title: Hairdressing and the prevalence of scalp disease in African adults.
abstract: BACKGROUND
  Anecdotal reports suggest that certain scalp disorders are common in Africans and may be associated with hairstyles.
  
  
  OBJECTIVE
  This study of 874 African adults in Cape Town was performed to test this hypothesis.
  
  
  METHODS
  A questionnaire was administered and scalp examinations performed, after ethics approval.
  
  
  RESULTS
  Participants included 30.9% men and 69.1% women (median age 36.1 years, range 18-99). Most men had natural hair: 91.7% vs. 24.3% women. The majority of men had recent haircuts (< 4 weeks): 74.8% vs. 9.9% women. The overall prevalence of acne (folliculitis) keloidalis nuchae (AKN) was 3.5%: higher in men than women (10.5% vs. 0.3%). AKN prevalence was not associated with whether clippers or blades were used. However, it was associated with haircut symptoms. Haircut-associated symptoms, i.e. at least one episode of transient pimples (or crusts) and bleeding (however small) were reported in 37% and 18.9% of men, respectively. The latter may have implications for disease transmission. Most women (58.7%) had chemically treated hair (49.2% relaxed and 9.6% permed hair) vs. 2.3% men. The prevalences of traction alopecia (TA) and central centrifugal cicatricial alopecia (CCCA) were 22.6% and 1.9%: higher in women (31.7% vs. 2.2% and 2.7% vs. 0%, respectively). CCCA was highest in women > 50 years (6.7% vs. 1.2%). TA prevalence was highest if the usual hairstyle was extensions attached to relaxed hair (48%).
  
  
  CONCLUSIONS
  We found associations between specific scalp diseases, hairstyles, gender, and age. These associations need further study, better to elucidate determinants and to improve disease prevention and treatment.
authors.affiliation: Division of Dermatology, Groote Schuur Hospital and the University of Cape Town, Observatory 7925, South Africa. nonhlanhla.khumalo@uct.ac.za
authors.forename: N P
authors.initials: NP
authors.lastname: Khumalo
authors.forename: S
authors.initials: S
authors.lastname: Jessop
authors.forename: F
authors.initials: F
authors.lastname: Gumedze
authors.forename: R
authors.initials: R
authors.lastname: Ehrlich
mesh_terms: D000153:Acne Keloid / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000505:Alopecia / Q000453:epidemiology*; D001461:Barbering; D044383:Black People / Q000208:ethnology; D003430:Cross-Sectional Studies; D005260:Female; D006203:Hair Preparations / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012536:Scalp Dermatoses / Q000453:epidemiology*; D013019:South Africa / Q000453:epidemiology
chemical_list: D006203:Hair Preparations