Alopecia in Senegalese women

Original article Oxford, UK International IJD Blackwell 0011-9059 44 Publishing, Science, Journal 2005 of Ltd. Dermatology

Alopecia in Senegalese women Alopecia Niang et al. in Senegalese women

Suzanne O. Niang, A. Kane, M. T. Dieng, T. N. Sy, M. Diallo and B. Ndiaye

Department of Dermatology, Le Dantec Hospital, Dakar, Senegal Correspondence Suzanne Oumou Niang Department of Dermatology Le Dantec Hospital BP 3001, Dakar Senegal E-mail: [email protected]

Introduction The condition of the hair is a cause of real concern for women, particularly African-American women. The aesthetic and emotional value placed on hair explains why alopecia may give rise to psychological damage. The aim of this study was to evaluate the characteristics and mechanisms of alopecia in the context of dermatological consultations at Le Dantec University Hospital, Dakar, Senegal. Materials and methods This prospective study included all women aged 14 years and above consulting for alopecia from 1 January to 30 August 2004. Hair care practices and techniques, in particular, were investigated.

Results

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Fifty female patients aged between 14 and 45 years were included in the study. This represents 7.6% of the 654 women aged 14 years and above who consulted a dermatologist during the period of the study. The course of the alopecia was progressive in 92% of cases. The pattern of alopecia was diffuse in 86% of cases and localized in 14%. Alopecia was partial in 78% of cases. Associated signs comprised scaling in 14 cases, pruritus in two cases, folliculitis in three cases (Fig. 1), anemia in one case and pregnancy in one case. There were 11 cases of tinea capitis and four cases of alopecia areata. The hair was tightly braided on a regular basis in 100% of cases, synthetic hair extensions were used in 90% of cases (Fig. 2), and in 70% of cases hair was pulled back into a chignon. Hair straightening using a “cold” method was practised by 78% of patients: on a regular monthly basis in 38% of cases, International Journal of Dermatology 2005, 44 (Suppl. 1), 22–23

Figure 1 Folliculitis decalvans secondary to chemical

straightening

every 2 months in 45% of cases, and every 3 months in 17% of cases. Thirty-seven per cent of patients used brushing techniques, hot curling irons, dryers and steam hoods. All patients used various types of cosmetic products regularly and simultaneously (gels or hair sprays, oil baths, lotions and creams). © 2005 The International Society of Dermatology

Niang et al.

Figure 2 Permanent traction alopecia caused by synthetic

hairpieces

Discussion Alopecia is a frequent reason for consulting a dermatologist in Senegal. The alopecias were mainly reversible because they were partial forms in which the root is spared. Total alopecias were either alopecia areata or tinea capitis. They were characterized by the predominance of diffuse forms (72%), testifying to the use of aggressive chemical procedures involving the whole of the scalp. Among the many products implicated in causing the alopecias, straightening products were at the top of the list. These straightening products modify the frizzy structure of the hair to make it smooth by breaking the disulfide crosslinks and by making the polypeptide chains slide into one another.1 The different steps involved may result in fragile hair shafts, loss of elasticity and drying by saponification of the sebum. Other aggressive chemical procedures include applying shampoo, conditioning creams, hair gels or sprays and dyes. In addition to their irritant or allergenic effects, these products can destroy the keratin in the hair if they are not used properly.1–6 An attack on the hair shaft appears microscopically either as splitting of the hair or trichoptilosis caused by wearing away of the cuticle or trichorrhexis nodosa caused by breakage of the cortex and formation of nodes. In the worst cases, the shaft breaks or trichoclosis occurs.7 Heat sources such as heated irons and combs, dryers and steam hoods cause real physical trauma. Dryers and steam hoods damage the hair shaft by allowing air bubbles to penetrate

© 2005 The International Society of Dermatology

Alopecia in Senegalese women Original article

it.2,4,5 The technique of curling hair with heated irons, which until recently had not been used for many years, is now again common practice. It uses overheated electric plates which can burn the hair shaft or scalp. Localized alopecias, which are found predominantly in the frontal and parietal regions, are secondary to mechanical traumas caused by the traction exerted by close rows of tightly braided plaits and lengths of cloth. In addition, the hair is connected by threads to synthetic hair which aggravates the traction, or the synthetic hair is held in place by sewing it onto tight braids. Traction can then damage the root and induce the type of inflammation seen in folliculitis with pruritus, pain, erythema and hyperkeratosis. Repeated inflammation can result in follicular atrophy leading to permanent alopecia. Traction can also cause deterioration of the shaft, as can frequent brushing and washing.3 Attrition is another mechanism of alopecia caused by prolonged pressure from chignons, hairpins and combs left in place for several days. This mechanism is similar to that of the rubbing caused by traditional head scarves and handkerchiefs. The distinction among physical, chemical and mechanical traumas is merely theoretical. In practice, we are dealing with Senegalese women with a conjunction of different effects: permanently straightened hair is regularly subjected to the damaging effects of styling and tightly braiding hair treated with numerous chemical products, often in hairdressing salons. References 1 Zviak C. Ondulation permanente et défrisage. In: Zviak C. ed. Science des traitements capillaires. Paris: Masson, 1987: 183–209. 2 Jan V, Roudier-Pujol C. Prise en charge d’une alopécie chez la femme. Ann Dermatol Venereol 2000; 127: 1S21–1S25. 3 Dawber RPR. Anomalies de la tige pilaire. In: Zviak C. ed. Science des traitements capillaires. Paris: Masson, 1987: 449–458. 4 Rebat M, Halder MD. Hair and scalp disorders in Black. Anais Brasileiros de Dermatologia 1993; 68, 4: 378– 380. 5 Dawner RPR. Alopécies. In: Zviak C. ed. Science des traitements capillaires. Paris: Masson, 1987: 463– 479. 6 Calnan C. Réactions indésirables aux produits capillaires. In: Zviak C. ed. Science des traitements capillaires. Paris: Masson, 1987: 419–433. 7 Hincky M. Les alopécies. In: Encyclopédie Medicochirurgicale (Paris). A10, 2–1981. 8 Piérard-Franchimont C, Piérard GE. Les alopécies, diagnostics et traitements. Revue médicale de Liège 1987; XLII: 13–14.

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