Seborrheic dermatitis management with Afro-textured hair

Dr. Renée Beach on the burden some patients experience when managing the inflammatory scalp condition (445 words, 2.5 minutes)

Many women with Afro-textured hair who complain of ‘dry scalp’ are experiencing seborrheic dermatitis, which can require a month of focused care to manage, said Dr. Renée Beach in a presentation at the virtual 2020 Skin Spectrum Summit.

Dr. Beach is a dermatologist in practice in Toronto.

She described a typical patient with this presentation as washing their hair once every two weeks with a moisturizer-based shampoo, after which they apply coconut or other oil to the scalp for additional moisture. The patient will experience significant itch, scale and flaking of the scalp, but not hair loss. Microorganisms on the scalp, primarily yeasts, are the driving factor of the condition, she said.

“When a patient [with this condition] first comes is I tell them right away, our first month is going to be a lot of work,” said Dr. Beach.

“I like to think of therapy as a triple threat,” she said. “We want to target yeast. We want to target inflammation. And we also want to think about lifting off some of those flakes or scales.”

The first part of the treatment is removing the yeast, usually with a medicated shampoo. “I recommend scalp shampooing twice per week. This is very laborious for patients with Afro-textured hair or curlier hair textures, but it is temporary.”

Patients may mix the medicated shampoo with some conditioner to reduce the feeling of the hair being stripped of moisture, as this can improve treatment adherence, Dr. Beach said.

“I like to think of [seborrheic dermatitis] therapy as a triple threat,” said Dr. Renée Beach. “We want to target yeast, we want to target inflammation. And we also want to think about lifting off some of those flakes or scales.”

Prescription antifungal lotions such as ciclopirox olamine, used every second night, are also an option, she said.

Dr. Beach said she would use mometasone furoate, or in severe cases, betamethasone valerate to reduce inflammation and manage itch.

A keratolytic agent such as salicylic acid will also speed the removal of scale, she said.

She said that after the seborrheic dermatitis is more under control, shampooing frequency can be reduced to once a week.

Other tips:

  • For patients with good treatment adherence to the medicated shampoo and anti-inflammatory treatments, the keratolytic agent may not be necessary

  • Wetting the scalp once a week between shampoos, using a spray bottle or a saturated towel, is also beneficial for patient comfort

  • The use of scalp oils should be avoided as the oil contributes to the buildup of scale and other debris

  • To encourage patients to shampoo more frequently, compare their scalp to their skin, and how frequently they clean it

Bottom line: The frequent shampooing needed to manage seborrheic dermatitis can burden individuals with Afro-textured hair. It is important to let patients know that the intensified routine is temporary and that they can take steps to improve their comfort.

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    Greg Fergus, chair of the Caucus of Black Parliamentarians and parliamentary secretary to Treasury Board President Jean-Yves Duclos, told CBC News that he believes these agreements are only acceptable if they are signed at the complainant's request.

    Fergus said the government needs to keep more detailed data regarding withdrawn complaints after the complainant signs a confidentiality clause.

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Dr. Jason Rivers speaks on how melasma presents in skin of colour.

Skin Spectrum Weekly is launching the Skin Spectrum Podcast series this summer. Please watch this space for more details. As always, we welcome your questions and comments on topics in Ethnodermatology.

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