Explaining alopecia and why it's no joke for sufferers

• Alopecia is an autoimmune skin disease that causes hair loss on the scalp and face.
• The link between hair and identity cannot be underestimated.
• In several studies, alopecia has been shown to lower women's self-esteem.

It will be remembered as one of the most bizarre moments in the history of the Academy Awards. 

“Will Smith just smacked the s**t out of me,” stand-up comedian Chris Rock said after Smith went onto the stage and slapped the comedian across the face. 

The tense altercation took place at Sunday's Oscars award ceremony, where Rock made a joke about Smith's wife, Jada Pinkett Smith appearing in “G.I. Jane 2”, a reference to her shaved head. The actress struggles with alopecia, a condition that leads to hair loss, in December 2021. Rock was presenting best documentary feature at the Oscars. 

Recorded footage from the telecast showed Pinkett-Smith rolling her eyes at Rock’s joke, just moments before the heated exchange between him and her husband.

The Academy later issued a statement on Twitter, stating that it “does not condone violence of any form”.

Pinkett-Smith first spoke about her diagnosis back in 2018 on an episode of her talk show, Red Table Talk, and has since embraced the challenges of the condition. In a recent Instagram video, she confidently spoke about the condition, saying: “Now this is going to be a little bit more difficult for me to hide, so I thought I’d just share it so y’all not asking any questions – but you know, mama’s going to put some rhinestones in there, and I’m going to make me a little crown.”

What is alopecia?

Alopecia is an autoimmune skin disease that causes hair loss on the scalp and face – and sometimes on other areas of the body. It arises from a combination of genetic and environmental influences. Currently, it has no cure. It is sometimes responsive to medical treatment, although this has limited effectiveness. It is more prevalent in adolescents and older adults than in children and affects one in every 500 to 1 000 people in the US, according to MedLine Plus.

The hair loss associated with the condition may not be painful or life-threatening, but since it causes changes in a person's appearance, it can severely impact their self-esteem, lead to a poorer quality of life, and have severe psychological consequences. In some people, alopecia can lead to depression and anxiety. 

Research into the psychological impact of alopecia indicates that the condition can be psychologically damaging, cause intense emotional suffering, and negatively affect a sufferer's personal and social life.

Hair loss and identity change

There is an important link between hair and identity, especially for women, as these three authors point out. One study noted around 40% of women with the condition developed marital problems as a consequence, while just over 60% indicated career-related problems.

Another study showed that some patients experienced an ongoing feeling of loss – in other words, coping with the condition may be equated with grieving after bereavement. 

In several studies, alopecia has been shown to worsen women's self-concept, leading to shock, embarrassment, and losing their sense of self, among other feelings. Understandably, alopecia can, therefore, cause poorer body image since scalp hair, as well as eyebrows and eyelashes, help to define one’s face. 

Mabel Peralta, a 43-year-old Afro-Latina woman, told NBC News in January this year that growing up, hair was a primary focus in her Dominican culture. Therefore, when she started losing her hair because of alopecia, she felt like less of a woman and struggled with the change in her physical appearance.

In an opinion article in The Sydney Morning Herald, Katie Hale, a communications adviser who is living with alopecia, wrote: “I am a bald woman. What Jada Pinkett-Smith experienced [at the Oscars] today is what so many young women and girls like me experience every single day. Staring faces, jokes at your expense, and derogatory comments. It’s endless and it’s exhausting.”

She continued: “When did it become OK to crack jokes and embarrass those who don’t fit the mould? How hard is it to show some compassion for those around you?”

Hale said that these kinds of interactions lead to a lasting impact on sufferers and “destroy your confidence”. 

Alopecia and the entertainment industry

Closer to home, South African actresses have also opened up about their alopecia diagnosis. In an interview on Unpacked with Relebogile Mabotja, Altovise Lawrence revealed the difficulties of having the condition while working in the entertainment industry. 

The actress said she cuts her hair every few days to hide the patches that show when her hair grows, and that using her face to communicate was a struggle since she lost her eyebrows too. Eventually, she decided to perform auditions with a bald head so that she could be judged for her talent and not her looks. 

Similarly, Blood & Water star, Gail Mabalane, started a YouTube series called My Hair Journey and discusses how she came to terms with living with alopecia.

“I knew this was a sensitive conversation for women, but I also knew it was a necessary one. I wanted to create a platform where, as women, we can come together and talk about something that is a big part of our identity," she said in one of her videos.

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