Black Patients Disproportionately Affected by Scalp Itch, Hair Loss

Black woman looking at her scalp, skin of color
Shot of a young african woman examining her scalp and hair in front of the mirror
High prevalence and ethnic variation of scalp pruritus and hair loss were noted in a general dermatology population.

Scalp pruritus, dysesthesia, and hair loss are more prevalent in Black patients compared with their White counterparts, suggests study data published in the Journal of the American Academy of Dermatology.

Patients attending a general dermatology clinic in Saint Louis, Missouri were invited to complete an anonymous, 22-question survey from April to September of 2016.  The questionnaire assessed scalp pruritus, hair care practices, and medical comorbidities. Patients also reported demographic data, including age, sex, and race/ethnicity. Multivariable logistic regression was used to assess differences in scalp symptoms by patient demographics.

A total of 648 patients completed the survey, of whom 62.8% were. The majority of patients were White (72.9%), and 23.9% were Black. Mean age was 52 ± 16 years. The overall prevalence rates of scalp pruritus, dysesthesia, and hair loss were 25.3%, 11.7%, and 40.2%, respectively. Compared with White patients, Black patients had greater prevalence of pruritus (40.1% vs 20.3%), dysesthesia (24.5% vs 7.5%), and hair loss (45.8% vs 39.2%). In logistic regression models, Black patients had significantly increased odds of scalp pruritus (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.10-4.13) and dysesthesia (OR, 2.73; 95% CI, 1.18-6.30). Black patients were also at increased risk for hair loss, even after adjusting for scalp pruritus (OR, 1.88; 95% CI, 1.05-3.37) and dysesthesia (OR, 1.77; 95% CI, 0.98-3.19). In Black patients, those with scalp pruritus (OR, 3.74; 95% CI, 1.39-10.10) and dysesthesia (OR, 10.95; 95% CI, 2.92-41.14) were much more likely to have hair loss. Model adjustments for hair care practices and medical comorbidities did not attenuate these associations.

Study limitations include the cross-sectional design, relatively small number of black participants, and the use of self-report data rather than medical records.

These data suggest that Black individuals are disproportionately affected by scalp pruritus, dysesthesia, and hair loss than the general dermatology population. “Future studies are needed to investigate the ethnic variations and temporal relationships of scalp pruritus, dysesthesia and hair loss,” investigators wrote.   


Osemwota O, Herbosa CM, Zhong C, Kwatra SG, Kim BS, Semenov YR. Ethnic variations in scalp pruritus and hair loss [published online May 30, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.05.116