Understanding Alopecia in Black Women: What an Expert Wants You to Know

August is Hair Loss Awareness Month, and for many Black women, the reality of alopecia is deeply personal. Public figures like U.S. Congresswoman Ayanna Pressley and actress Jada Pinkett Smith have helped raise awareness by speaking about alopecia areata. But alopecia is not just one condition. It includes scarring and non-scarring forms, each with different causes, symptoms and treatment options.

The Root spoke with metro-Detroit dermatologist Dr. Bobbi Edwards about what Black women should know about alopecia.

Scarring alopecia causes inflammation that can permanently damage hair follicles, preventing future hair growth. The main types of scarring alopecia are Central Centrifugal Cicatricial Alopecia (CCCA),  Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA), which Edwards described as a variant of LPP.

According to the Cleveland Clinic, CCCA is the most common form of scarring alopecia in Black women, typically starting as a small spot on the crown. Edwards said it can also affect the forehead, temples or back of the scalp.

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For non-scarring alopecia, including alopecia areata, Edwards explained that genetics play a major role. But don’t be quick to blame mom. It can be inherited from either parent, skip generations and vary in severity. Other examples of non-scarring alopecia include traction alopecia, drug-related alopecia and metabolic or hormonal hair loss.

However, Edwards placed more emphasis on the link between CCCA and trauma for Black women. “Everything that we do is traumatic, and we do it at a frequency that is very high,” she said. Relaxers carry the greatest risk because they are typically applied every six to eight weeks. Edwards also pointed to permanent hair color, high-heat styling, and tension from braids, weaves and wigs, adding that glue-based installations can cause dermatitis and hair loss during removal.

Why Scarring Alopecia Can Go Undetected

One of the biggest challenges with scarring alopecia is that it can progress slowly. Edwards said a woman can lose 30 to 40 percent of her hair before noticing visible changes. Early on, the scalp may look like “pegs missing from a pegboard,” with a few strands missing here and there before a larger patch develops.

Some experience scalp tenderness, but many have no symptoms. Edwards recommends regular scalp checks by a stylist or trusted friend or family member, since early changes are often easier for someone else to spot.

How Different Forms of Alopecia Appear

Scarring alopecia can appear differently depending on the type. Edwards said CCCA typically begins at the crown, though it can also affect the forehead, temples or back of the scalp. Lichen planopilaris (LPP) may cause redness, hyperpigmentation and thinning across the scalp. Frontal fibrosing alopecia (FFA) starts at the hairline and gradually moves backward, leaving smooth skin. One characteristic of FFA is the “lonely hair sign,” where a single strand remains along a receding hairline.

Non-scarring alopecia can appear differently. Alopecia areata often causes smooth, round patches that look as though someone placed a quarter on the scalp and shaved beneath it. Edwards explained it can range from a single patch to complete hair loss across the scalp and body. Other forms of non-scarring alopecia include traction alopecia, drug-related alopecia, and hair loss caused by hormonal or metabolic conditions.

What to Expect During a Hair Loss Evaluation

Edwards recommends arriving at an evaluation with freshly washed, unstyled hair with no styling products so the scalp can be properly examined.

The visit may include questions about styling habits, hair products and family history, plus photographs, blood work and, in some cases, a punch biopsy. The biopsy involves numbing the scalp, removing a small tissue sample and placing a couple of stitches. Results are typically available within about 10 days.

Why Early Treatment Matters

According to Edwards, treatment for alopecia areata has changed significantly in recent years. Unlike scarring alopecia, treatment for alopecia areata has traditionally included topical or oral minoxidil and injectable or topical corticosteroids. Edwards added that FDA-approved JAK inhibitors have expanded options for people with more severe disease.

For scarring alopecia, the goal is to stop inflammation before follicles are permanently destroyed. Edwards said there is often a period when follicles are damaged but not yet gone, making early diagnosis and treatment critical. Depending on the stage of disease, treatment may reduce inflammation, promote some regrowth or stabilize hair loss.

For permanent loss, options are case-specific, but may include hair transplantation or scalp micropigmentation, often called a hair tattoo.

For women who might feel embarrassed, isolated or afraid to ask for help, Edwards’ message was, “You are not alone.” She encouraged readers to see a dermatologist with a special interest in hair loss, ideally an MD or DO with experience diagnosing and treating alopecia. She also emphasized that people should not assume today’s options are the same as they were even a decade ago.