Relaxer users, take note - The early signs of hair loss an SA doctor says are often mistaken for ordinary damage

Chemical hair relaxing is one of the most common hair treatment practices among South African women with afro-textured hair. For some women, breakage and thinning following years of relaxing may be temporary. For others, the same symptoms can be an early sign of permanent hair loss.

For Dr Kashmal Kalan, Medical Director at Alvi Armani South Africa, telling normal damage apart from something more serious is one of the first steps he takes when a patient of African descent presents 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.

Initial analysis and hair shaft damage

“Chemical processing is part of my initial analysis: the pattern of breakage, where it's concentrated, and how the scalp responds. Disclosing this information is not something a patient needs to feel awkward or ashamed about. It is simply another piece of useful information, amongst others, that informs treatment.”

Hair loss, he stresses, is rarely the result of one factor alone. He draws a firm line between two very different problems: injury to the hair shaft, and damage to 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.”

That distinction played out in one of Dr Kalan's own cases. He consulted a patient with a pattern of hair loss that looked, on examination, straightforward: no visible inflammation, and no obvious scarring. She underwent a hair transplant procedure, but when the results fell short of what's normally expected by the time transplanted hair has had a chance to grow in, he investigated further.

A scalp biopsy revealed an underlying scarring condition, one that hadn't been visible during his original examination, and had quietly been limiting how well the transplanted follicles could survive. Taking a closer look at the patient's history, years of chemical relaxing stood out as a likely contributor in this case.

Scalp conditions and clinical warning signs

A 2019 study in the South African Medical Journal tested 121 relaxers sold in South Africa, including products marketed for children. All of them were highly alkaline, with a median pH of 12.36, above the threshold considered corrosive to skin. Dr Kalan is clear about what that finding does and doesn't show.

“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."

He also notes that if someone notices the hair at the crown is getting shorter, thinner, or simply behaving differently from the rest of the scalp, they shouldn't automatically assume it's typical relaxer damage. That’s exactly the kind of pattern that deserves a proper look, and the sooner, the better.

Dr Kalan also pays close attention to other areas on the scalp where breakage or thinning is most pronounced. At the hairline, this 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.

"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."

Alvi Armani is a hair restoration practice specialising in surgical and non-surgical treatment for hair loss, with more than 50 years of combined experience. The practice offers personalised treatment for hair loss, with its services including hair transplant procedures and non-surgical treatment options. Alvi Armani combines clinical expertise with advanced technology, including AI-assisted and robotic-assisted procedures.