Jada Pinkett-Smith has been vocal about her ongoing challenges with alopecia for years, breaking the silence on her struggles with hair loss in a Red Table Talk episode in 2018. Additionally, the actress made an Instagram video in 2021 explaining her condition that received over 2.6 million views. 

What is alopecia?

Alopecia areata is a disorder that causes the affected person to lose their hair, usually in round patches. 

It is classified as an autoimmune skin disease and generally falls under three different types—alopecia universalis, alopecia totalis, and alopecia areata. Alopecia areata is relatively common and it affects up to 6.8 million people in the U.S. alone with a lifetime risk of 2.1%, as stated by the National Alopecia Areata Foundation. Alopecia is the only form of hair loss that affects children and young adults, citing Nature. And while it is associated with baldness on the scalp, the condition can also affect the eyelashes and the eyebrows, and other facial hair. 

One third of Black women will get alopecia during their lives

“Alopecia areata and age related hair thinning are two forms of alopecia that are fairly common and occur equally in all ethnic groups,” says Dr. Crystal Aguh, an associate professor of dermatology who specializes in alopecia and the director of the Ethnic Skin Program at the Johns Hopkins School of Medicine. “However, hairstyle related alopecia like traction alopecia, for example, occurs almost primarily in Black women. And it’s a very, very common form of hair loss affecting up to one third of Black women. Many Black women will experience some form of alopecia in their life, whether it’s age-related, autoimmune, hairstyle-related, or other forms. And so alopecia is somewhat unfortunately normalized in our community just because so many of us deal with it at some point in our lives.”

Central centrifugal cicatricial alopecia (CCCA) or “hot comb alopecia,” in particular, predominantly affects Black women, with between 2.7% to 5.7% of women of African descent living with the disease.  It is the number one cause of hair loss in Black women and leads to hair follicle destruction, scarring and permanent hair loss. And while genetics play a factor into the disorder—people with alopecia are more likely to have family members with alopecia and other autoimmune disorders—so do grooming and hairstyling practices. CCCA has been associated with hot combing and hairstyles that promote excessive tension like tight braids and hair weaves. Commercial hair straighteners—such as chemical perms—have also been linked with alopecia for women in the Black community. 

How does hair discrimination put Black women at risk of developing alopecia?

Alopecia can be a negative result of Black women overmanipulating their hair in an effort to retain or get corporate job opportunities. 

Hair length and texture are markers of femininity in Western culture, with women with more feminine Eurocentric hairstyles—long and straight hair—being deemed more professional and more likely to succeed in corporate America. 

“As Black women, we have a much harder time achieving what’s considered feminine on top of the fact that Black women are already considered to be less feminine than other ethnic groups,” Aguh says. “And so hairstyles play a big role and that’s one of the reasons that we see a heavy reliance on the use of extensions and weaves to help achieve this femininity if we can’t do it ourselves. It ends up being a big distinguishing factor socially for a lot of women in a way that it wouldn’t be for Caucasian women. It’s been used as social capital in a way that can be very harmful, I think, for our community.” 

According to a 2019 study conducted by the JOY Collective, 80% of Black women said they believed they had to alter their natural hair to gain acceptance in the office. 

“Every day, Black folks suffering from alopecia and baldness are being robbed of employment opportunities, education, and dignity because employers and institutions can cloak their racism in dress code policies and vague concepts like ‘professionalism’ that were designed to shut us out,” says Arisha Hatch, vice president and chief of campaigns at Color Of Change. 

As a result of “occupational traumatic hairstyling,” and attempting to fit into Eurocentric beauty standards, Black women can permanently damage their hair and scalp and end up with hair loss conditions like alopecia, as well as accompanying psychiatric conditions like depression and anxiety.

What should we do about it?

Hair is an important identity marker in the Black community with numerous studies showing the correlation between healthy self esteem in Black girls and women and positive self-perceptions of their hair. The idea that personal style and grooming choices have negative educational and employment consequences for Black people in ways that are not consistent for white individuals is the driving force behind The CROWN Act, which bans hair discrimination.

“Everyday in this country, Black people are policed, humiliated, and suspended because employers and peers want to control our expression with discriminatory codes designed to negate who we are,” Hatch says. 

In her opinion, there is only one thing to do—pass the CROWN ACT and ban hair discrimination once and for all. 

“Discrimination is no joking matter,” Hatch told Fortune. “Ridding our schools, workplaces, and communities of hostile hairstyle discrimination and respecting the diversity of Black women will not only ensure greater equity for Black people, but will create a world in which Black women can be themselves without fear of repercussion.”