The hidden toll of alopecia in Black women: New survey reveals emotional, social, and economic impact
Research sheds light on the profound QoL effects of hair loss—from emotional distress to disruptions in daily life and financial burden (Issue #248, 1,500 words, 8 minutes)
Findings from a new study show alopecia has an emotional burden that negatively affects patients’ quality of life (QoL) and potentially increases their financial burden.
In the paper, published in the International Journal of Women’s Dermatology (June 2025; 11(2):p e203), the authors note that hair loss is common in Black women, but much is unknown about how it affects their QoL and patient experience.
The investigators conducted a survey study from June to Sept. 2021, contacting 420 Black women over age 18 diagnosed with alopecia at a single academic center from 2015 to 2020. There were 100 respondents to the survey.
Researchers surveyed the patients using the modified English version of the Hairdex Questionnaire to determine the impact of alopecia on QoL, and created 21 additional questions to assess patient discovery of hair loss, lifestyle adjustments to hair loss, patient-provider relationships, and opinions on treatment outcomes.
Among the respondents, 28.0% had nonscarring and 72.0% had scarring alopecia subtypes, with the most common diagnosis being central centrifugal centripetal alopecia (35.0%). The mean score of the Hairdex Questionnaire was 29.5, which included emotions (41.8), symptoms (32.9), self-confidence (27), functioning (20.2), and stigmatization (18.3). The emotions domain had the highest normalized mean score compared with other domains, and this difference was statistically significant (p<0.0001).
Other findings included:
58.2% perceived increased financial spending to either conceal or treat their alopecia
55.1% perceived spending a lot of money on treatments that did not help with their hair loss
44.9% of patients reported wearing a wig
45.9% wore a head covering such as a hat or bandana
64.3% wore specific hairstyles to conceal their hair loss
60.4% of patients sought dermatologic care more than three months after noticing hair loss
The authors note that, while not statistically significant, the 16 patients who had biopsies were more likely to experience improved symptoms or symptom resolution, be happy with the outcome of their dermatologist’s treatment plan, feel confident that their dermatologist was adequately trained to treat their hair type and trust their dermatologist’s treatment plan.
The authors say this study underscores areas for improvement in managing Black women with hair loss and that scalp biopsies could improve the patient experience and should be considered when managing patients.
Bottom line: Alopecia has a significant emotional burden on Black women, impacting their self-confidence and day-to-day functioning. More than half the patients surveyed reported increased costs, including on treatments that didn’t help their hair loss. Limited evidence suggests that incorporating biopsies into alopecia diagnosis may improve the patient experience.
From the literature on hair and scalp dermatology in skin of colour
Effectiveness of blue LED in enhancing hair treatments: Analysis in different hair ethnicities
This study evaluated the efficacy of blue LED light in enhancing the permeation of cosmetics into hair and enhancing hair treatments in different hair ethnicities. Researchers also analyzed the changes in the physicochemical properties of the hair fibre after treatment.
Investigators used sample hairs of Caucasian, African, and Asian types free from previous chemical treatments. They explored different application approaches with blue LED light: spot application and sweeping application. For the analyses, researchers prepared six hair samples for each ethnic group, comprising: 1) Control without treatment; 2) Treated with leave-in cosmetic; 3) Treated with leave-in cosmetic and irradiated with blue LED light in sweeping mode; 4) Treated with leave-in cosmetic and irradiated with blue LED in spot mode; 5) Untreated hair fibre irradiated with blue LED in sweeping mode; 6) Untreated hair fibre irradiated with blue LED in spot mode.
The authors observed differences in cosmetic permeation into the hair strand after irradiation with blue LED light among different hair ethnicities. The Caucasian and Asian hair groups, when treated with cosmetics and irradiated with blue LED light in the form of spot application and sweeping, showed a significant increase in cosmetic permeation, diameter, and resistance of the hair fibre compared to the African hair group.
Dissecting cellulitis of the scalp successfully treated with a combination of ixekizumab and tofacitinib
The authors of this paper note that dissecting cellulitis of the scalp (DCS) is a rare form of neutrophilic primary cicatricial alopecia that usually occurs in Black males and is less commonly reported in Asian populations. They mention that while there are no systematic treatment guidelines for this disease, the hypothetical co-pathogenesis of DCS and hidradenitis suppurativa (HS) has led to most of the current biological therapies for DCS being based on the experience of HS. Combining biologics and Janus kinase inhibitors (JAKi) may be a new strategy for severely refractory DCS.
In this case, researchers describe a 28-year-old Chinese man who presented with multiple painful nodules and alopecia patches on the scalp that had persisted for three years. Previous treatment included oral and topical antibiotics and traditional Chinese medicine. After physicians had confirmed a diagnosis of severe DCS, the patient was prescribed 160 mg ixekizumab for the first dose, followed by 80 mg every two weeks, combined with oral 10 mg tofacitinib per day, 200 mg doxycycline per day for 10 days, then transferred to 20 mg isotretinoin per day. After three months, his scalp abscesses and exudate were significantly regressed, and new hair grew. The white blood cells dropped below the normal value. Isotretinoin was stopped, and ixekizumab was reduced to 80 mg per four weeks. Most of the nodules disappeared after 10 months of treatment, and the Dermatology Life Quality Index decreased to 6 from 18. The researchers reported no serious adverse events.
Types and characteristics of hair across the globe: Results of a multinational study on 19,461 individuals
Researchers assessed the types and characteristics of hair, their variations according to age, gender, ethnicity, and country, and their effects on individuals' daily lives.
The study was conducted between Feb. 2022 and June 2023 and collected data from 19,461 individuals aged 18 years and older from the USA, France, Brazil, India, China, Mexico, Japan, South Africa, and Indonesia.
Participants completed a structured digital questionnaire evaluating hair thickness, type, damage, and curl degree alongside stress, sleep, and well-being questions.
Investigators found that 23.7% of males and 29.2% of females reported thin hair. Dry hair was more common in females (38.9%) than males (32.1%). Damaged hair was reported by 47% of females and 30% of males. Ethnic differences showed that thick hair was most common in African (40.7%) and least in Asian (26.3%) populations. The impact of hair type on daily life varied significantly across countries. Individuals with damaged or dry hair experienced higher stress, lack of sleep, and poor well-being, especially in Japan, India, and France. Hair type (straight, wavy, curly, kinky) also affected personal and professional stress levels differently in each country.
VIDEO: Skin of Colour Savvy: Hair Loss Misconceptions, Clinical Insights, and Management
Victoria Barbosa, MD, MPH, MBA, associate professor of dermatology at the University of Chicago and president of the Skin of Color Society (SOCS), and Janiene Luke, MD, clinical professor of dermatology at Loma Linda University, discuss hair care myths, patient habits, and the management of hair loss in patients with skin of colour.
At the intersection of skin and society
Monroe Nichols, the new mayor of Tulsa, Oklahoma, has proposed a $100 million private trust as part of a reparations plan to provide descendants of the 1921 Tulsa Race Massacre scholarships and housing help in a city-backed bid to make amends for one of the worst racial attacks in U.S. history.
As reported by The Associated Press, Nichols, the first Black mayor of Oklahoma's second-largest city, said the proposed trust would not provide direct cash payments to descendants or the last two centenarian survivors of the attack that killed as many as 300 Black people. He made the announcement on June 1, 2025, at the Greenwood Cultural Center, located in the once-thriving district of North Tulsa that was destroyed by a White mob.
Nichols said he does not use the term reparations, which he calls politically charged, characterizing his sweeping plan instead as a “road to repair.”
“For 104 years, the Tulsa Race Massacre has been a stain on our city's history,” Nichols said at the announcement. “The massacre was hidden from history books, only to be followed by the intentional acts of redlining, a highway built to choke off economic vitality and the perpetual underinvestment of local, state and federal governments.
“Now it's time to take the next big steps to restore.”
Nichols said the proposal wouldn't require approval from the city council. However, the council would need to authorize the transfer of any city property to the trust, something he said was highly likely.
This week
June 9 to 15 is Diabetes Week in the U.K.
June 10 is International Day for Dialogue among Civilizations
June 13 is International Albinism Awareness Day
Something to think about in the week ahead . . .
—B. F. Skinner, (1904-1990), U.S. psychologist
Next week
In a presentation at the first annual Indigenous Skin Spectrum Global Summit, Dr. Carolyn Jack reviews ways that collaboration with Indigenous communities can support improved AD outcomes in these populations.
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