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

Published online December 19, 2019

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

Nutrafol. The patient continued on Nutrafol 4 capsules daily and occasional Vitalize hair serum (she ran out). At follow up exam after 10 months on Nutrafol, clinical evaluation revealed positive hair growth in bilateral temporal areas. Patient reported less shedding, less pain and overall positive results. (Figure 4).


Hair loss is an increasingly common condition that will impact over 50% of both men and women at some point in their lives. Although not life-threatening, it is frequently seen as destructive to self-image and emotional well-being, leading to significant psychological impact. Differences in straight and curly hair can be seen in the follicle’s shape, in the density of the hair and in the growth rate.8 Follicle shape is what determines the hair’s shape. Round to slightly oval-shaped follicles produce straight to wavy hair in Asians. The oval shaped follicles in Caucasians form straight to curly hair. The curly to coiled hair is produced by oval to elliptical follicles.

Growth rates also vary between races. Caucasian hair grows at a rate of about 1.2cm a month and has the greatest density of all three hair types. Blondes have about 146,000 hairs on their heads, black hair about 110,000 hairs, brunettes 100,000 hairs, and redheads roughly 86,000 hairs. African American hair is predominantly black, and a healthy person possesses about 50,000 to 100,000 hairs on their head. This population has the slowest growth rate of about 0.9cm per month. Asian hair – the most dominant hair type in the world – out speeds the rest with a growth rate of 1.3cm per month, and despite an estimated 80,000 to 140,000 scalp hairs, it usually has the least density.9

Likewise, the manifestation, presentation, morphology, and prevalence of hair loss varies amongst ethnic groups as well. In African American women specifically, scarring, and inflammation can be contributing factors in hair loss, commonly presenting in CCCA, making diagnosis and early treatment imperative. 2,3,4 However, differential diagnosis with androgenetic alopecia (AGA) can be challenging due to mixed presentation, assisted with clinical evaluation, dermoscopy, and biopsy. It is not uncommon, nevertheless, to see a combination of both of these and/or other types like traction alopecia in this population.2 Treatments to date are limited and have relied mainly on modern medicine’s reductionist approach—narrowly focusing on singular targets and pathways.10 Among the few FDA approved solutions available, many carry associated side effects, application, and compliance issues, and provide variable success. Efficacy is improved with use of multiple therapies at the same time, requiring a multi-modal, multi-targeted approach, especially in African American patients.

New research has revealed that a multitude of signaling pathways, as well as internal and external triggers underlie all hair loss pathophysiology.5 Nutrafol supplements leverage the power of standardized nutraceuticals to multi-target the numerous triggers and pathways that compromise hair health and contribute to hair loss: inflammation, cortisol, and mediators of stress, dihydrotestosterone (DHT), and hormonal imbalances, environmental insults, and oxidative damage.6 The mechanisms behind these standardized nutraceutical botanicals was described in detail by Farris et al in 2017.6 In a 2018 double-blind, placebo-controlled, randomized clinical study published in Journal of Drugs in Dermatology, the women’s formulation was demonstrated to safely and effectively promote hair growth in female subjects with hair loss and thinning with skin types I-IV.11 The case studies reviewed here suggest that the efficacy of this multi-targeting nutraceutical alone or in combination with other therapies is showing success without ethnic barriers, specifically in darker skin types of African descent.

We have demonstrated four successful cases of improved hair growth in African American women. The thought process and treatment regimens for acquiring healthy hair is moving towards a multi-targeted approach, addressing many of the possible ‘stressors’ that can affect one’s hair biology within any ethnic background.


Dr. Burgess, Dr. Roberts, Dr. Downie, and Megan Kera PA-C have not received payments or services for any aspect of the submitted work including grants, personal fees, non-financial support, or patents, and have no conflicts of interest to disclose. Drs. Kogan and Belpulsi are medical researchers at Nutraceutical Wellness Inc.


1. Tanus A, Oliveira CC, Villarreal DJ, Sanchez FA, Dias MF. Black women's hair: the main scalp dermatoses and aesthetic practices in women in African ethnicity. An Bras Dermatol. 2015;90(4):450-465

2. McMichael A.J. Hair and scalp disorders in ethnic populations. Dermatol Clin. 2003;21(4):629–644.

3. American Academy of Dermatology Association. 2016. Survey: Almost Half of African-American Women Have Experienced Hair Loss. Retrieved from: https://www.newswise.com/articles/survey-almost-half-of-african-americanwomen- have-experienced-hair-loss.

4. Okereke U, Simmons A, Callender VD. Current and emerging treatment strategies for hair loss in women of color. Int J Womens Dermatol. 2019;5(1):37- 45. 5. Sadick NS, Callender VD, Kircik LH, Kogan S. New insight into the patho-