Chemical hair relaxing is one of the most common hair treatment practices among South African women with afro-textured hair. While breakage and thinning after years of relaxing can sometimes be temporary, similar symptoms may also signal a more serious underlying condition.
For Dr Kashmal Kalan, Medical Director at Alvi Armani South Africa, distinguishing between routine hair damage and signs of follicle damage is an important part of assessing patients of African descent who present with hair breakage, thinning or scalp changes. Research from the University of Cape Town’s Division of Dermatology found chemically relaxed hair in 78% of schoolgirls and 49.2% of adult women studied.
“Chemical processing is part of my initial analysis: the pattern of breakage, where it’s concentrated, and how the scalp responds,” says Dr Kalan. “Disclosing this information is not something a patient needs to feel awkward or ashamed about. It is simply another piece of useful information that informs treatment.”
The difference between breakage and permanent hair loss
According to Dr Kalan, one of the most important distinctions is whether the damage affects the hair shaft or the follicle beneath it. “A significant number of patients I consult with breakage or thinning still have healthy, viable follicles under the hair shaft, whether they use relaxer or not. That kind of damage usually responds well to the right hair care and treatment. “A cause for concern is when the follicle itself has been affected. Once a follicle is replaced by scar tissue, treating the hair shaft alone won’t reverse that damage.”
When the problem isn’t immediately visible
Dr Kalan recalls consulting with a patient whose hair loss initially appeared relatively straightforward. There was no visible inflammation or obvious scarring, and she subsequently underwent a hair transplant. However, when the results fell short of what was normally expected after the transplanted hair had time to grow, he investigated further.
A scalp biopsy revealed an underlying scarring hair-loss condition that had not been apparent during the initial examination and was limiting the survival of the transplanted follicles. A closer review of the patient’s history identified years of chemical relaxing as a likely contributing factor in this particular case.
What research tells us about relaxers
A 2019 study published in the South African Medical Journal tested 121 hair relaxers sold in South Africa, including products marketed for children. All were highly alkaline, with a median pH of 12.36 — above the threshold considered corrosive to skin. Dr Kalan stresses that the findings need to be interpreted carefully.
“This study tells us that relaxers are strong products that should be treated with respect. However, it doesn’t outright indicate that relaxers cause conditions like Central Centrifugal Cicatricial Alopecia (CCCA), a form of scarring hair loss that usually begins at the crown, where breakage can be an early sign.
“What we can say is that repeated chemical exposure can damage the hair, and in some cases the scalp. That damage can contribute to hair loss or worsen an existing condition.”
Don’t ignore changes at the crown
Changes in the crown area can be particularly important. If hair in this area starts to become shorter, thinner, or noticeably different from the rest of the scalp, it should not automatically be dismissed as ordinary relaxer damage. “That’s exactly the kind of pattern that deserves a proper look, and the sooner, the better,” says Dr Kalan.
He also assesses other areas where breakage or thinning is most pronounced. Hair loss around the hairline, for example, may indicate traction alopecia, which can result from repeated mechanical tension caused by tightly braided or woven hairstyles. South African research found traction alopecia in 32.1% of girls who braided relaxed hair, compared with 22.9% who braided natural hair.
Your scalp is telling you something
For women who relax their hair, the message isn’t necessarily to stop using chemical treatments. Rather, it is to recognise when changes in the hair or scalp may require closer attention. “No hairstyle or product should cost you your hair, or cause permanent damage,” concludes Dr Kalan. “Relaxer isn’t the enemy here. Ignoring what your scalp is telling you is.”
