On the second day of the 2023 AAD Annual Meeting, Victoria Holloway Barbosa, MD, FAAD, opened her session, “The Intersection of Hair and Health in Black Women,” by discussing how hair and exercise are big issues for Black patients.

She shared how over half of African American women are obese, and one of the biggest barriers to exercise is hair concerns. She showed a study finding that 29% of Black women reported hair concerns as one of the barriers to exercise, with additional studies finding that 50% of patients modify hairstyle and 40% avoid exercise altogether due to hair concerns. Another showed that the women who wear hair straightened with relaxers are less likely to exercise because they do not want to sweat out their straight hair.

Next, she went over relaxers, noting that there has been an uptick in relaxer use again, with some studies presenting concerning associations. The studies showed that there were possible associations between relaxers and:

• breast cancer
• fibroid
• central centrifugal cicatricial alopecia (CCCA)
• ovarian cancer
• uterine cancer.

“What I want to point out is that association doesn't mean causation,” Dr Barbosa added.

She transitioned to endocrine disruptors, which are natural and manmade chemicals that mimic or interfere with the body's hormones. She shared multiple studies that took hair products demonstrating estrogenic activity off store shelves, including hair oils, and brought them into the lab. In one study, 3 out of the 8 products pulled demonstrated anti-estrogen activity. Another took 18 hair products off the shelves and tested them for endocrine disruptors and asthma associated chemicals. This study found 45 chemicals, particularly in root stimulators, hair lotions, relaxers, and anti-frizz products. Additionally, about 84% of the ingredients were not listed on the label. Regarding endocrine disruptors and the amount of styling products used on children, some studies raised the question of whether hair oil, especially those with some estrogenic activity, may be partly what is responsible for the early menarche commonly seen in Black girls.

“We need to understand this better,” she stated, “What are the lifestyle factors? If people are wearing relaxers and they're not exercising as much, what else are they doing that's different that might play a role?”

She emphasized that there are more factors that could play a role aside from relaxers. For example, there are many support products that go along with the relaxer, such as a neutralizer, the shampoo that comes with the relaxer, and more.

Finally, Dr Barbosa ended her session encouraging dermatologists to grow more comfortable treating Black patients.

“My goal is for everyone to feel comfortable treating these patients with cultural humility and sensitivity because this could be so much better,” she stated, “If people were more educated, then we could prevent traction, catch CCCA early, and have patients not afraid to use the treatments. I hope that we all actively involve ourselves in educating our patients and the public,” she concluded.

Reference
Barbosa VH. The intersection of hair and health in black women. Presented at: AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.