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Hair and Scalp Disorders


Overview of Scarring Alopecia


Cicatricial Alopecia is defined as a group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss.  This group of disorders is referred to as scarring alopecia.  Prior to or during hair loss, other symptoms are often presented.  Itching, pain and burning can accompany the hair loss. However, hair loss can progress gradually or rapidly without any other symptoms.

This form of alopecia is said to include inflammation that destroys the follicle below the skin’s surface. Although inflammation is noted, often there is no redness, scaling, or pustules visible on the scalp.  As stated in the April 2011 edition of Skin and Allergy News, “Cicatricial alopecia is still poorly understood.”  The only fact that can’t be challenged is that all cicatricial alopecias involve inflammation directed at the upper part of the hair follicle where the stem cells and sebaceous glands are located.  Whenever the stem cells and sebaceous glands are destroyed, there is no possibility of hair regrowth.  Therefore, permanent hair loss is the ultimate result.

Cicatricial alopecia is split into two groups:  primary or secondary.  Primary is where the hair follicle is the target of the destructive inflammatory process.  In the secondary form, destruction of the hair follicle is a result of an external issue unrelated to the follicle.  For example: injury, severe infections, burns, radiation or tumors. Although there are several forms of cicatricial alopecia, this discussion will be confined to Central Centrifugal Cicatricial Alopecia (CCCA).


CCCA is referred to as an “idiopathic” condition.  This means that there is no proven or known cause.  There are also no known treatment or cure for the condition.  Let’s start by breaking down the meaning of CCCA. Central (begins in the middle or central portion of the scalp); Centrifugal (the hair loss radiates outward on the scalp); Cicatricial (scarring of the hair follicles);  Alopecia (hair loss).  In researching CCCA, it can fall into both categories of cicatricial alopecia.

 There are several hair related practices that have been recorded to lead to CCCA.
·      Improper chemical treatments (relaxers and dyes)
·      Excessive heat

·      Chronic tension (braids, weaves)

Other causes noted involve burns, which can be a result of chemical treatments or hot irons.

CCCA is said to occur almost exclusively in African American women.  The demographics often include middle-aged women.    The typical process of CCCA is:
·      Scalp itching, burning, tenderness or no symptoms
·      Thinning starts near the vertex or top of the scalp (gradually or rapidly)
·      The thinning spreads in an outward direction
·      Balding becomes visible and is usually smooth and shiny with decreased hair density

·      The remaining surrounding hairs are dry and brittle

When researching this condition, it was noted that most patients suffering from CCCA used chemical relaxers, dyes, and/or weave extensions with great tension.  However, the Cleveland Clinic Institute of Dermatology and Plastic Surgery continues to reiterate that the cause and risks are still unknown.  The study that they completed earlier this year included the following findings:
a.    Traction, such as weaves and braids, could lead to CCCA.  This is so because traction can lead to folliculitis of the scalp.  If inflammation is prolonged, scarring is possible.

b.    The use of chemical relaxers could not be proven to cause scarring because there is no proof that the chemical can be absorbed into the skin.  However, the relaxers were proven to cause hair breakage by weakening the hair shaft.

This subject is of great debate but difficult to prove.  Research shows that 91% of African American women report using relaxers.  The average age of starting relaxers was 10 years old.  For that reason, it is difficult to find enough subjects for comparison that suffer CCCA with no history of relaxer use.

While trying to understand the correlation between chemical relaxers and CCCA, it is important to understand the chemicals used and their risks.  Sodium Hydroxide is the main ingredient found in professional relaxers.  It is described as being strongly corrosive and is a powerful irritant when exposed to the skin.  It can cause severe burns and permanent damage to any tissue it comes in contact with.  The area of contact is the only affected area.  It does not produce effects away from the point of contact.  There are different levels of injury caused by contact with sodium hydroxide.  Chemical and thermal burns can occur and lead to deep tissue injury.  Irritation can be displayed as:  burns, inflammation, redness, or swelling.  A higher level of exposure can also cause dermatitis.  It is critical to remove the solution completely from the hair by rinsing for at least 15 minutes.

When reviewing the effects of sodium hydroxide, it is obvious that its effects can lead to damage of the scalp and ultimately the follicle.
1.     Chemical burns can be left on the scalp that could ultimately damage the follicles.
2.     Inflammation can be caused by the product and result in damage to the follicles.
3.     Dermatitis is a form of inflammation that could damage the follicles.

4.     Improper rinsing and removal of the chemical from the scalp could lead to irritation of the scalp and possible follicular damage.

These findings lead to the conclusion that chemical relaxers could definitely be a source of damage to the scalp and follicles. According to MedlinePlus, whenever there is damage present follicles become inflamed. Though there may not be a direct link between chemical relaxers and CCCA, the effects of the relaxers can definitely lead to scarring.  It would therefore be recommended that all chemical processes be given by a qualified professional.  Also, any hair styles/extensions that cause excessive tension should be eliminated. These steps would help to decrease the incidence of CCCA.

Article written by LaVon Morrow, IAT

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