All hairstyles are not created equal

April 27, 2016

In a review of 19 studies, researchers at Johns Hopkins say they can confirm a "strong association" between certain scalp-pulling hairstyles -- many common among African-Americans -- and the development of traction alopecia, gradual hair loss caused by damage to the hair follicle from prolonged or repeated tension on the hair root. An estimated one-third of African-American women suffer from traction alopecia, making it the most common form of hair loss among that group.

In a report on their analysis, published ahead of print in the Journal of the American Academy of Dermatology, the investigators urge dermatologists to better educate themselves about the damaging hairstyles -- which include tight ponytails, braids, knots and buns -- and advise patients of risks and alternatives.

"Hair is a cornerstone of self-esteem and identity for many people," says Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, "but ironically, some hairstyles meant to improve our self-confidence actually lead to hair and scalp damage." Traction alopecia, she adds, is entirely preventable, and early intervention can stop or reverse it. "We have to do better as care providers to offer our patients proper guidance to keep them healthy from head to toe," she says.

In their research review, Aguh and her colleagues categorize hair practices into low-, moderate- and high-risk styles based on the degree to which follicles are exposed to tension, weight, heat and hair-altering chemicals, such as straighteners.

Moderate-risk styles, the authors say, include some of the same styles noted to be high risk, but because they are performed on natural, unprocessed hair, they are less likely to result in hair loss. Low-risk styles generally included low-tension styles, such as loose buns, and loose-hanging styles, such as wearing the hair down, as well as practices that decrease the amount of friction on the hair and scalp and avoid chemical relaxers. Aguh and her colleagues say the highest-risk styles include braids, dreadlocks, weaves and extensions, especially when applied to chemically straightened hair. These styles are popular among African-Americans, she says, because they are low maintenance and chemical-free, but the constant pulling of the hair in one direction, the tight-locking patterns and added weight can result in significant breakage and eventually traction alopecia.

Damage can also be done if extensions are affixed with adhesive glue put directly on the scalp, especially when the glued-on hair is removed. Chemical straightening weakens the hair shaft, causing breakage.

In the more moderate risk category are thermal straightening, permanent waving and use of wigs. Temporary thermal or heat-related straightening of the hair, such as the use of flat irons and blow drying the hair -- while not by itself significantly associated with traction alopecia -- can weaken shafts, leading to "significant" hair loss when traction is applied, the researchers conclude. Permanent waves made with ammonium thioglycolate to create or alter curl pattern, together with added tension from chemical treatment, do the same. And wigs attached with clips and adhesives to keep them in place can cause significant breakage.

Aguh also noted that cotton and nylon wig caps that rub the hairline may also weaken hair shafts, while satin ones are less likely to do so. Observations among clinic patients reported in the reviewed studies, Aguh says, found that loose, low-hanging styles or even updos are low risk for traction alopecia. So are natural styles that avoid chemicals and the use of frequent moisturization with conditioning agents.

Untreated and unprocessed hair, she says, can withstand greater traction, pulling and brushing, and overall decreases the risk of traction alopecia, regardless of styling.

In their review, the investigators also offered guidelines for dermatologists and other care providers to prevent and manage hair loss from traction alopecia. The first line of therapy, they say, is to loosen braids and other high-tension styles, as well as weight on the follicle permanently or periodically. Braided hairstyles should be in place no longer than two to three months, they say, and weaves and extensions should also be removed for a period of time after six to eight weeks.

The investigators also recommend people alternate styles, mainly reducing or avoiding updos, to allow follicles to recover from stress.

"Dermatologists need to be conscious of the fact that many high- and moderate-risk hairstyles greatly improve hair manageability, and simply telling patients to abandon them won't work for everyone," says Aguh. "Instead, physicians can educate themselves to speak with patients about making the best hairstyling choices to minimize preventable hair loss."
-end-


Johns Hopkins Medicine

Related Weight Articles from Brightsurf:

How much postmenopause weight gain can be blamed on weight-promoting medications?
Abdominal weight gain, which is common during the postmenopause period, is associated with an array of health problems, including diabetes and heart disease.

Commercial weight management groups could support women to manage their weight after giving birth
Women who were overweight at the start of their pregnancy would welcome support after they have given birth in the form of commercial weight management groups, University of Warwick-led research has found.

Rollercoaster weight changes can repeat with second pregnancy, especially among normal-weight women
Everyone knows that gaining excess weight during one pregnancy is bad, but clinicians rarely consider weight gains and losses from one pregnancy to the next -- especially in normal-weight women.

Early and ongoing experiences of weight stigma linked to self-directed weight shaming
In a new study published today in Obesity Science and Practice, researchers at Penn Medicine and the University of Connecticut Rudd Center for Food Policy and Obesity surveyed more than 18,000 adults enrolled in the commercial weight management program WW International, and found that participants who internalized weight bias the most tended to be younger, female, have a higher body mass index (BMI), and have an earlier onset of their weight struggle

Being teased about weight linked to more weight gain among children, NIH study suggests
Youth who said they were teased or ridiculed about their weight increased their body mass by 33 percent more each year, compared to a similar group who had not been teased, according to researchers at the National Institutes of Health.

Association between weight before pregnancy, weight gain during pregnancy and adverse outcomes for mother, infant
An analysis that combined the results of 25 studies including nearly 197,000 women suggests prepregnancy body mass index (BMI) of the mother was more strongly associated with risk of adverse maternal and infant outcomes than the amount of gestational weight gain.

Study: Faster weight loss no better than slow weight loss for health benefits
Losing weight slowly or quickly won't tip the scale in your favor when it comes to overall health, according to new research.

What your choice of clothing says about your weight
It's commonly said that you can tell a great deal about a person by the clothes they wear.

Stand up -- it could help you lose weight
You might want to read this on your feet. A new study published today in the European Journal of Preventive Cardiology found that standing instead of sitting for six hours a day could prevent weight gain and help people to actually lose weight.

Cash for weight loss
A new study, published in the journal Social Science and Medicine, has shown that selling rewards programmes to participants entering a weight loss programme is a low cost strategy to increase both the magnitude and duration of weight loss.

Read More: Weight News and Weight Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.