Dr. Alisha Fluker is a dual-certified nurse practitioner specializing in women's mental health. The owner of Peace of Mind Psychiatric Services, PLLC, she offers telehealth for anxiety, depression, postpartum, and premenstrual mood disorders, blending conventional and holistic approaches for personalized care.
In the quiet moments before work, as you style your hair, that sinking realization hits as you notice thinning spots or a widening part. For many women, these subtle changes often signal the onset of alopecia, a condition that can feel confusing and isolating. Alopecia is defined as hair loss on any part of the body where it normally grows. For this article, we will focus on alopecia confined to the scalp only.
Did you know that there are over ten variations of alopecia? Studies indicate that 50% of women will experience visible signs of hair thinning by age 50. To put this in perspective, while normal hair shedding amounts to around 50-100 strands a day, losing more than 125 hairs daily can signify a problem. This can lead to a widening part, thin or bald patches, hair breakage, and even a visible scalp.
The most common type of hair loss among women is female pattern hair loss (FPHL), also known as androgenic alopecia, affecting up to 30 million women in the United States alone. Unfortunately, this inherited condition is often linked to genetic factors.
For African American women (AAW) specifically, two prevalent forms of alopecia are traction alopecia and central cicatricial alopecia (CCCA). Traction alopecia arises from hairstyles that pull hair tightly, damaging the hair follicles and potentially leading to permanent scarring and hair loss, particularly along the edges.
CCCA, the second most common type of alopecia in AAW, is a form of scarring alopecia that primarily affects Black women. While the exact cause remains unknown, it's believed to be linked to autoimmune diseases, environmental factors, and genetic predispositions. Some theories also suggest connections to specific hair care products, such as relaxers, which can impact hair health.
Factors contributing to alopecia
The reasons behind hair loss in women are diverse and can include:
Stress
Medical conditions
Vitamin deficiencies
Hormonal changes
Chemical treatments (perms, relaxers, color)
Medications
Genetics
Hairstyles
Steps to take to reduce your risk for alopecia
There are several proactive steps you can take to help prevent or slow the progression of hair loss:
Avoid hairstyles that create tension on the scalp: Opt for looser styles instead of tight ponytails or braids.
Limit chemical exposure: Be cautious with products that contain harsh chemicals that can damage hair follicles.
Maintain scalp hygiene: Regularly clean your scalp to prevent product buildup that can clog follicles and hinder hair growth.
Manage stress: Engage in physical activities to help lower cortisol levels and promote relaxation.
Improve your diet: Focus on a balanced diet rich in nutrients while reducing sugar and processed foods.
When to seek help
If you notice persistent hair thinning, it's time to consult your healthcare provider. A dermatologist can assess your scalp to determine the type of hair loss you're experiencing. In some cases, a scalp biopsy may be necessary, which involves taking a small skin sample from the affected area for microscopic examination. This can help identify inflammation, scarring, and other characteristics associated with alopecia.
Remember, early intervention is key—time lost can mean more hair follicles at risk. Treatment should be tailored to the severity of the condition and individual response to initial therapies. For those with CCCA, collaborating with a dermatologist experienced in hair disorders is essential to develop a comprehensive treatment plan. Early action can effectively manage symptoms and potentially preserve hair follicles before irreversible scarring occurs.
The psychological impact of alopecia
Experiencing hair loss can significantly impact confidence and self-esteem. Hair is often tied to personal identity and cultural perceptions of beauty. Hair loss can challenge one’s sense of self and identity, impacting how we see ourselves and how we think others see us. The emotional journey—marked by grief, frustration, embarrassment, and sometimes guilt—can lead to anxiety and depression.
If you find that these emotions are negatively impacting your quality of life, know that you don’t have to navigate this challenge alone. Peace of Mind Psychiatric Services, PLLC is here to help you manage the emotional and psychological effects of alopecia. Having a provider who listens with genuine empathy can be incredibly empowering and supportive. It’s not just about getting help—it’s about feeling understood and supported on your path to healing.
Read more from Alisha Fluker
Alisha Fluker, Mental Health Clinician and Practice Owner
Dr. Alisha Fluker, DNP is a dedicated women's health and psychiatric mental health nurse practitioner with over a decade of experience. She specializes in treating anxiety, depression, premenstrual mood disorders, and postpartum conditions via telehealth for women aged 18-60. Drawing from her personal health journey, Dr. Fluker integrates holistic and conventional treatments. With a background in community, correctional health, and private practice, she empowers patients through compassionate care for emotional balance and self-acceptance.
References:
American Academy of Dermatology. (n.d.). Female pattern hair loss. Retrieved August 8, 2024, from https://www.aad.org/public/diseases/hair-loss/types/female-pattern
Fabbrocini, G., Cantelli, M., Masarà, A., Annunziata, M. C., Marasca, C., & Cacciapuoti, S.(2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review.International Journal of Women's Dermatology, 4(4), 203-211. https://doi.org/10.1016/j.ijwd.2018.05.001. PMID: 30627618; PMCID: PMC6322157
Gabros, S., Sathe, N. C., & Masood, S. (2024, March 13). Central centrifugal cicatricial alopecia. In StatPearls (2024 Jan-). StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559187/
Herskovitz, I., & Miteva, M. (2016). Central centrifugal cicatricial alopecia: Challenges and
solutions. Clinical, Cosmetic and Investigational Dermatology, 9, 175-181.
https://doi.org/10.2147/CCID.S100816. PMID: 27574457; PMCID: PMC4993262
