The ethnic specificities of hairstyling and the biological and physiological peculiarities of the hair and scalp of African-Americans are at the origin of multiple pathologies to which are added pathologies common to other ethnic groups (Caucasians, Mongoloid).
Thus, medical, cosmetic and surgical treatments must adapt to etiology on the one hand and to ethnic specificity on the other hand. Characteristics of Afro-American Hair The hair and scalp of African-Americans have structural, anatomical and physiological features. The hair and scalp of African Americans have structural, anatomical and physiological peculiarities:
A helical and spiral stem, flattened or elliptical section, curved roots, a hair density 20% lower than that of Caucasians, a growth rate 30% lower than that of Caucasians and a higher percentage of telogen. Few are pure African negroids, but have rather bi- or multiracial characters.
Pathologies common to the three major ethnic groups.
3.1 The alopecia
There are several types whose diagnosis, prognosis and treatment are similar to those of other ethnic groups.
- Plate shapes
3.2 Male and female androgenetic alopecia.
Male and female androgenic alopecia have the same topography and are prognostic in African Americans as in other ethnicities, but the therapeutic approach and treatments are not always the same.
Minoxidil lotions at 2% and 5% paradoxically have a better cosmetological appreciation than in Caucasians and Mongoloids: this is due to the “greasy” effects of propylene glycol on the capillary stems. Their prescription advice is similar. Finasteride is almost identical to other ethnic groups. Hair transplants in men and women are almost similar to those of other ethnic groups. The particularities of transplants in African Americans are essentially:
- a sample in the mid-occipital donor area to avoid a hypertrophic scar or keloid
- a transplant preparation in follicular units of 2 to 4 hairs rather than in 1-hair micrografts
- in the man, a drawing of the front frontal line more rounded than in the other ethnic groups
- in women, a more rectilinear design associating a frontal and temporal reconstruction.
Trichotillomania is seen in children and adults.
The clinical and psychological aspects are similar to those of other ethnic groups. It will always be necessary to look for other additional traction phenomena, peculiar to the Afro-American ethnic group.
3.4. Scarred alopecia in children and adults
Scarring alopecia is defined by the destruction of hair follicles, replaced by fibrous tissue. The diagnosis is clinical, the diagnostic confirmation is histological, with examination in direct immunofluorescence. The etiologies are multiple and one distinguishes:
– Congenital cicatricial alopecia
– Primary acquired scar alopecia with lymphocytic infiltrate (discoid lupus erythematosus, lichen planar plane, Brocq pseudopelade, follicular degeneration syndrome, mucinous alopecia)
-The primary acquired scar alopecia with neutrophilic infiltrate (dissecting folliculitis, favic ringworm, dissecting scalp cellulitis, keloid acne, necrotic acne, tufted folliculitis)
-The secondary acquired cicatricial alopecia (of physical origin, tumoral or infectious)
3.5 Seborrheic dermatitis
It should be emphasized the aggravating effect of products often used by African Americans: lanolin, soybean oil, wheat germ oil, lecithin, squalene and castor oil.
Stopping their use is essential.
Rather than frequent washing, it is better to recommend a weekly shampoo with the help of at least a weakly corticosteroid lotion.
Pathologies specific to African-Americans
4.1 Alopecia of traction
Linked to the various types of hairstyles practiced in this ethnic group (ponytails, braids, brushings, hair curlers, hairpieces) they are located mainly in fronto-temporal region.
The treatments consist of stopping the pulls and applying a 2% minoxidil lotion. Hair transplants will be recommended for areas remaining alopecic after 6 months of treatment.
4.2 Alopecia of the ‘heating comb’
Follicular degeneration syndrome, Sperling caused by the association of hot oil and a heating comb or a curling iron
Provoked by the association of hot oil and a heating comb located preferentially at the vertex. The preventive treatment aims to eliminate these manipulations and the final treatment is provided by the transplantation of hair transplants or the use of a hair prosthesis.
4.3 Folliculitis and pseudo-folliculitis
Folliculitis and pseudo-folliculitis are the result of cutaneous penetration by curved hair (after shaving in men or after hair removal in women) which causes the formation of papules, follicular papulopustules, perifollicular papulo-pustules or of ganulomas with foreign bodies.
Prevention consists of removing shaving or waxing with a tweezer and recommending waxing, the use of depilatory lotions or creams, the use of special razors or permanent hair removal.
The treatment of lesions is based on the administration of local antibiotics (topical erythromycin) or per os.
4.4 Keloid folliculitis
Localized mainly on the neck, the keloid folliculitis is characterized by a beginning papule and a granulomatous infiltrate then by a cicatricial plate.
Do not shave this area, and treat with local and oral antibiotic therapy, intralesional corticosteroid therapy, liquid nitrogen cryotherapy and surgical excision, performed with caution.
- Dissecting cellulitis of the scalp
(perifolliculitis capitis abscedens and suffodiens)
Of ill-defined etiology, dissecting cellulitis of the scalp is a mixture of follicular occlusion, acne conglobata and suppurative hidradenitis. Observed primarily in humans, it presents clinically with multiple coalescing abscesses, follicular occlusions, scarring alopecia, hypertrophic scars or keloids.
The bacteriological analyzes are negative (staphylococci).
Various treatments can be applied: corticosteroids and oral antibiotics, surgical excisions, isotretinoin (40 mg / d), zinc sulphate (400 mg per os), cephalosporin (500 mg) + rifampicin (600 mg / d) or incision / drainage during fluctuating abscesses.
The treatments will adapt to the demands of these ethnic particularities.
5.1 Cosmetological peculiarities
In African-Americans the cosmetological peculiarities are related to the dryness and the fragility of the capillary stems. The cosmetological council will then have the mission to prevent and permanently correct these structural abnormalities of the hair.
5.2 Surgical Treatments Among African Americans
Surgical treatments are specific because of the kinkiness of the stems, the curvature of the roots, the risk of hypertrophic and even keloidal healing, and the risk of hyperpigmentation or hypopigmentation.
They must always be selected according to the location of the act to better prevent the risks of excessive or dyschromic healing. The surgical techniques themselves (excisions, flaps, grafts, etc.) must be adapted to the particularities of the African-American scalp.
As with any scalp dermatologic surgery, the indications are guided by many parameters such as the nature, extent and location of alopecia, sex, age and individual peculiarities of the patient. scalability of the alopeciant phenomenon. This surgery obeys three main technical principles:
- Rotation or transposition of flaps
- The reduction simple or assisted by the installation of a expander or expander.
– 5.3 Medical treatments
Medical treatments will be selected to essentially extinguish the inflammatory phenomena that have appeared despite prevention efforts.
In addition to all pathologies common to all three ethnic groups, the hair pathology of African-Americans presents genetic particularities, socio-cultural particularities (types of hairstyles), the chemical characteristics of the hair (stem dryness) and the tissue characteristics of the leather. hairy (inflammatory reactions).
Prevention and therapeutic advice will be mainly guided by the fragility of the stems, the risk of folliculitis and poor healing, and seek to change some ancestral styling habits.