Painfully tight braids and weaves might be the culprit behind baldness and scalp scarring in middle-age African-American women, according to a study published in the journal Archives of Dermatology and reported by HealthDay News.

For the study, Cleveland Clinic Institute of Dermatology and Plastic Surgery researchers examined the hair of 326 African-American women. The participants answered questions about both their hair and health.

Researchers found that 28 percent of women showed signs of hair loss in their central scalps, a condition called central centrifugal cicatricial alopecia (CCCA). Of those women, almost 60 percent showed signs of severe hair loss. What’s more, these women were also more likely to have type 2 diabetes and bacterial scalp infections and to have worn their hair in braids or weaves.

These tightly pulled hairstyles can cause baldness because they scar the scalp, which leads to permanent hair loss.

“If you think you’re having hair loss, you need to have it evaluated and see if it’s this type of hair loss,” said Angela Kyei, a Cleveland Clinic dermatologist and lead study author. “And if you’re relaxing your hair, if you’re having tight braids, I would just put that on hold until you find out what’s going on with your hair.”

To get to the root of the problem, find a dermatologist who specializes in hair, not just skin and nails, to evaluate the problem.

Click here to learn more about how braided hairstyles can lead to baldness.