Diagnostic dilemmas and treatment options for patients with Afro-textured hair
Dr. Renée Beach discusses issues sometimes faced by patients with Afro-textured hair including seborrheic dermatitis, traction alopecia and androgenetic alopecia (790 words, 3 min)
Patients with Afro-textured (AT) hair can have various issues, including seborrheic dermatitis, traction alopecia and androgenetic alopecia. During a talk on hair and scalp disorders at Skin Spectrum Summit in Toronto, Dr. Renée Beach discussed diagnostic and treatment options for patients with conditions related to AT hair.
Seborrheic dermatitis mainly affects the scalp, causing scaly patches, red skin and dandruff. For treatment, Dr. Beach recommends the use of a triple-threat therapy including an anti-yeast, anti-inflammatory medication and, in some cases, debris removal.
“I have a discussion with [patients] about increased washing, at least temporarily. I ask them to wash their scalp twice a week, which I know is really a lot for Afro-textured hair types,” she said. “Also, [I ask them to] consider the use of ciclopirox lotion, if they need to, a few nights a week.”
Mometasone lotion is an option to aid with itching, and scaling can be done with a 2% salicylic acid compound.
Although the recurrence of seborrheic dermatitis can be limited by washing and rinsing the scalp, traction alopecia requires patients to modify their hairstyle.
Traction alopecia is the gradual receding of the hairline. There is hair at the front of the hairline, and then there are patches of hair with a noticeable regression. The condition can be caused by wearing the hair in slicked-back updos and top-knot buns.
“Patients will admit, sometimes reluctantly, to headaches, tenderness, sometimes broken hairs with certain hairstyles. And typically, they get a fringe sign [of hair loss]. Patches of hair along the hairline [are] a dead ringer for traction alopecia,” said Dr. Beach.
In addition to hairstyle modifications to reduce tension on the scalp, Dr. Beach recommends the off-label use of 5% minoxidil foam. Traction alopecia is reversible if diagnosed and treated in the early stages.
Weathering and trichorrhexis nodosa—defects in the hair shaft—occur when there is a lack of hair growth. Hair strands appear like broomstick hair. Patients also have broken shafts, simple knots and complex knots throughout the scalp. The hair has been weathered, caused by heating the hair strands with a blow dryer or ceramic straightener.
“When we heat the hair strands, they literally get air bubbles in the shaft, and the air bubbles are tied to breakage,” said Dr. Beach. “When patients with Afro-textured hair dry comb their hair without any product on their hair, it can amount to a daily haircut in terms of the breakage that they sustain.”
She suggests air-drying the hair and minimizing the friction with a seamless comb. Products with “slip” that contain ingredients such as glycerine, can be helpful in treatment, as can trimming off dead ends.
Androgenetic alopecia is a type of hair loss common in middle age. Affecting 40% of females and 50% of males, androgenetic alopecia is gradual and progressive and can be described as follicular miniaturization. Thicker hairs turn into vellus hairs and whisk away.
This type of hair loss is a combination of genetics, heritage and androgen activity.
The takeaway: Dr. Beach suggests a 5% minoxidil foam for treatment and notes that if spironolactone is prescribed to patients, there is a dosage difference between men and women.
FROM THE LITERATURE ON AFRO-TEXTURED HAIR
Hair pull test: A clinical update for patients with Asian- and Afro-textured hair
For patients with Afro- or Asian-textured hair, a hair pull test of up to two hairs is an effective method for evaluating hair loss disorders. The method was pervasively established based on Caucasian hair textures, and the recent study evaluated the pull test in 198 patients with Afro- and Asian-textured hair.
Bi-temporal scalp hair loss: Differential diagnosis of nonscarring and scarring conditions
In a literature review of articles on bi-temporal scalp hair loss, the authors found that the condition is challenging to treat due to several differential diagnoses. They noted that traction alopecia, common in Black women, is often a cause of the condition.
A multimodal hair-loss treatment strategy using a new topical phytoactive formulation: A report of five cases
In a study of five cases of patients with androgenetic alopecia, including one of a 35-year-old African American male, and one of a 50-year-old African American female, the researchers found improvements in hair regrowth after five months of treatment with a topical botanical formulation containing 12 phytoactive ingredients.
VIDEO: Norrin protein may activate hair growth, lead to new therapies
AT THE INTERSECTION OF SKIN AND SOCIETY
In a new cooking and poetry book, Hamilton, Ont.-based writer Tania Hernandez (pictured below) mixes Jamaican recipes with Canadian culture, according to a recent profile in the Hamilton Spectator. In the profile, Hernandez talks about the inspiration behind the recipes found in her book “One Pot,” which are rooted in her Jamaican heritage but influenced by her Canadian experience. In addition to recipes like Curry Chicken Chickpeas Style and Crispy Golden Mac and Cheese, the book also contains stories and poetry inspired by her life in Jamaica, anecdotes about the culture shock she experienced moving to Canada, and essays on racial justice, according to the report. “I want to try and unite everyone together,” Hernandez told the Spectator. “If everyone shares the best of their culture, I think the world will be a better place,” she said. Read the full article here.
This Week
April 11 to 17 is National Medical Laboratory Week
April 13 is Functional Neurological Disorder Awareness Day
April 14 to 15 World Congress on Cardiac Nursing and Cardiology
Something to think about during the week ahead…
Next Week
Light patches on the trunk may turn out to be progressive macular hypomelanosis, said Dr. Andrew F. Alexis in a presentation titled “Diagnoses Not to Miss.”
Thank you to our panellists and delegates for making the Indigenous Skin Spectrum Summit a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.