Clinical and anthropological perspectives on chemical relaxing of afro-textured hair

Factors associated with traction alopecia in women living in Yaoundé (Cameroon)

BACKGROUND

Traction alopecia (TA) is very common in Africa but few studies on African population are available. We sought to determine factors associated with TA and measure the association between these factors and TA.

METHODS

We carried out an analytical cross-sectional study in 29 hairdressing saloons in the city of Yaoundé. A questionnaire was administered and scalp exams were performed in order to look for TA and determine Marginal TA severity score if present. Participants were separated in two groups: TA group and a group without TA.

RESULTS

We finally included 223 women (77 having TA and 146 without TA). The median age was 26 years for women with TA and 24 years for women without TA. The factors associated with traction alopecia we found included: age ≥ 35 years (adjusted OR = 4; p = 0.016). Hairdressing undertaken by hairdressers only (adjusted OR = 0.2; p = 0.008), the avoidance of the regular use of nets, caps and head ties (OR = 0.2; p = 0.006) and relaxing hairs once a year or less (adjusted OR = 0.2; p = 0.005) could be protective factors. As well, we found a positive correlation between age and TA severity (r = 0.235; p < 0.001).

CONCLUSION

Age and some haircare practices are associated to TA occurrence in our context. Women therefore need to be educated on these various factors that could be able to cause, worsen or prevent TA.

Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana

BACKGROUND

Hair relaxers and skin lighteners have been commonly used by African women, with suggestions that they may have hormonal activity.

OBJECTIVES

To investigate the relationship of hair relaxer and skin lightener use to serum estrogen/estrogen metabolite levels.

METHODS

We utilized the postmenopausal population-based controls of the Ghana Breast Health Study to estimate adjusted geometric means (GM) and 95% confidence intervals of individual circulating estrogen levels by hair relaxer/skin lightener exposure categories.

RESULTS

Of the 585 postmenopausal women included in our analysis, 80.2% reported hair relaxer use and 29.4% skin lightener use. Ever hair relaxer use was positively associated with estriol (adjusted GM 95.4 pmol/L vs. never 74.5, p value = 0.02) and 16-epiestriol (20.4 vs. 16.8, p value = 0.05) particularly among users of lye-based hair relaxers. Positive associations between scalp burns and unconjugated estrogens were observed (e.g., unconjugated estrone: 5+ scalp burns 76.9 [59.6-99.2] vs. no burns 64.0 [53.7-76.3], p-trend = 0.03). No association was observed between use of skin lighteners and circulating estrogens.

SIGNIFICANCE

This study presents evidence that circulating 16-pathway estrogens (i.e., estriol and 16-epiestriol) may be increased in users of lye-based hair relaxer products. Among hair relaxer users, unconjugated estrogen levels were elevated in women with a greater number of scalp burns.

IMPACT STATEMENT

In this population-based study of hair relaxer and skin lightener use among postmenopausal women in Ghana, altered estrogen metabolism was observed with hair relaxer use, particularly among women using lye-based products or with a greater number of scalp burns. In contrast, skin lightener use was not associated with differences in estrogen metabolism in this population. Continued investigation of the potential biological impact on breast cancer risk of hair relaxer use is warranted.

Hair care and epidemiological-clinical profile of traction alopecia among women in hair salons in Yaoundé, Cameroon

Background

Hair is valued by all individuals especially women. The perception of beauty is specific to everyone. In order to fulfil their ideal beauty, women use various methods to modify their hair's appearance. Afro hair is particularly fragile, so using these methods can be particularly deleterious for black women's hair.

Objectives

Describe hair care practices of women living in Yaoundé, determine the prevalence of traction alopecia (TA) and describe its clinical profile.

Methods

We carried out a cross-sectional study in hairdressing saloon in Yaoundé. A questionnaire was administered and scalp exams were performed to determine Marginal TA severity score.

Results

We included 223 women with a mean age of 24.9 ± 7 years. The prevalence of TA was 34.5%. Mild and moderate stages were most represented. As far as haircare is concerned, extensions were regularly used by 95.1% of participants. Wigs were regularly worn by 58.7% of participants. Chemical hair straightening was done by 87.9% of women and was performed twice to thrice a year by 43.9%. Almost 76% of women used hair straightener and hair dryer. Hair washing was done monthly by 43.8% of participants and the main cosmetic used was shampoo (75.3%).

Conclusion

Traction alopecia is a very common disease in women living in Yaoundé. Extensions, wigs and shampooing are their main hair care practices.

Afro-Ethnic Hairstyling Trends, Risks, and Recommendations

Hairstyling trends among Black women fluctuate with social, cultural, and environmental pressures. Dermatologists should be aware of current trends and their associated risks in order to provide the best care to this population. In order to summarize the updated trends and associated health risks for the most common hairstyles worn by Black women, a literature review was performed. PubMed and EMBASE were used to identify articles related to hair styling practices, studies on the effects or risks of various styling practices, and magazine articles citing current styling trends among women of African descent. All hairstyles were found to have associated health risks; however, natural styles had the fewest adverse associations of all styles reviewed. Central Centrifugal Cicatricial Alopecia (CCCA) is the most cited hair disorder in this population, possibly linked to both chemical relaxants and traction styles. Additional studies are needed to further establish causality between these styles and CCCA. Additionally, while acceptance of natural hairstyles is on the rise, there is more work to be done throughout society to help protect and encourage women who choose to wear Afrocentric styles. Dermatologists should be well versed in these hairstyles and ready to lend appropriate advice to patients when it is requested.

Microscopic Characteristics Of Scalp Hair Subjected To Cultural Styling Methods In Ghanaian African Females

Purpose

To provide data for forensic use and provoke ideas to preserve shaft integrity, we studied microstructural alterations of female scalp hair subjected to Ghanaian cultural styling methods. Hence, topographical features of female hairs styled by braiding/weaving, and chemical relaxation sampled from five different scalp regions were assessed and compared with natural (Afro) hair.

Subjects and methods

Ninety-six indigenous Ghanaian females volunteered 480 hairs, which were analyzed by light microscopy. Hairs were plucked using a pair of cosmetologist’s tweezers from frontal, left temporal, right temporal, vertex, and occipital regions of the scalp. Hairs were categorized by their grooming styles as Afro (natural-unstyled), natural-styled (weaved/braided), and chemically relaxed. These were studied according to shaft/medulla dimensions and conventional cuticular scale features, and comparisons were made between styling procedures and scalp regions.

Results

Chemically styled hair had the widest shaft diameter, but the lowest incidence of continuous medullation. Medullary diameter and index increased from chemically relaxed, natural-styled, to Afro hair. A positive but modest correlation between shaft and medullary diameters existed for Afro (r = 0.320, p = 0.011) and natural-styled hairs (r = 0.235, p = 0.022) but not chemically relaxed hair (r = 0.122, p = 0.2). Scale margins were predominantly smooth in Afro hair, crenate in natural-styled hair, and rippled in chemically relaxed hair. With respect to scalp regions, hair shaft diameter was widest in vertex hair and smallest in right temporal hair in all styling methods.

Conclusion

Medulla was thickest in Afro hair, which also exhibited a correlation with shaft diameter in conformity with the published data. Chemically relaxed hairs did not exhibit these characteristics, which affirm altered morphology. Research on how chemicals affect these changes should help find antidote. The dimensional variations of hairs from different scalp regions are instructive for both cosmetic and forensic examination of hairs.

Skin lighteners and hair relaxers as risk factors for breast cancer: results from the Ghana breast health study

Skin lighteners and hair relaxers, both common among women of African descent, have been suggested as possibly affecting breast cancer risk. In Accra and Kumasi, Ghana, we collected detailed information on usage patterns of both exposures among 1131 invasive breast cancer cases and 2106 population controls. Multivariate analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for breast cancer risk factors. Control usage was 25.8% for ever use of skin lighteners and 90.0% for use of hair relaxers for >1 year. The OR for skin lighteners was 1.10 (95% CI 0.93-1.32), with higher risks for former (1.21, 0.98-1.50) than current (0.96, 0.74-1.24) users. No significant dose-response relations were seen by duration, age at first use or frequency of use. In contrast, an OR of 1.58 (95% CI 1.15-2.18) was associated with use of hair relaxers, with higher risks for former (2.22, 1.56-3.16) than current (1.39, 1.00-1.93) users. Although numbers of burns were inconsistently related to risk, associations increased with duration of use, restricted to women who predominately used non-lye products (P for trend < 0.01). This was most pronounced among women with few children and those with smaller tumors, suggesting a possible role for other unmeasured lifestyle factors. This study does not implicate a substantial role for skin lighteners as breast cancer risk factors, but the findings regarding hair relaxers were less reassuring. The effects of skin lighteners and hair relaxers on breast cancer should continue to be monitored, especially given some biologic plausibility for their affecting risk.

Design considerations for identifying breast cancer risk factors in a population-based study in Africa

Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens.