/ponytail type of hairstyle or have had recent facial plastic surgery (like a brow or a face lift) since both of these can result in the hairline thinning you describe. You are correct in that women rarely lose their hairline with female pattern/genetic hair loss, but it can happen and that is why you should be examined by a doctor who specializes in hair with an indepth assessment for miniaturization.

Finally, Rogaine has been studied best at the top of the scalp, but I have seen some hairline results in women so it is worth a try. Unfortunately for women, there are no medical alternatives for thinning hair other than Rogaine. It is also noteworthy that hairloss can profoundly affect a woman’s emotional health, much more so than with men although men suffer hairloss more commonly. I would urge you not only to proactively address the hair loss, but to take steps to treat the emotional impact it is having on you as well.

Steroid Creams and Hair Loss in Women

/by William Rassman, M.D./0 /,

Hello Dr. Rassman

I have a major problem. I am 39 y.o. black female. I see a dermatologist for severe psoriasis in the palm of my hands and my feet. I have had this problem now for more than five years. I was not diagnosed with psoriasis until jan of this year. I saw podiatrists, dermatologists, allergist and no one diagnosed me with this condition. These doctors could not tell me what was wrong with me, they gave different diagnosis and treated me for latex allergy fungus, no sweat gland, vitamin b12 injection, prednisone, lamasil, and none of these treatments worked. I finally gave up and changed doctors and my primary sent me to a dermatologist in the Tampa Bay area. He took his time and treated me with different medications like clobetasol, propionate cream, different ointment combinations, and different creams such as salex, naftin, etc, etc. He did a biopsy on my foot, because at this time the psoriasis was creeping up my legs. That’s when I was finally diagnosed with this problem. I was placed on soriatane with the lowest dosage and then he increased it. I could see a difference in a few months. My labs were monitored monthly and I knew of some of the side effects and the problems that goes along with taking this med, but I was happy. I was in the process of taking soriatane qod until all the pills were finished. While I was in JA on vacation, the hair dresser noticed a bald spot on my scalp the size of a 1/4. It was not there when I left the USA. I have been getting relaxers, weaves, braids and wearing wigs for many years and I also have a hair dresser. She has been taking care of my hair very well and I had no problems. My scalp was itching me very badly and my scalp was tough and leathery and very dark. My hair was breaking and falling out pretty badly. When I washed my hair the shower floor was covered with hair. I got very scared and when into a depression which sent my self esteem in a tail spin. I saw my dermatologist and he gave me a topical abt for scalp due to the itching. The problem still persist and I had a biopsy done on the spots that were bald. The results were neg for any disease process. He told me I was losing my hair due to braids and relaxers and tension on my scalp and I should look into having hair replacement done. That still did not tell me how I came to have bald spots that seem to pop up over night and losing almost half the amount of hair in the front and middle. The back is still thick and less hair loss is seen there and no bald spots but I continue to have an unbearable itch to my scalp. I have not started any kind of treatment as yet. Its about 2 1/2 months now. I have to wear wigs everyday now. I don’t go to the hairdresser any more. I don’t want anyone to see me without hair. I don’t know what to do anymore. I would like to know if the soriatane and other steroid creams could cause my hair to fall out and if it would ever grow back. Will this itching ever stop and will my scalp feel like scalp again? Please give me some hope. I am desperate. Thank you.

I went to the internet to look up Soriatane, which is related to Accutane (known to cause hair loss). This drug does cause depression, amongst other things. One lawyer has a website where he warns people about this drug: Soriatane Overview at YourLawyer.com

Braids do cause hair loss, as does genetic propensities, and an entire class of most drugs have hair loss as a stated side effect. It sounds like your case is too complicated for me to just make a stab at your problem via the internet. Steroids are a cayuse of hair loss also and you must be careful with their use. Even creams with steroids in them will absorbe through the skin and they can impact your body’s cortisone balance if they are used regularly. This is too important of an issue to not have a good doctor meet with you in person to take charge of your problems, as evident by your desperate email.

Transplanting African Hair

/by William Rassman, M.D./0 /,

HI I understand that hair transplant is not favorable for black man. it causes spots pimples and scarces!
do you know of a procedure that would work! I am located in montreal Canada

Simply stated, you are incorrect. Black people do great with hair transplants, often better than white people because the color contrast between hair and skin is low, and the hair has a very curly character which is a far better characteristic than the straight hair of an Asian, for example. Also, scars and pimples are rarely a problem. Sometimes, surgeons do not want to perform hair transplants on people with African hair because it is a more difficult job for the surgical team and requires a high degree of skill, more than on Asians and Caucasians.

Body Hair Transplant Case Studies?

/by William Rassman, M.D./0 /,

I know you recently stated that you were reviewing the progress on transplants using body hair. Have you done any case studies? Do you believe this will be a viable alternative to those prone to scarring with donor hair taken traditionally from the scalp. Since many like me have a chest full of hair with, I’m assuming limited donor hair due to previous surgeries.

I have had three previous surgeries, none within the last six or seven years. My last surgery having been performed by Dr. Bernstein. I have had considerable hairloss since my last surgery. I am thinning to about a 5A. I have two linear keloid scars in the back of my scalp. Not to mention some cobblestoning in the front of the hairline, that is very difficult to hide with the increased balding. I would really like to have surgery soon, but I am worried about further scarring, and receiving transplants producing little or no real hair growth for my money and time. By the way, I am African American.

I would suggest that you consider another visit with Dr. Bernstein. With that said, body hair transplants are still unproven and are experimental procedures only, at this time. In African Americans, the risk of keloid scarring is higher than in Caucasians, and you have a higher risk of keloid scarring on the body than on the scalp. In addition, the recipient site will almost certainly develop white scars. In an African American, these scars may become very noticable, far more than in Caucasions. Read the past blog entries for my previous posts about body hair transplantation here, here, and here.