While the natural hair movement is gaining traction in South Africa, many South African women with afro-textured hair still opt for chemical relaxers. A UCT Division of Dermatology study found that 78% of schoolgirls and 49.2% of adult women had relaxed hair.
Scalp deep
But for clinicians treating hair loss, the visible effects of chemical processing are not always enough to explain what is happening beneath the surface.
For Dr Kashmal Kalan, medical director at Alvi Armani South Africa, another key question to ask when assessing a patient with hair loss is whether the damage is confined to the hair shaft or has affected the follicle itself.
“Chemical processing is one part of my initial analysis: the pattern of breakage, where it’s concentrated, and how the scalp responds,” he says.
“It is useful information that helps me understand what I’m seeing and informs treatment.”
But identifying the pattern is only the starting point.
That analysis ultimately aims to determine whether the damage stops at the hair shaft or reaches 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.”
Relaxer challenge
The challenge became apparent in one of Kalan’s own cases.
A patient presented with a pattern of hair loss that appeared straightforward on examination, with no visible inflammation or obvious scarring.
She subsequently underwent a hair transplant, but the results fell short of what would normally be expected once transplanted hair had had time to grow.
Further investigation, including a scalp biopsy, identified an underlying scarring condition that had not been apparent during the initial examination and was limiting the survival of the transplanted follicles.
A review of the patient’s history identified years of chemical relaxing as a likely contributor in this case.
Product PH
The chemistry of the products themselves adds another dimension to the discussion.
A 2019 study published in the South African Medical Journal tested 121 hair relaxers sold in South Africa, including products marketed for children.
All 121 products were highly alkaline, with a median pH of 12.36, at levels considered corrosive to skin.
“This study tells us that relaxers are strong products that should be treated with respect.
“However, it does not indicate that relaxers cause conditions like CCCA (central centrifugal cicatricial alopecia), a form of scarring hair loss.
“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.”
Clued up
For clinicians and hair professionals, the location of the damage can provide another useful clue.
At the hairline, breakage or thinning may point to traction alopecia caused by mechanical tension from tightly braided or woven styles.
South African research found traction alopecia in 32.1% of girls who braided relaxed hair, compared with 22.9% who braided natural hair, although the difference was not statistically significant.
CCCA typically presents differently.
According to the American Academy of Dermatology, it usually begins at the centre or crown of the scalp, where hair breakage can be an early sign before more obvious hair loss develops.
“If someone notices the hair at the crown is getting shorter, thinner, or simply behaving differently from the rest of their scalp, they shouldn’t automatically assume it’s typical relaxer damage.
“That pattern deserves a proper examination, particularly if it is persistent.”
For an industry in which chemical relaxing remains a significant part of haircare, the distinction is important: visible breakage does not necessarily reveal what is happening at the follicle.
“No hairstyle or product should cost you your hair, or cause permanent damage,” concludes Kalan.
“Relaxer isn’t the enemy here. Ignoring what your scalp is telling you is.”
