Hairstyling Practices to Prevent Hair Damage and Alopecia in Women of African Descent

Amaris N. Geisler, BS; Oyetewa Oyerinde, MD; Deborah A. Scott, MD


Cutis. 2022;109(2):98-100. 

In This Article

Techniques for Braids, Weaves, and Twists

Braids and cornrows, sewn-in or glued-on extensions and weaves, and twists are popular hairstyles. When applied improperly, however, they also can lead to alopecia.[1–5,11,12] When braids are too tight, the patient might complain of headache. Characteristic tenting—hair pulled so tight that the scalp is raised—might be observed.[3,5] Twists are achieved by interlocking 2 pieces of hair, which are held together by styling gel.[1,4] When twists remain over many months, hair eventually knots or tangles into a permanent locking pattern (also known as dreadlocks, dreads, or locs).[1,2,4] In some cases, the persistent weight of dreadlocks results in hair breakage.[1,3,5]

The following recommendations can be made to patients who style their hair with braids or cornrows, extensions or weaves, twists, or dreadlocks:

  • Apply these styles with as little traction as possible.

  • Change the direction in which braids and cornrows are styled frequently to avoid constant tension over the same areas.

  • Opt for larger-diameter braids and twists.

  • Leave these styles in place no longer than 2 or 3 months; consider removing extensions and weaves every 3 or 4 weeks.

  • Remove extensions and weaves if they cause pain or irritation.

  • Avoid the use of glue; opt for loosely sewn-in extensions and weaves.

  • Consider the alternative of crochet braiding; this is a protective way to apply extensions to hair and can be worn straight, curly, braided, or twisted.[5,12]


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