Explanation: Alopecia affects millions, including children

Millions of people around the world suffer from focal alopecia, an autoimmune disease that causes hair loss and was thrown into the spotlight after actor Will Smith hit comedian Chris Rock at the Oscars.

The slap stunned millions, sparked widespread condemnation and earned Smith a 10-year ban on the ceremony after he apologized. It came after Rock joked that some felt that Jada Pinkett Smith was inattentive about her hair loss.

Lawyers said at the time that raising awareness of the condition, which is fairly common but little discussed, may be a small amount of good to get out of the blast. On Wednesday, Jada Pinkett Smith dedicated an episode of “Talk of the Red Table” to this disorder.

Here’s a look at the frustration and how hair is related to beauty and race, culture and self-identity:

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WHAT ARE THE CAUSES OF ALOPETIA?

Focal alopecia can cause hair to fall out of the scalp areas and also affect other parts of the body such as eyebrows and nose hair.

Alopecia can be rapid, unpredictable and can be incredibly difficult for mental struggle, said Brett King, an expert on hair loss from Yale Medicine, told the Associated Press in March.

“Imagine if you woke up today without half an eyebrow,” he said. “This unpredictability is one of the things that is so mentally treacherous and horrible because you don’t control it … it’s a disease that robs people of their identity.”

Although this is rarely discussed, in fact it is quite common: the second most important cause of hair loss after male or female pattern baldness. About 2% of people have it. It is not physically painful, in some cases it passes spontaneously and can be treated.

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HOW DOES IT AFFECT WOMEN? AND TO CHILDREN?

It is unclear whether Rock knew about Pinkett Smith’s diagnosis, hair is a significant part of any man’s appearance, and for women it is associated with cultural notions of what makes them feminine.

“Most women are expected to have good hair,” said William Yates, a certified hair loss surgeon from Chicago. “They know very well that men lose their hair and, so to speak, ‘gracefully go bald,’ but a woman’s hair loss is devastating.”

The condition also tends to affect people when they are relatively young. Most are diagnosed before the age of 40, and about half are children when the disease first appears, said Christopher Ingleshill, a certified dermatologist at Intermountain Healthcare in Salt Lake City.

The disease is especially severe for adolescents, for whom appearance anxiety and peer pressure are often already at the highest level, said Gary Sherwood, director of communications for the National Alopecia Foundation.

Rio Allred, a 12-year-old girl with the disorder, committed suicide after being bullied at a school in Indiana. Her mother appeared on Red Table Talk to talk about the loss less than two weeks before the Oscars.

Some studies have also shown that the disease is more common among blacks and Hispanics, Sherwood and Yates said. The National Institutes of Health claims that it affects all racial and ethnic groups, men and women.

Rock’s joke was “unusual,” Sherwood said. “It’s been so long since humans existed on Earth … for centuries people haven’t talked about it.”

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What is Alopecia?

Rock’s joke was hard to hear for New York City interior designer Sheila Bridges.

She spoke to Rock in his 2009 documentary Good Hair about the importance of hair in black culture.

For many black Americans, choices of care and style are intertwined with a desire to undo what is considered normal or acceptable in the general public. Black hair can be more than just an expression of style.

In her interview, Bridges spoke about the shame and humiliation of hair loss due to illness, about how her hair is intertwined with her racial identity and how hair loss has affected her sense of femininity and social currency.

The Oscar slap left Bridges conflicting emotions: she condemned Smith’s attack on Rock, sympathized with Pinkett Smith and was deeply disappointed in Rock.

“It’s not easy for a woman to navigate a life without hair and a society obsessed with hair,” Bridges said.

She does not wear wigs because she does not want to and also hopes to normalize and remove the stigma of bald women’s appearance.

But even ten years after she decided to go bald in public, Bridges said some still find it hard to reconcile: “I rarely hold a week for someone to say something very, very insensitive.”

Hair in general can already be a difficult landscape for black women, who for generations have been expected to change the natural texture of hair to meet white standards of beauty. Black women are 80% more likely to change their natural hair to meet social standards at work, according to a study conducted in 2019 by the Dove personal hygiene division of Unilever USA.

Black students are also much more likely than other students to be dismissed for dress code or hair violation, according to a study that helped persuade the U.S. House to vote for a ban on discrimination based on natural hairstyles in March.

“The only good thing that can come out of all this is that alopecia is anterior and central,” Bridges said of the Oscar slap.

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Writers of the AP race and ethnicity Annie Ma of Charlotte, North Carolina, and Aaron Morrison of New York City contributed to this story. Whitehurst reported from Salt Lake City.

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