An overview on common black African-Amercian hair disease.

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Hair disease in African Americans
There are a few infectious hair diseases that are more common in African-American / African populations compared to other ethnic groups. The most common of these diseases include Seborrheic dermatitis, Atopic dermatitis and Tinea Capitis. Seborrheic dermatitis is common in both African American adults and infants while Tinea Capitis and Atopic Dermatitis is common mostly in small children.

In African-American adults the other common hair disease is Acne keloidalis nuchae. It is more common in men though a few cases of the same hair disorder have been reported in women. Whilst it is not clear what genetic effect makes African-Americans more susceptible to developing these conditions, the problems are more likely to occur as compared to other ethnic groups and they need to be treated to keep them under control.

Atopic dermatitis
Atopic dermatitis, also called eczema and atopic eczema, generally affects infants. It is the most common form of dermatitis. Dermatitis refers to a rapidly evolving red rash that may be blistered and swollen. The condition is sometimes chronic which refers to a longstanding irritable area which is often darker than the surrounding skin, and causes considerable itching.

Appearance and location
There is quite a variation in the appearance of Atopic dermatitis. It generally develops into acute flares with inflamed, red and sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from dry, thickened and itchy areas. It can often occur on the scalp in amongst the hair and this can affect the quality of hair growth. Other than the scalp, the disease can occur in the diaper area, hands, arms, feet, or legs of infants.

Although the color, severity and location of the rash may vary, the rash always itches which tends to become uncontrollable and makes the problem worse. Kids can’t help but scratch themselves, but massive scratching and rubbing can tear the skin, leaving an opening for bacteria to enter and cause infections.

Treatments and medication for black hair care
Topical emollients and low- to mid-potency topical corticosteroids have been the mainstay of treatment for this severe scalp hair disorder. For children who are above 2 years of age, topical tacrolimus ointment and cream has been approved for daily use. In general, corticosteroids are not used in children except perhaps mild topical corticosteroids. Use of an emollient as a steroid-sparing agent is used in the treatment of mild to moderate atopic dermatitis in children. For the treatment of moderate to severe dermatitis where the skin is broken and there may be a risk of infection, oral antibiotics can be used.

In the infant, little hair care can be taken as the length of hair is short and it is not advisable to use artificial black hair care products on the tender skin. These hair care products can further irritate the scalp dermatitis and make it worse. The only black hair care that can be taken up in the case of infants is the maintenance of a clean scalp and soft combing.

Acne keloidalis nuchae
Acne keloidalis nuchae (AKN) invovles the presence of skin-colored, to hyper pigmented follicular based papules on the nape of the neck and posterior part of the scalp. In this severe hair disease pustule formation and severe keloid development is observed. A keloid is a thick, irregular scar which is caused by excessive tissue growth.

The causes of the disease are not known exactly, but some researchers suggest that the disease can be due to the injury produced by short haircuts. In African men it is a fairly common practice to shave the posterior hairline with a razor and this may be the underlying cause of the acne keloidalis nuchae. Others have suggested that the causes of this scalp hair disease are constant irritation from shirt collars, chronic low-grade bacterial infections and also the use of antiepileptic drugs. All these factors result in the accumulation of increased numbers of mast cells in the posterior region of the scalp skin.

Combinations of treatments can bring the greatest success in this hair disease. Topical or oral antibiotics can help decrease inflammation. These oral antibiotics can be coupled with intralesional steroids which can be directly injected into the papules or keloidal nodules for best results. But before the usage of intralesional steroid treatments, patients should be aware that the injected area might become hypopigmented. If this side effect occurs, it may remain for 6-12 months.

For the severe cases of acne keloidalis nuchae, hair removal by laser can be used. Laser hair removal will reduce the hair growth in the particular area thereby reducing the likelihood of inflammation. But it should be always remembered that after the application of carbon-dioxide laser, the hair growth of the particular area will be permanently reduced.

Other conditions
African American people, especially women, generally suffer from Traction Alopecia due to their tight braiding and various other tight hairstyle accessory like hard rubber hand. These tight hair styles lead to the loosening of the hair from the follicle accompanied by follicular-based inflammation in the scalp. Another hair disease that the African women are generally more likely to suffer from compared to other ethnic groups is Scarring Alopecia.

There are various categories and sub categories of Scarring Alopecia. African American women are more prone to suffer from chronic cutaneous lupus, and central centrifugal scarring alopecia, Central Centrifugal Scarring Alopecia completely destroys the hair follicle and replaces it with scar tissue, causing permanent hair loss.

Treating scalp hair disorders is a challenging task because of the emotional nature of hair loss and sometimes because the pathogenesis of the condition is unknown. Treating African-American patients can add an extra degree of complexity as the characteristic feature of African hair is usually rigid and curly. So it is necessary to approach a dermatologist who is expert in his skills and has prior experience specifically with hair conditions in African-Americans. But before you approach, remain informed yourself about the common scalp diseases and their related medications or other useful black hair care products.

Amy J. McMichael, “Hair and scalp disorders in ethnic populations”, 2003, Dermatol Clin 21 629–644

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