Scarring Alopecia Associated with Continuous Use of Alkaline Hair Relaxers: A Case Report of Comfort Centred Management

Abstract

Alkaline hair relaxers are widely used in Brazil and can injure the scalp. When follicular loss is irreversible, therapeutic goals must be redefined. We report a 35 year old Black man with a seven year history of scarring alopecia associated with continuous use of relaxers containing guanidine hydroxide and sodium hydroxide. The scarred area showed no clinical or trichoscopic signs of inflammatory activity; the main complaints were pruritus, burning, scalp tenderness, xerosis and recurrent follicular papules and pustules on the occipital scalp, consistent with pseudofolliculitis related to close clipper shaving. Over seven months of fortnightly visits, he received a multimodal approach combining microneedling with sterile saline, 660 nm photobiomodulation, clay therapy, topical tonics and scalp care guidance, including less frequent close clipping. Pruritus, burning, tenderness and xerosis improved and follicular lesions became less frequent, while no clinically relevant regrowth occurred. The design does not allow the improvement to be attributed to any single component, and reduced mechanical trauma is a plausible contributor. This case illustrates that, in established scarring alopecia, comfort and scalp health are legitimate therapeutic goals that should be agreed with the patient from the outset.