Hair Oils in The Black Community: Treating Androgenetic Alopecia

In this feature video, Dr Prince Adotama provides an overview on androgenetic alopecia, its prevalence in the Black community, and how hair oils can be utilized as treatment.

Prince Adotama, MD, is an assistant professor at the Ronald O. Perelman department of dermatology at NYU Grossman School of Medicine in New York, NY. He is also the director of Diversity, Equity and Inclusion, and an assistant program director in the Dermatology Residency Program.

Transcript:

The Dermatologist: Can you provide an overview of the study’s focus on androgenetic alopecia (AGA) and its prevalence in the Black Community?
Dr Adotama: Just to go back on alopecia, androgenetic alopecia is the most common form of alopecia out there. And there's not a lot of treatments available. For women, minoxidil topical is the only FDA-approved treatment for hair loss. For minoxidil and finasteride are the only FDA approved treatments. And so some people have limited options, and they may not be happy with those options or they may not be willing to deal those side effects.
So many people are turning towards oils. Oils have been a part of the Black community for decades, even centuries. It's a staple. I grew up using oils. And so I do think that patients are looking for more natural options, and oils really kind of fits what they're looking for. And they're already comfortable with it, right? Why try to change something that patients feel comfortable using already? What we want to do is guide them into the right oil, because some oils are better than others, and this study really helps to highlight some of those differences.

The Dermatologist: The study discusses essential oils such as rosemary, peppermint, lavender, and tea tree oil. Can you provide insights into the hair growth-promoting effects of these essential oils, including any mechanisms of action identified in the studies?
Dr Adotama: So, what I like to do with oils, I like to divide it into two categories. There are carrier oils and there are essential oils. Carrier oils are usually very fatty, sometimes vegetable oils, and those are really meant for moisturizing. So, say you wet your hair, you apply the oils onto the hair, and that moisturizes, it helps to lock in that moisture. So carrier oils that you may be familiar with include coconut, olive, avocado, jojoba, caster. Those are really moisturizing properties. They don't really have any medicinal properties.
Essential oils, they're like the essence of a plant, right? So they're plant and they are medicinal. When you think of plants, you take of medicinal. So essential oils are medicinal, and they actually have benefits and they are applied directly to the scalp, not so much the hair, but to the scalp with the goal of improving hair growth.
Now, some help improve hair growth, some don't do much, but this study really helps us to tease that out. So even though we're talking about essential oils, I do want to mention one carrier oil that has been shown to promote hair growth, and that is pumpkin seed oil. Pumpkin seed oil is a carrier oil that inhibits 5-alpha-reductase. 5-alpha-reductase inhibitors is similar to how finasteride works for hair growth. And we know finasteride works really well for male pattern baldness, and so pumpkin seed oils are thought to inhibit 5-alpha-reductase as well. Although there are no human studies, in animal studies, they did see some benefits. So I do think pumpkin seed oil can be used both topically, and they even have tablets as well.
Now we're talking about essential oils, the ones that are plant-based mostly. They have been shown to have the most evidence. One of them is rosemary. Rosemary is probably ubiquitous. Rosemary's having its moment right now as being a very effective treatment for hair loss. And how rosemary works as an essential oil is that it also blocks 5-alpha-reductase. It's a specific active constituent that blocks 5-alpha-reductase. And so I use rosemary oil a lot, and I do think it's beneficial and there are some studies showing that it works.
Additional ones that have been shown to work include peppermint oil. Peppermint oil has menthol, which is a vasodilator, so it increases blood flow. Rogaine helps increase blood flow to the scalp, so does the menthol and peppermint. Also, when you look at the studies, it actually increases insulin-like growth factor 1. And when insulin growth factor is expressed, that is more likely to lead to growth promoting properties. So prolongs, the antigen phase, promotes hair growth. So increased insulin growth factor one is a good thing. And peppermint has been shown in animal studies to increase insulin growth factor one. So another aspect of how peppermint works. Unfortunately, we don't have any human studies yet. Hopefully that's to come.
Another one that I wanted to mention is tea tree oil. Tea tree oil is what we think of as an anti-inflammatory, antibacterial. So it's really good for inflammation. People who have dandruff or seb derm sometimes use tea tree oil. And when they combine tea tree oil with minoxidil or Rogaine, they found that patients had less shedding, responded earlier, and had a relatively good response, a robust response. So that was a human study. More studies are needed, but some of these studies are showing some promise as potential oil for promoting hair growth.

The Dermatologist: Are these oils beneficial to all hair types, for example 4C and more?
Dr Adotama: So usually when you're thinking about types, you're thinking about carrier oils, right? Because essential oils are for the scalp and that's usually to treat something. But for carrier oils, yes, the thicker your hair, the more curlier hair, as you go from 3 to 4C, you often might need a thicker oil. So I think if you have a 4C hair, you might want to use a Castor oil, something a little thicker, while if you have 3B, you might be able to get away with a lighter oil like an avocado or something like that. So it really just depends on your hair type to determine which oil is best for you. And sometimes it just takes trial and error. Although we say these numbers like 4B, 4C, most people don't know what they are. So, a lot of it's trial and error and finding an oil that works best for you.

The Dermatologist: Can you discuss any potential adverse effects or risks associated with the use of hair oils, particularly in individuals with sensitive scalps and skin conditions?
Dr Adotama: So, tea tree oil is probably the most common oil we think of because it's antiinflammatory, it may help with dandruff and seb derm. However, that has been shown to be a huge irritant. And so you have to be very cautious with using tea tree oils. Not everyone can handle it, especially if you have sensitive scalps. And oftentimes, patients when they're using oils, sometimes they become chefs in the kitchen and they combine various oils, and that's when things get dicey. If you apply oils, it can definitely be irritating. Essential oils in general really should never be applied on its own. They should always be diluted. In fact, essential oils are often diluted with some carrier oils. But sometimes when people are Googling or finding concoctions online, they apply these things that might work with someone else but might be a little too rough or too irritating for themselves. People can get scalp burns or irritation.
Other things like lavender oil has been shown to be somewhat beneficial in animal studies. More studies are needed. Lavender oils has a lot of fragrance mix. It has a lot of linalool, and linalool is a very common allergen, so people can be allergic to that product. So I think you should be very cautious when using oils and be mindful of the potential for side effects. Also, not all oils are great for women who are pregnant. So oils like rosemary oil and peppermint oil potentially can cause contractions, especially early on. So I usually don't recommend my patients use many of these essential oils why they are pregnant.

The Dermatologist: What further studies are required regarding the use of hair oils in the treatment of androgenetic alopecia?
Dr Adotama: Human studies. We need way more human studies, because even if a study shows that a medication like peppermint works really well in mice, is it safe? Is it efficacious? Does it have a lot of side effects? That's what we really want to know. And how does it compare to other medications, so if we can have an active comparator? So comparing it to water or saline is great, but is it more effective than minoxidil? Is it more effective than Rogaine? Those are questions we really don't have an answer to. So I do think we need more human studies. We need more active comparator studies in order for us to really go all out on a limb and promote this. The good news is with these oils, even though the studies are pretty low, many of these oils are found online. You can get some of these oils that's cheap as 6, $7.00. So I think it's a very cheap, I don't like to use the word cheap, inexpensive option for treating hair. So I think it's a lot of promise. We just need more human-based studies.
It impacts it a lot. So when you're in a clinic, some dermatologists see 30, 40, 50 patients in a day and you see a patient, you know it's male pattern hair loss, or it's female pattern hair loss, and you want to get through the visit. You want to say, "Okay, I think you should do X, Y, and Z."
But oftentimes patients have their own ideas, and if you don't take into account the patient's perspective, you're going to lose your patient, especially Black patients. There's already evidence that Black patients sometimes want race concordant physicians as it is. And a lot of that comes with this cultural idea that a Black physician may have better understanding of what they like to do for their hair and their haircare practice. Because truthfully, I follow some of the same haircare steps a lot of my Black patients follow. And so there is that commonality that I have.
And so really just listening to your patients and asking, "What do you do? What do you apply to your scalp? What do you do for moisturizing, for hydration for your hair?"
And when you get a better idea of what they use, you can be like, "Well, that's not a bad idea, using rosemary oil. Actually, there's evidence that rosemary oil works and maybe you shouldn't concoct it yourself, but there's a brand that I like that makes rosemary oil and it puts it in a very easy way and there's very low side effects, and it's been tried and tested. Why don't you try this?"
And patients really love knowing that their physicians are listening to them. I'm a big proponent of shared decision making. You and the patient are coming together to make a decision how to treat your hair, especially for Black hair. Black hair is not just giving them hair growth promoting properties and treatments. It's about talking about hairstyles, hair practices. How often do you wash? How often do you shampoo? How often do you condition. Maybe avoid these type braids? Maybe try box braids. There's a lot of discussions with patients that don't even include a prescription. So, it's really important when you're treating a Black patient that you're cognizant of all these different factors that may impact either positively or negatively, their hair growth journey.

The Dermatologist: Are there tips or insights you would like to share with your dermatology colleagues who’re considering the use of hair oils for the treatment of androgenetic alopecia in the Black community?
Dr Adotama: I think having a list of products. And so sometimes you don't know how to make that list. Ask a colleague, ask a friend, do some research on your own. But having a list of products. It's kind of like when I think of sunscreen, sunscreen can be a little sticky, make you like Casper the Ghost, especially mineral sunscreens. And so if I just tell a patient, "Hey, you need sunscreen, go out and buy it."
And they're a patient who has Fitzpatrick's 6 skin, they're going to be like, "Okay," and they're going to buy something. They're going to hate it. It's greasy, it makes them look white, and they'll never use it again.
So, I have a list of sunscreen that I've tried on my own skin and even darker skin types, and I provide it to them. Same thing with oils. If there's oils that you want to recommend into your clinic, have a list of oils. I don't want to enlist any brand-name products here, but I have a list, a really strong list of different oils, some that have rosemary, some that have pumpkin, some that have tea tree, a combination of tea tree and rosemary. So, I have a list of products that I like that have been tried and tested that I'm very confident recommending to patients. So, it's not so much just saying, "Incorporate oils," is really giving people a roadmap to follow so that they can do this correctly and avoid any adverse events.

Reference:
Dinkins J, Iwuala C, Akintilo L, et al. Commonly used hair oils in the Black community: a narrative review in their use to treat androgenetic alopecia. Int J Dermatol. 2023;62(8):980-985. doi:10.1111/ijd.16657