Hijab wearing is associated with unique hair and scalp disorders that are largely preventable through early recognition and culturally sensitive care.A review of literature presented at AAD 2026 reveals an association between hijab wearing and unique hair and scalp disorders.
“The strongest association is with traction alopecia, which is linked to chronic pinning and tight wrapping, particularly at the frontal and temporal hairline,” the investigators said. The resultant follicular traction and perifollicular inflammation/folliculitis from the repetitive mechanical tension may lead to scarring alopecia. [Int J Womens Dermatol 2023;9:e107]
The warm, humid, occlusive environment from constant hijab wearing may also promote Malassezia proliferation, barrier dysfunction, and inflammation, eventually leading to seborrheic dermatitis. [Scientific Reports 2023;13:11797]
Occlusion and friction may also cause follicular obstruction and microtrauma, leading to acne mechanica, a condition characterized by inflammatory papules or pustules along pressure zones. [Int J Dermatol 2021;60:799-809] “Occlusion increases transepidermal water loss and reduces barrier recovery, predisposing [hijab wearers] to irritation and infection,” the researchers noted.
The consistent coverage of the hair and scalp also reduces ultraviolet B penetration, contributing to vitamin D deficiency. [Nutr Res 2014;34:688-693]
Other dermatologic issues that may afflict hijab-wearing women are contact dermatitis, frictional dermatitis, hyperpigmentation, and hyperhidrosis/heat rash. [AAD 2026, abstract 74993]
Head coverings worn for extended periods create a warm, humid, occlusive scalp microenvironment that can alter the skin microbiome, barrier function, and hair-follicle health, the researchers said. The sustained heat, humidity, occlusion, and friction predispose wearers to distinctive patterns of hair loss and scalp disease.
Both humid and dry environments may contribute to these scalp issues—the former may increase sweating and lead to seborrheic dermatitis and folliculitis; the latter may increase irritant dermatitis and cause flaking.
“Despite its prevalence, dermatologic issues among hijab-wearing women remain understudied and clinically underrecognized. Furthermore, cultural factors may delay care-seeking and complicate provider-patient communication,” the researchers noted.
Fifteen peer-reviewed studies and grey literature were included in the literature review. The pooled cohort comprised over 2,000 women from the Middle East and North Africa, South and Southeast Asia, and Western regions.
Approximately three-quarters of hijab-wearing women report scalp symptoms. However, 45 percent are hesitant to remove their hijab for an examination, potentially due to modesty concerns, limited access to female physicians, and fear of judgment. [Int J Womens Health 2023;15:1661-1672]
“[Taken together,] hijab wearing is associated with unique hair and scalp disorders that are largely preventable through early recognition and culturally sensitive care,” the researchers said.
“[However,] the absence of standardized guidelines for a population exceeding half a billion women underscores an urgent need for focused research and clinical awareness,” they added. “Effective management requires more than topical treatments. It calls for empathy, awareness of modesty practices, and open communication that fosters trust and adherence.”
Culturally sensitive practices, such as private examination rooms, clear communication, and respect for preferences regarding removal of the hijab, may improve trust and adherence. [Br J Dermatol 2022;186:176-177]
The investigators called for larger studies to better characterize the prevalence of hair and scalp disorders in this patient population, as well as to characterize microbiome alterations and establish tailored management strategies (eg, use of breathable fabrics, non-staining topical formulations).
They also highlighted the importance of promoting vitamin D screening, hygiene education, integrating cultural competence into dermatology training, and ensuring access to female clinicians and private spaces to provide a patient-centric approach for hijab-wearing women.