A Closer Look at a Multi-Targeted Approach to Hair Loss in African American Women

January 2020 | Volume 19 | Issue 1 | Editorials | 95 | Copyright © January 2020

Cheryl Burgess MDa Wendy Roberts MD,b Jeanine Downie MD,c Megan Kera PA-C,c Sophia Kogan MD,dDanamarie Belpulsi MDd

aCenter for Dermatology and Dermatologic Surgery, Washington, DC bGenerational and Cosmetic Dermatology, Rancho Mirage, CA cImage Dermatology P.C., Montclair, NJ dNutraceutical Wellness, Inc., New York, NY

Abstract
Hair loss is a common problem that spares no gender or ethnic group. As we know, there are differences in straight and curly hair including follicle shape, growth rate and density.2Similarly, there are also differences epidemiologically in what types of hair loss are more commonly seen in different ethnic groups, as well as how it’s diagnosed and treated.2

INTRODUCTION

Hair loss is a common problem that spares no gender or ethnic group. As we know, there are differences in straight and curly hair including follicle shape, growth rate and density.¹ Similarly, there are also differences epidemiologically in what types of hair loss are more commonly seen in different ethnic groups, as well as how it’s diagnosed and treated.2

However, hair loss among the various groups can result in the same psychosocial distress leading to depression, anxiety and frustration often further precipitated by the limited availability of treatment options that traditionally produce variable results with a chance for side effects. According to the American Academy of Dermatology, a 2016 survey showed that almost half of African American women experience hair loss, while only few bring it to the attention of a physician.2,3 In fact, African American women are prone to hair loss, which can be compounded by certain styling practices. Most importantly, this population has the highest risk of central centrifugal cicatricial alopecia (CCCA), marked by inflammation and progressive destruction of follicles through scarring – limiting treatment options further when diagnosed late or not at all.2,3,4

While the presentation, morphology, and prevalence of hair loss vary within different ethnic groups, science shows that etiological factors are still numerous regardless of ethnicity. They include genetics, hormones, psycho-emotional stress, environmental factors, inflammation, oxidative damage, as well as lifestyle and styling habits, to name a few.5,6 Sadick et al describes the research behind the ever-growing number of pathways involved in the undermining of a healthy follicle. He and colleagues call for a paradigm shift in therapeutic approach to hair loss from mono-targeting to multi-targeting interventions, to reflect the multi-factorial nature of all types of hair disorders.5,6 The multi-targeting nature of these interventions supports their use in any patient population, regardless of age, ethnicity, gender, etc.

In this case series, attempting to highlight one particular hair type- African American, which has the slowest growth rate and is more affected by breakage with easily observed fragility in vivo,7 we present four African American female patients who consistently ingested a nutraceutical for 3 months, 10 months and 2 years after experiencing significant hair loss and failed previous treatments. The addition of the nutraceutical therapy to these patients’ regimens showed significant improvement, as seen by both patients and their treating physicians. The carefully formulated ingredients found in this supplement have resulted in positive outcomes for all four patients as evidenced below with photographic documentation before and after. Further, we will discuss the multi targeted approach and the mechanisms of action that support the success of this nutraceutical.

CASE 1

A 41-year-old healthy African American female (Fitzpatrick V) presented with a history of wearing wigs, extensions, and hair weaves for >20 years. Gradually, the hair enhancements caused thinning of the frontal and temporal hairline with sewn in and adhesive weave attachments. There was no past medical or family history of hair loss. She takes Vitamin D supplements; otherwise, is not on any medications. She routinely gets chemical relaxers and color treatments every 6-8 weeks along with a touch up of the hair weave.

She was advised to alter her hair care practices and not combine color with chemical relaxers at the same hair appointment to prevent hair fragility and breakage. This can be cumbersome when expensive hair weave touch ups are also scheduled at each hair treatment. She was likewise advised to wear a natural hairstyle to strengthen the hairline. The patient was placed on Nutrafol® hair supplements, four capsules daily, with food. Within 2 years, she had healthy hair regrowth along the hairline, and she continues to take Nutrafol daily along with additional Vitamin D supplementation (Figure 1).