Figures
Explore figures and images from publications
Figure 2 - uploaded by Olayinka A Olasode
Content may be subject to copyright.
Alopecia in a woman exposed to chemical hair relaxers 

Alopecia in a woman exposed to chemical hair relaxers 

Source publication
Article
Full-text available
Background The use of chemical hair relaxers has found widesp read use in African Negroid women because of the desire to straighten their cur ly hair. The hair texture in Negroids is essentially coily and the process of straightening makes easier to comb and style. This beautification process, however, is not without its own hazards to the users. W...

Context in source publication

Context 1
... involves both the skin and its appendages. Scalp hair dressing in women is of major social and sexual display and importance. The African woman prides herself in her hairstyles ranging from tying with thread, weaving of hair strands and later hair straightening initially by the use of hot combs ( Figure 1 ). Heating and coiling hot combs were promptly replaced by the use of chemical hair relaxers that allow for permanent hair straightening. The need for repeated applications of these relaxers has resulted in short and long term impacts on the texture and quality of the hair in users. The study centers used were hairdressing saloons for a period of three months. Identified hair saloons randomly selected were included in the study. Selection criteria of saloons included the inclusion only of those hairdressing saloons operated by hairdressers that had undergone minimum of two years apprenticeship training. This was done to eliminate the effect of unprofessional hair handling. Information was obtained using self-administered pre-tested questionnaires on women patronizing these saloons and who had regularly applied chemical hair straighteners for a period ≥ one year. The questionnaires were designed to elicit socio- demographic data, motivation for this practice, duration of exposure and various side effects that has been experienced. Exclusion criteria for respondents included history of hair loss prior to initiating the chemicals, history of use of hair dyes and previous scalp disease. Hairdressers were interviewed and observed in the processing and application of the hair straighteners. Label inserts were examined and noted for contents of the commonly used hair straighteners. Instruction leaflets were studied and noted. Two hundred and fifty women filled the questionnaire. Their ages ranged between 11- 60years with a peak between 21-40years. The duration of first exposure was 1-20years with repeated application every two to three months to relax the new hair undergrowths. Sixty two percent (155 out of 250) of the women were married while the remaining 38% (95 out of 250) were single. The occupation of the women affected included various professionals, artisans, students and housewives. The hair straightening products were noted to all contain sodium hydroxide or ammonium thioglycate as the active ingredient. Guanidine hydroxide/carbonate was the other common active ingredient of relaxer chemical used referred to as “no-lye” relaxers. Seventy eight percent of the women stuck to one product while the remaining selected products available when needed. The packaging of the ‘no-lye’ relaxers was as a kit containing an activator for mixing before application. The instruction sheets included information on the precautions, directions on hair preparation before use, time chart for hair relaxation, use of strand test (test on a small section of hair), use of neutralizing shampoo and conditioner. The hair relaxers came in three strengths: mild, regular and super to be used depending whether the hair type is fine, medium or coarse. Super strength was never to be used on fine hair. Reasons for opting for use of chemical hair relaxers included beauty, social acceptability, convenience and ease of management of the relaxed hair. Others are previously tough hair texture, advice of friends and feeling of improved self- esteem. Self- reported adverse effects included dandruff, itchy scalp, scalp burns, scarring of scalp, weak breaking hair, loss of scalp hair ( Figure 2 )and change in hair colour ( Table 1 ). Hair loss was defined as substantial amount to cause alarm to the patient or leave an area of scalp totally without hair. The African-American American hair shaft is elliptical or flattened in cross-section section and spiral or tightly curled in tertiary structure. 1 A feature of black African hair has an apparent increased fragility of the hair shaft compared to other ethnic groups as measured by the tensile force needed to break the hair fibre. 2 Chemical cal hair straightening is a process of changing naturally curly or kinky hair to permanent straight hair using chemical agents. Chemical relaxers used on the hair in Negroids contain sodium, potassium, or guanine hydroxides, sulfites, or thioglycolates. All Al of these chemicals work to produce a straight appearance by affecting the cysteine disulfide bonds of the hair. This process weakens the hair shaft, as the rearrangement of disulfide bonds does not occur without structural damage to the shaft and decrease e in tensile strength compared to untreated hair. 3 The process leaves the hair dry, weak, and susceptible to breakage. Hair breakage, hair thinning, lack of hair growth, scalp irritation, scalp damage, hair loss are some of the complaints from many who experience problems due to the misuse or chronic use of chemical hair relaxers. 4 Allergic contact dermatitis to thioglycate products has been reported. 4 Other complications of chemical hair straighteners straight with potent chemicals include delapitation, traumatic c hair breakages, hair discolouration from bleaching, scalp abrasions, sores and burns especially with chemicals emicals with unacceptably high pH. 5 One of concerns is the change of hair's pH level. Hair in a healthy state should have a pH of 4.5-5.5. Hair's natural al oil, sebum, has a pH of 5. On the pH scale of between 1-14, 1 1 being the most acid and 14 being the most alkaline, relaxers have a pH of between 8.4 and 14, thus changing hair's naturally slightly acid state to alkaline. This will cause the hair to feel dry, coarse, and in extreme cases cause hair breakage. Necrosis of the scalp has been a reported sequele. 6 Hair discoloration appears to be quite high in current series of women with more than 50% occurrence rate ( Table 1 ). Hair discoloration and bleaching is as a result of some chemicals inhibiting some stages in the enzymatic synthesis of melanin resulting in depigmentation. 5 Some hair neutralizers used after application of straighteners with high PH contain shellac which may react with alcohol groups to cause hair discolouration. 5 Chemical hair relaxers have been documented to cause alopecia. Forty five percent of the women complained about various degrees of hair loss. In 2000, Swee et al . reported a major outbreak of hair breakage and alopecia among users of a particular hair straightening product. The severity of the adverse effects from this particular product prompted the Food and Drug Administration (FDA) to remove it from the market. 7 Nicholson et al. 8 documented chemically induced alopecia in young Afro Caribbean females related to the misuse of chemical hair straightening agents. They typically displayed hair loss in the vertex. Butengo-Ransby et al . 9 also reported another case of chemical and traumatic alopecia from thioglycate in a black woman with unusual clinical and histological findings. The alopecia was verrucal and histology did not show physical characteristics of features seen in other cosmetic products. Some women have a potentiality to ready hair loss from genetic predisposition and incipient common baldness and therefore are more liable to alopecia as a complication. Hair straightening may be a cause of preventable alopecia and other scalp problems in the Negroid woman. Allergic contact dermatitis to thioglycate products has been reported. 4 Irritant contact dermatitis complicated by deep seated staphylococcal infection after the use of chemical hair relaxers was reported in a woman by Kaur et al. 10 The use of chemical hair relaxers cuts across all ages of women for different reasons. All the women were aware and reported adverse reactions to the regular application of these chemicals. Body image and self- esteem are not negotiable especially in career women who need coperate appearance to make an impression in their places of work. However, great care needs to be taken in the use of chemical hair relaxers. Safety precautions and information on the ingredients used are compulsory on instruction leaflets included in the packaging of chemical relaxers. In general, the more sodium hydroxide used and the higher the pH, the quicker the chemical reaction will take place on the hair, and the greater the danger will be of hair damage. The use of caustic soda preparations on the scalp requires pre-application of protective oil or wax. The users should insist that a strand test using few strands of hair should be carried out before the ...

Citations

... In an effort to beautify themselves, Black women would straighten their hair, a practice which Erasmus (1997: 14) links to colonial undertones of beauty. Hair straightening is done through chemical relaxers which straighten the hair of the Black women to alter and make it look as if it is naturally straight (Olasode, 2009), and it is a Euro-centric fashion in the blatant face of African beauty industry. Correspondingly, Thompson (2009: 101) avers that "creating straight hair and imitating a Eurocentric standard of beauty was the preferred standard of representation for Black women post slave era, with straight and long hair being the highly sought after commodity, the natural repercussion was that delineations started to erupt in Black communities." ...
... [1] Approximately 42% of African American girls (aged <15 years), [2] 78% of South African (SA) schoolgirls (median age 17.4 years, range 6 -21) [3] and 49.2% of SA women (median age 38.3 years, range 18 -86) [3] with afrotextured hair chemically straighten their hair. [3][4][5] Several studies have suggested that relaxer use is associated with an increased risk of traction alopecia (TA), [3][4][5][6] central centrifugal cicatricial alopecia (CCCA), [5][6][7] hair breakage, scalp irritation, burns, scarring [6,8,9] and allergic reactions. [10] The prevalence of TA is higher (22.1% v. 5.2%) in girls with relaxed compared with natural hair. ...
Article
Full-text available
Background: Hair relaxers are used by up to 70% of females of black African ancestry. Occupational safety regulations list a pH ≥10.5 as irritant and a pH ≥11.50 as corrosive to the skin. Objectives: To determine the pH of all relaxers sold on the South African market and whether it is lower in no-lye relaxers and those marketed for children. Methods: Relaxers were purchased from retailers in Cape Town, but more than half (54%) of the 39 brands tested were international. The pH was determined using a benchtop pH meter with an electrode for emulsions. Three pH readings were done over 3 consecutive days for each sample, and the average was used for data analysis. Differences between relaxers were analysed using Kruskal-Wallis, Wilcoxon rank-sum (Mann-Whitney) and two-sample t-tests (p<0.05). Results: The median pH of all relaxers (calcium hydroxide, lithium hydroxide and sodium hydroxide) was 12.36 (interquartile range 12.10 - 12.62). The active ingredient was sodium hydroxide (lye or caustic soda) in 63% of the total of 121 relaxers (6/76 (7.9%) of these marketed for children). Lithium hydroxide and calcium hydroxide (no-lye) relaxers comprised 17% and 20%, respectively. No difference in pH was found between relaxers marketed for adults and those for children (sodium hydroxide p=0.2703, lithium hydroxide p=0.6787 and calcium hydroxide p=0.1048) or between lye (sodium hydroxide) and no-lye (calcium hydroxide) relaxers (p=0.2740). Furthermore, 64/70 (91%) of sodium hydroxide relaxers for adults and 4/6 (67%) of those for children were sold packaged without a neutralising shampoo. Conclusions: The pH of all the relaxers tested was at levels deemed corrosive to the skin and may contribute to the high prevalence of alopecia in females with afro-textured hair. A review of permissible safe pH levels for cosmetic use is warranted.
... 11,12 Majority of the time, the allergic reaction occurs due to the presence of allergens in the cosmetics. 13 In developed countries, there are different systems do exist for reporting ARs to cosmetics. 14 There is a good number of studies conducted in the western world with respect to the monitoring and reporting of ARs related to use of cosmetics. ...
Article
Full-text available
Background: Adverse reactions (ARs) are one of the most important causes of morbidity, hospitalization and increased healthcare cost. ARs to cosmetics are often underreported. The aim of our study was to assess the incidence, nature, causality and the outcome of ARs to cosmetics.Methods: This was a prospective observational study conducted in a dermatology outpatient clinic of a secondary care hospital of UAE. All the patients with suspected AR to cosmetics and reporting to dermatology clinic were included. The required data were collected from patient case files, patients and their caretakers. The Colipa causality scale was used to assess the causality of reported ARs.Results: The incidence of cutaneous ARs to cosmetics was 1.58%. Shampoo was the most common [7 (16.6%)] type of cosmetic suspected to cause AR, followed by face cream [6 (14.2%)]. The most common cutaneous AR to cosmetics observed in our study was rash and pruritus [13 (30.9%)] followed by itching [10 (23.8%)]. The majority of the cutaneous ARs in our study were on scalp, face and lower limbs each contributing about 21.4%. Causality assessment reveals that 16 (38%) of the cutaneous ARs were very likely type, while 25 (60%) of ARs were of not clearly attributable to use of cosmetic/s.Conclusions: Good number of the adverse reactions documented were mild in nature. Majority of the adverse reactions were not clearly attributable type. The results of this study can form a basis for creating awareness regarding the most common cosmetics associated with ARs. The study fosters the role of initiating cosmetovigilance activities.
... Historically, they were mainly used by African-American women to straighten their curly hair and easy management. 5 Hair relaxers are divided into two types: "Lye" relaxers, no-lye relaxers and "thio" relaxers. 6 An observational questionnaire based study of the adverse events recorded by a sample from repeated application of chemical hair relaxers. ...
... Chemical relaxers used on the hair contain sodium, potassium, or guanine hydroxides, sulfites, or thioglycolates. 5 All these chemicals work to give a straighten look of hair by breaking the disulfide bonds of the hair. This weakens the portion hair, as the dislocation of disulfide bonds occurs only by structural damage to the shaft which decreases the tensile strength compared to untreated hair. ...
... Hair breakage, hair thinning, lack of hair growth, scalp irritation, scalp damage, hair loss are some of the complaints from many who experience problems due to the misuse or chronic use of chemical hair relaxers. 5,21 In our study, 18 females and 9 males had the most common complaint of hair loss. 12 females had complaint of frizzy hair, 8 had thinning and breakage of hair, 7 had graying of hair, 4 had dandruff and 4 had split ends. ...
... Curly hair is difficult to manage as desired and more prone to hair breakage and damage which cause psychological distress. 2 Chemical hair straightening is a process of changing naturally curly or kinky hair to permanent straight hair ...
Article
Full-text available
Background Chemical hair straightening becomes popular for managing frizzy hair. Keratin in hair care products can penetrate the cortex of the hair fiber improving the mechanical properties of damaged fibers and promote a surface coating that prevents or decreases water diffusion through the hair fibers. This may have beneficial effects on the hair structure; however, the side effects and safety of this treatment have not yet been completely evaluated. Aims To evaluate the efficacy and safety of chemical hair straightening application on the hair shaft. Subjects and Methods Thirty female subjects older than 15 years with hair curl types III–V were included. They were subjected to full history taking and dermatologic examination of hair and scalp prior to and after application of chemical hair straightener. To detect the presence of transverse fissures, split ends, or possible side effects, the distal 3‐5 cm of hair fibers were cut before and after the last step of chemical hair straightener application for light microscopy examination. Three randomly selected samples were examined by transmission electron microscope. Results Chemical hair straightening led to significant decrease in the degree of hair curl and increased hair smoothness and shine. The treated hair fibers showed significant repair of the broken cuticle (P < 0.001), while no significant improvement was observed regarding transverse fissures or split ends (P 0.60 and 0.74, respectively). Conclusion Although chemical hair straightening application has a beneficial effect on hair shafts, some side effects may occur after. Hence, it is necessary to develop a more safe tool.
... Enfatizamos que os produtos reprovados foram adquiridos no mercado varejista, ou seja, estavam à disposição dos consumidores, podendo ser adquiridos e utilizados sem qualquer impedimento ou desconfiança. Sendo assim, torna-se preocupante a segurança dos consumidores, uma vez que quantidades elevadas de ácido tioglicólico podem ocasionar sérios danos à saúde, como efeitos adversos variados que vão desde casos caspa a coceiras, enfraquecimento e quebra dos fios, queimaduras que geram cicatrizes no couro cabeludo, mudança na cor e perda de cabelo [19]. Em concordância com o mencionado, Bárbara & Miyamaru (2008) [20] advertem que os alisantes capilares podem ser nocivos ao consumidor mesmo se utilizados de forma adequada, isso quando apresentam concentrações de ativos acima do limite máximo permitido. ...
Article
Full-text available
Considering the market demand for knowledge in the area of hair straightening, it is important to perform quality control procedures in smoothing creams in order to ensure the safety of its users and the aesthetic professionals. The objective of this study was to evaluate the quality of capillary straighteners that contain ammonium thioglycolate in their formula. Ten samples of hair straighteners were analyzed. The tests performed were: dosing of thioglycolic acid and ammonia, analysis of organoleptic and pH determination. Regarding the thioglycolic acid content, three samples classified as of general use showed results above the allowed limit while all samples (both of general and professional use) were approved as far as the ammonia content goes. As for the pH evaluation, all samples had values above the established limit. The use of products with inadequate concentrations of ammonium thioglycolate and pH above the allowed limit can lead to adverse reactions to the consumer and cause damage to the hair strands. In conclusion, it is of the utmost importance to perform quality control procedures in these products in order to provide a safer experience while using them and avoid any possible adverse reactions.
... Nevertheless, the hair damage caused can be minimized or even avoided with a correct usage of the products and few repetitions of the procedure [79]. Incorrect or over usage of hair straightening and waving products may lead to problems including hair thinning and weakening, discoloration, scalp irritation, itching, skin burn, scalp damage, lack of hair growth and hair loss, apart from the allergic reactions to chemicals [93][94][95]. In treatments with lye-based straighteners, petrolatum needs to be applied to the scalp and hairline prior to the procedure to avoid skin burn. ...
Article
Full-text available
Hair can be strategically divided into two distinct parts: the hair follicle, deeply buried in the skin, and the visible hair fiber. The study of the hair follicle is mainly addressed by biological sciences while the hair fiber is mainly studied from a physicochemical perspective by cosmetic sciences. This paper reviews the key topics in hair follicle biology and hair fiber biochemistry, in particular the ones associated with the genetically determined cosmetic attributes: hair texture and shape. The traditional and widespread hair care procedures that transiently or permanently affect these hair fiber features are then described in detail. When hair is often exposed to some particularly aggressive cosmetic treatments, hair fibers become damaged. The future of hair cosmetics, which are continuously evolving based on ongoing research, will be the development of more efficient and safer procedures according to consumers’ needs and concerns.
... The reasons for women seeking hair chemical treatments, such as dyes and relaxers, include beauty, social acceptability, convenience, and ease of management of the relaxed hair. 1 Hair coloring systems are divided into three categories according to the color durability time and coverage power after application onto hair strands: temporary, semi-permanent, and permanent. 2,3 Temporary dyes consist of acid water-soluble molecules of high molecular weight which do not penetrate the cuticle and are deposited onto the surface layers. ...
Article
Full-text available
Hair chemical treatments, such as dyeing and straightening products, are known to cause damage that can be assessed by protein loss. The aim of this study was to evaluate the hair protein loss caused by combined chemical treatments (dye and relaxer) using the validated bicinchoninic acid (BCA) method. Three kinds of straighteners, based on ammonium thioglycolate, guanidine hydroxide and sodium hydroxide, were evaluated and the least harmful combination indicated. Caucasian virgin dark brown hair tresses were treated with developed natural brown color oxidative hair dyeing and/or straightening commercial products based on ammonium thioglycolate, sodium hydroxide, or guanidine hydroxide. Protein loss quantification was assessed by the validated BCA method which has several advantages for quantifying protein loss in chemically treated hair. When both treatments (straightening and dyeing) were combined, a higher negative effect was observed, particularly for dyed hair treated with sodium hydroxide. In this case, a 356% increase in protein loss relative to virgin hair was observed and 208% in relation to only dyed hair. The combination of dying and relaxers based on ammonium thioglycolate or guanidine hydroxide caused a small increase in protein loss, suggesting that these straightening products could be the best alternatives for individuals wishing to combine both treatments. These results indicated that when application of both types of products is desired, ammonium thioglycolate or guanidine hydroxide should be chosen for the straightening process. © 2015 Wiley Periodicals, Inc.
... 32 The motivation for undertaking hair straightening in women with afro-textured hair are complex, but includes easier manageability of hair, perceived beauty, improved self-esteem and social acceptance (Dadzie OE, Salam A., submitted). 32,33 Thus, when grooming choices are considered, women with afro-textured hair may feel that they do not have the luxury of choice because they live in societies where the dominant aesthetic norms for hair are the opposite of their natural condition. In many European, American and international business contexts, afro-textured hair is associated with negative stereotypes and lowered expectations. ...
... These include scalp itch/irritation/burns or burning sensation, hair loss, hair breakage and change in hair colour. 30,32,33 Hair breakage ...
... This denaturation does not occur without a disruption in the structural strength of the hair fibres. 33 When compared with untreated hair, Syed et al. 36 found the tensile strength of chemically treated hair to be lower, with an associated increase in porosity, indicating damage. Khumalo et al. 39 also found the cysteine levels of chemically relaxed afro-textured hair to be lower than that of natural hair. ...
Article
The culturally engrained practice of 'relaxing' afro-textured hair has been linked with hair and scalp disorders. Herein, we discuss the evolution of human hair types, focusing in particular on afro-textured hair. We explore the biological features of this hair type, and discuss the different methods employed to straighten afro-textured hair, focusing in particular on chemical straightening. We also examine clinical, anthropological, and psychological issues associated with this latter practice. Examples of common scalp pathologies associated with chronic hair relaxing, such as alopecia, hair breakage, caustic burns and irritant contact dermatitis, are also highlighted. The data presented herein should enable clinicians to engage in culturally appropriate discussions with their patients about issues of appearance and conformity. © 2015 European Academy of Dermatology and Venereology.
... The politicisation and commodification of identities in an intrinsically hierarchised world of unequal encounters and relationships is well exemplified by the resilient debates and divisions on 'natural African hair' versus 'fake or non-African hair' that resonate with similar, often racialised, debates and divisions around nature and nurture, primitive and civilised, authentic and acculturated or fake, tradition and modern, past and present, local and global, good and bad, human and non-human, etc. 38 Among African Americans, the debate takes the form of 'good hair' versus 'bad hair'', with bad hair taken to mean various gradations of natural, short, coarse, nappy black hair. Good hair -as epitomised by the Hanna Montana wig and other aspirational images produced and actively promoted by global industries of desire modelled after Eurocentric ideals of beauty -is generally long, relaxed and smooth like a white girl's or its closest substitutes in other races. ...
Article
Full-text available
In this article, we use the consumption of and perspectives on hair by Africans on the continent and in the diaspora to demonstrate the extent to which African identities as permanent works in progress refuse to be impoverished by dichotomies. If relationships forged and entertained with hair are anything to go by, Africans, it seems to us, are more amenable to flexible, composite and negotiated personal and collective identities than they are to fixities and purities. Perhaps schooled by repeated encounters with the violence of dominant others or simply enlightened by the wisdom of centuries of intimate conversations across myriad divides and chasms, Africans have cultivated a collective gaze that sees beyond appearances in their everyday understanding and articulation of reality. They have trained themselves to recognise and provide for the present absences and the absent presences of their lived and social worlds, bridging and providing for interdependence and conviviality between the apparently contradictory. They are just as keen on nature and the natural as they are on human interactions and relationships with nature. Beauty is as much a work of nature as it is the outcome of working on nature. Aware that beautiful hair can be both natural and cultivated, Africans are as enamoured with their hair of birth and nature in its gradations and complexities as they are with their artistic and creative investment in the social shaping of the hair they wear. Beautifying and transcending the thrills and trappings of birth and birthmarks has been and remains an African preoccupation. As a collective presence in simultaneous diversities, Africans are united by a determined freedom to consume hair – natural and artificial or enhanced, raw and cooked or domesticated, pure and hybrid, and authentic and transformed.