Hair Loss in Black Women: Traction Alopecia, CCCA and Hormones

TL;DR: Hair loss in Black women has several common causes. Traction alopecia comes from styles that pull too tightly for too long, and it is reversible if caught early. Central centrifugal cicatricial alopecia (CCCA) starts at the crown, can scar the scalp, and needs a dermatologist. Shedding after pregnancy is usually temporary, while thyroid problems, low iron and PCOS (now also called PMOS) can all thin your hair. Scarring hair loss is permanent, so see a doctor early if you notice tenderness, burning or a spreading patch.

Hair carries a lot for Black women. It is identity, creativity, family time on a Saturday afternoon, the hours in a salon chair in Lagos or Peckham, and the joy of a fresh set of braids before a wedding. So when you notice thinner edges, a crown that seems to be widening, or a scalp that stings, it can feel personal in a way that is hard to explain to anyone who has not lived it.

This guide is not here to tell you to stop braiding or to give up your wigs. Protective styles are part of our culture, and they can be worn safely. The goal is to help you understand what might be happening, which signs mean "adjust your style" and which mean "see a dermatologist soon".

How much hair loss is normal?

Losing some hair every day is normal. The NHS says most people lose between 50 and 100 hairs a day, often without noticing. If you wear braids or twists for several weeks, the hair you shed builds up inside the style, so a large amount coming out on takedown day is usually expected. What is worth paying attention to is hair that does not grow back, patches that get bigger, a hairline that keeps moving, or any pain, burning or itching on the scalp.

Traction alopecia: when styles pull too hard

Traction alopecia is hair loss caused by repeated pulling on the hair roots. The American Academy of Dermatology (AAD) notes that it is especially common in girls and women of African descent, partly because tight styles are common in our cultures and partly because the shape of our hair follicles makes the hair more likely to be damaged by tension. The hairline and edges are usually the first places it shows.

According to the AAD, styles that can cause it when they are too tight include cornrows, locs, tight braids, tightly pulled buns and ponytails, and weaves or extensions, especially on relaxed hair. The style itself is not the problem. Tension and time are.

Early warning signs

Check your hairline once a month for:

• Broken hairs around your forehead and temples.
• A receding hairline or thinning edges.
• Patches of hair loss where hair is pulled tightly.
• Pain, stinging, crusts or small bumps on the scalp, or "tenting", where the scalp lifts under a tight section.

Pain is a clear message. As the AAD puts it, if your hairstyle feels painful, it is too tight.

How to protect your hair and keep your styles

The AAD suggests:

• Loosen up. Ask your stylist for looser braids, especially around the hairline, and choose thicker braids or locs.
• Keep length and weight in check. Longer, heavier braids pull more.
• Limit wear time. Wear braids for no longer than 6 to 8 weeks.
• Weaves with care. Wear them for short periods, choose sewn-in over glued-in, and remove them straight away if they hurt.
• Rotate. After cornrows, switch to loose braids or wear your hair natural for a while.
• Cover gently. If you wear a headscarf or wig, pull your hair back loosely underneath. Silk or satin is gentler on hair.

Caught early, traction alopecia can often be reversed by easing the tension. If the pulling continues for years, follicles can scar and stop producing hair for good. A dermatologist can help, and may suggest treatments such as corticosteroids, antibiotics or minoxidil alongside style changes.

What is CCCA?

Central centrifugal cicatricial alopecia (CCCA) is a scarring hair loss that starts at the crown and spreads outward. The AAD describes it as the most frequent cause of scarring hair loss in African American women, usually beginning in middle age. Inflammation damages hair follicles, which are then replaced by scar tissue, so lost hair cannot grow back. Treatment can stop it from spreading.

Early signs include a small round thinning patch at the top of the head, a smooth or shiny scalp in that area, and burning, stinging, itching or tenderness. Some women feel small raised bumps. Because the hair around the patch can still look full, CCCA is easy to miss until it is advanced, which is one more reason to take an itchy or tender crown seriously.

How common is it? In a study of 529 African American women published in the Journal of the American Academy of Dermatology, about 5.6% had extensive hair loss at the centre of the scalp. That study found no clear link between extensive hair loss and relaxer or hot comb use, though it did find a link with a history of scalp fungal infection (tinea capitis).

CCCA also runs in families. A 2019 study in the New England Journal of Medicine found variants in a gene called PADI3, which helps build the hair shaft, in some women with CCCA. In other words, CCCA is not caused by "bad hair care" alone, and nobody should be shamed for it. Gentle styling still helps, but the most important step is getting diagnosed early. Over-the-counter products will not treat CCCA. A dermatologist can confirm it and prescribe treatment. The AAD also notes that hair loss at the crown can occasionally point to a thyroid problem or low iron, so your dermatologist may check for those too.

Hormones and your hair

Not all hair loss starts on the outside. Several common hormonal and nutritional causes affect your hair from the inside.

Postpartum shedding

Many new mothers notice handfuls of hair coming out a few months after giving birth. The AAD explains that this shedding usually peaks around four months after birth, and most women regain their usual fullness by their child's first birthday. It is called telogen effluvium, and it is temporary. Gentle styling, avoiding tight styles while it settles, and patience are usually enough. If your hair has not recovered by around a year, see a doctor to check for other causes.

Thyroid problems

Both an underactive and an overactive thyroid can affect your hair. The NHS lists dry hair or hair loss as a symptom of an underactive thyroid, and patchy hair loss or thinning as a symptom of an overactive one. Thyroid problems can also change your periods, which we explain in how your thyroid affects your period. A simple blood test can check.

Low iron

Iron deficiency is common in women with heavy periods, and the NHS includes hair loss, where you notice more hair coming out when brushing or washing it, among its symptoms. If you also feel tired, breathless or foggy, ask your GP for a blood test. Our guides to iron deficiency anaemia and iron-rich West African foods can help while you wait.

PCOS (PMOS)

PCOS, recently renamed polyendocrine metabolic ovarian syndrome (PMOS), is linked to higher androgen levels. The NHS lists excessive hair growth or hair loss among its main symptoms. Thinning can sit alongside other PCOS signs such as acne, irregular periods or extra facial hair, and minoxidil, which the NHS notes can be used for female pattern hair loss, is one option a doctor may discuss. Our guide to PCOS symptoms, causes and treatment covers the options, and hormonal acne and skin changes looks at the skin side of the same story.

When should you see a dermatologist?

See a dermatologist or your GP soon if you have scalp pain, burning, itching or tenderness, a patch at the crown that is growing, a hairline that keeps receding even after you loosened your styles, or shiny, smooth skin where hair used to be. Scarring hair loss cannot be reversed, so the earlier you are seen, the more hair you can keep.

It also helps to see a doctor if you have sudden shedding all over, hair loss with tiredness or period changes, or patchy bald spots. If you can, look for a dermatologist with experience in Afro-textured hair and skin of colour, and bring photos of your scalp taken over a few months. A clear record makes the conversation much easier.

Caring for your hair, and yourself

Hair loss can affect how you feel about yourself, and that matters as much as the medical side. You can keep wearing braids, wigs, locs and weaves with a few adjustments, and asking for help early is a form of self-respect, not vanity.

Asele can help you spot the hormonal side. Logging hair shedding next to your cycle, energy and period flow can reveal patterns that point towards thyroid, iron or PCOS, and the Asele Health Brief turns those notes into a short summary for your doctor. If you want to talk it through first, Amara can chat with you in Yoruba, Hausa, Igbo, Swahili, French or English. You can find us at Asele.

This post is education, not medical advice. If you notice a tender, itchy or spreading patch of hair loss, please see a dermatologist or doctor as soon as you can.

References

1. NHS. Hair loss. nhs.uk
2. American Academy of Dermatology. Hairstyles that pull can lead to hair loss. aad.org
3. American Academy of Dermatology. Central centrifugal cicatricial alopecia. aad.org
4. American Academy of Dermatology. Hair loss in new moms. aad.org
5. Olsen EA, et al. "Central hair loss in African American women: incidence and potential risk factors." Journal of the American Academy of Dermatology, 2011. pubmed.ncbi.nlm.nih.gov
6. Malki L, et al. "Variant PADI3 in Central Centrifugal Cicatricial Alopecia." New England Journal of Medicine, 2019. doi.org
7. NHS. Underactive thyroid (hypothyroidism): symptoms. nhs.uk
8. NHS. Overactive thyroid (hyperthyroidism): symptoms. nhs.uk
9. NHS. Iron deficiency anaemia. nhs.uk
10. NHS. Polyendocrine metabolic ovarian syndrome (PMOS): symptoms. nhs.uk