|Year : 2016 | Volume
| Issue : 3 | Page : 148-152
Prevalence and pattern of alopecia in secondary and tertiary institutions in Ibadan
Hadiza Sani1, O Adebola Ogunbiyi2, Adekunle O George2, OE Okoro3
1 Department of Medicine, Kaduna State University, Kaduna State, Keffi, Nasarawa, Nigeria
2 Department of Medicine, University College Hospital, Ibadan, Oyo State, Keffi, Nasarawa, Nigeria
3 Department of Medicine, Federal Medical Center, Keffi, Nasarawa, Nigeria
|Date of Submission||04-May-2016|
|Date of Acceptance||14-Sep-2016|
|Date of Web Publication||19-Sep-2016|
Department of Medicine, Kaduna State University, Kaduna State
Source of Support: None, Conflict of Interest: None
Background: Hair loss in African women appears to be on the increase and has been associated with some hair-care practices. Objectives: The aim of this study was to determine the prevalence, pattern, and possible hair-care factors associated with alopecia in females in some educational institutions in Ibadan, Nigeria. Methodology: The respondents were interviewed using a pretested questionnaire containing information about their bio-data, hair-care practices, and history of hair loss if any. Subjects were examined for the presence and pattern of hair loss. Results: The prevalence of alopecia was 46.7%, with the traction alopecia being the most common (97.5%). The age range of those with alopecia was mainly 20-29 years. Hair loss was more common in subjects who had chemically treated their hair (P < 0.001). Conclusion: Alopecia is common among female students in secondary and tertiary institutions in Ibadan. Traction alopecia was the most common pattern of hair loss in this study supporting claims of hair-care practices as important etiological factors.
Keywords: Alopecia, Ibadan, pattern, prevalence
|How to cite this article:|
Sani H, Ogunbiyi O A, George AO, Okoro O E. Prevalence and pattern of alopecia in secondary and tertiary institutions in Ibadan. Sub-Saharan Afr J Med 2016;3:148-52
|How to cite this URL:|
Sani H, Ogunbiyi O A, George AO, Okoro O E. Prevalence and pattern of alopecia in secondary and tertiary institutions in Ibadan. Sub-Saharan Afr J Med [serial online] 2016 [cited 2022 Dec 9];3:148-52. Available from: https://www.ssajm.org/text.asp?2016/3/3/148/190856
| Introduction|| |
In African women, alopecia has been associated with hair-care practices.  Unfortunately, loss of scalp hair can cause psychological distress affecting quality of life. The African hair is naturally curly and the desire for a straight hair has resulted in the use of chemical treatments and different grooming practices with adverse effects on hair growth and density. Treatment of scarring alopecia has posed a challenge to physicians, especially in resource-poor settings. It ranges from the use of wigs, topical medications, and laser therapy to hair transplantation. The cost of treatment is between 50 and 18,000 US dollars. Despite this high cost, treatment is still associated with side effects and involves several sessions which may last for more than 12 months and hair loss may reoccur when treatment is stopped. Therefore, the importance of prevention cannot be overemphasized. In our environment, it has been suggested that use of chemicals and excessive styling occur at a younger age. This study seeks to find the prevalence and pattern of hair loss in some secondary and tertiary institutions and its association with hair-care practices. These will provide opportunities for prevention and early intervention.
| Procedure|| |
Four hundred and fifty female students were enrolled in this descriptive, cross-sectional study over an 8-week period from May 2012 to June 2012 using interviewer-administered questionnaires to obtain data from the students. Informed consent was obtained from each student before inclusion in the study. Ethical approval was obtained from the Research and Ethics Committee of the University College Hospital, Ibadan, before commencement of the study with an ethical clearance number of NHREC/05/01/2008a.
Demographic information included age, sex, tribe, and religion. Hair-care practices recorded information on hair type, presence of hair loss and duration, family history of hair loss, past and present medical history, hair-care practices, symptoms associated with the hair-care practices and hair loss. Examination of the scalp was carried out and documentation of pattern of hair was recorded. Dermatoscope was used to visualize scalp in those with hair loss.
| Methodology|| |
A total of 450 students were recruited from selected secondary and tertiary institutions in Ibadan, Nigeria between May and June 2012. The respondents were interviewed using a pretested questionnaire containing information about their bio data, hair care practices, and history of hair loss if any. Subjects were examined for the presence and pattern of hair loss.
Data were Analysed using Statistical programme for social sciences (SPSS) version 20.0, statistical software (SPSS Inc, Armonk, New york, USA).
| Results|| |
All 450 students were females with a mean age of 17.4 ± 3.9 years range (9-34 years) and most of them were Yorubas. Most of the respondents were in the age group of 10-19 years, followed by those aged 20-29 years (24.0%) [Table 1]. However, there was a higher prevalence of alopecia (80.6%) in the older age group. This was statistically significant (P < 0.0001) [Table 2].
Hair loss was found in 210 of the 450 participants (46.7%), of those 208 (99.04%) had traction alopecia while alopecia areata was found in two (0.96%) study participants.
Most of the respondents, i.e., 296 (66%), had natural hair. The fringe sign was seen in 73 (3.48%) of the 210 participants who had alopecia [Table 3].
| Discussion|| |
The prevalence of alopecia in this study population was 46.7%. Although there are no previous community studies of alopecia in females in this environment to compare with, it is high. It is also worrisome because it is in young females who are likely to continue to lose scalp hair with the aging process. Equally of note in this study is the increased probability of hair loss as the level of education changes from lower to higher levels. This difference could be attributed to changes in hair practices as the level of education advances. Those who spend more than 1,000 naira per month on their hair care had more hair loss than those who spent less than that. The study did not clarify whether the money was used for cost of chemicals like relaxer. However, it turned out that most of the respondents that spent less than 1,000 naira had natural hair or low cuts. This finding is similar to the observations of Khumalo et al.,  who looked at the prevalence of alopecia in students in South Africa where they found the prevalence of traction alopecia to be 31.7% in students. Furthermore, they found that the prevalence of alopecia increased with age in girls from 8.6% in those aged between 6 and 7 years to 21.7% in those aged 17-21 years old.  With increasing age, females tend to change and try more hair styles.
Forty-seven (20.9%) secondary school students and 163 (74.2%) tertiary school students had alopecia, suggesting that alopecia increases with age or level of education. This may be due to the various hair-care practices or options open to those in the tertiary institutions compared to those in secondary schools where the school regulations stipulate specific hair styles or low cut for the students. Traction alopecia was the most common type of alopecia, which was 98.04% of all alopecia [Table 3]. This was seen more in those with treated hair than those with natural hair. Eighty-nine students (30.1%) of those with natural hair had alopecia compared with 121 (78.6%) of those with treated hair [Table 3]. These findings are similar to a study on school pupils in South Africa where traction alopecia was found to be higher in girls with relaxed hair than in those with natural hair. 
Most of the young females in tertiary institutions in this study had treated hair and changed their hairstyles frequently. Most of the hairstyles involved traction from braiding, rollers, ponytails, etc., Traction alopecia is said to be most common in African-American women, a high percentage of whom treat their hair chemically. 
The likelihood of developing traction Alopecia (TA) also increases with age, which is likely the result of a longer history of these hair practices. The application of traction (e.g., braids, weaves) on relaxed hair is associated with the highest risk of traction alopecia compared to natural hair. 
TA has been extensively reported in the literature to occur in many different regions of the scalp the location of which depends on an individual's hair-care practices and may or may not be related to his or her racial or ethnic background. In a study by Samrao et al.,  it was found that young and adult African-American females, who developed TA from braids or hair weaves, had hair loss localized to the temporal scalp, anterior and superior to the ears. These were the main areas of the scalp affected in this study [Figure 1],[Figure 2] and [Figure 3] and may be explained by the various braiding patterns practiced in this environment, where hair extensions are usually applied from the frontal and temporal scalp regions. The prevalence of fringe sign was 34.8% among the 210 students who had alopecia in this study. The "fringe" is seen as retained hairs along the frontal and temporal rims. It is a common finding in patients with traction alopecia [Figure 2]. Clinically, it is said to be a useful guide to diagnosis in patients with marginal hair loss.  In a study by Khumalo et al., they found the fringe sign to be present in 100% of the 41 women studied who had traction alopecia. The high value in their study may be as a result of the type of hair styles done in their environment leaving out the vellus hairs. However, if the hairstyles involve braiding or weaving which starts with vellus hair or hair at periphery, the fringe sign may not be present as these hairs also fall out. Such hairstyles are common in this environment, for example, Ghana braids.
|Figure 2: Traction alopecia with the "fringe sign" (retained hairs along the frontal and temporal rim) as shown between the arrows|
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|Figure 3: Patch of hair loss (alopecia areata) in a study participant shown in between the arrows|
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Alopecia areata was found to have a prevalence of 0.96% in this study, but the overall prevalence in the general population is 1.7%.  It was found in a set of dizygotic twins aged 11 years. It was first noticed as a patch of hair loss along the parieto-occipital region of the scalp after removal of a weave-on. There was no family history of alopecia areata or atopy and any associated skin or nail change in the twins.
| Association Between Alopecia and Various Hair Care Practices|| |
Although there were more people with alopecia who left their relaxer on for more than 20 min, this was not statistically significant. This contradicts the study by Nnoruka et al., where it was found that those who left the relaxer for more than the written instruction of 20 min resulted in hair loss due to increased fragility of the cuticle.  More studies will need to be carried out to sort these differences.
Similarly, there was also no correlation between alopecia and relaxer strength (regular and super) and type (Lye and no Lye). Recall bias could play a role in this, and the participants had used relaxers with different constituents in the past.
There was no association between relaxer symptoms (burns, itching, pain) and alopecia, but a previous study in Southeast Nigeria looking at older women found that women with scarring alopecia complained of local chemical burns and local contact irritation of the scalp.  The cumulative effects from use of relaxers could have contributed to this.
There was a trend toward individuals with braiding symptoms having more hair loss, but this did not achieve statistical significance. This is in contrast with a previous study by Khumalo et al., where it was found that traction alopecia risk increased with hairdressing symptoms and this risk increased with tight braids that cause papules and pustules.  Braiding symptoms include pain, headaches, pustules, and folliculitis, which usually come on as a result of tight hair do's. There is a need to further look at the relationship between braiding symptoms and alopecia in this environment.
[Table 4] shows that the odds ratio of those aged (20-39 years) having alopecia was 7.52 times higher than those aged ( 10-19 years) P < 0.001. Similarly, those with tertiary level of education had almost a ten times increased risk of developing alopecia compared to those in secondary schools.
Those with permed hair had a nine times chance of having hair loss than those with natural hair while there was a 0.12 chance of having hair loss in those who wore their hair long as compared with the respondents who had short or natural hair.
| Conclusions|| |
Prevalence of alopecia in females in secondary and tertiary institutions in Ibadan, Southwest Nigeria, is 46.7%. Traction alopecia, which is preventable, is the most common cause. Excessive styling of treated hair causes more hair loss. There is a need to educate young women on the need to avoid excessive styling, which leads to hair loss.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Nnoruka EN. Hair loss: Is there a relationship with hair care practices in Nigeria? Int J Dermatol 2005;44 Suppl 1:13-7.
Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing is associated with scalp disease in African schoolchildren. Br J Dermatol 2007;157:106-10.
Farahnaz F. Prevalence of androgenic alopecia among women between 20-70 years old in Isfahan. J Dermatol Cosmet 2010;1:134-9.
Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing and the prevalence of scalp disease in African adults. Br J Dermatol 2007;157:981-8.
Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Determinants of marginal traction alopecia in African girls and women. J Am Acad Dermatol 2008;59:432-8.
Samrao A, Price VH, Zedek D, Mirmirani P. The "Fringe Sign" - A useful clinical finding in traction alopecia of the marginal hair line. Dermatol Online J 2011;17:1.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]
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