Treating scalp psoriasis in women of African ancestry

Dr. Andrew Alexis emphasizes that dermatologists should take into account a patient's cultural differences when prescribing treatments. (720 words, 2.4 min)

When treating a woman of African ancestry with psoriasis of the scalp, Dr. Andrew F. Alexis recommends that doctors consider differences in hair structure and hair-care practices.

“When prescribing topical therapy, in particular, we have got to go an extra step and think about prescribing something that will be compatible with this patient’s hair type and hair-care regimen, especially hair-washing frequency,” said Dr. Alexis in a presentation at Skin Spectrum Summit in Vancouver. 

Generally, he said, hair-washing frequency is lower in women of African ancestry for various practical and cultural reasons. Once-weekly or once-every-other-week washing is common, he said. 

“To prescribe something that involves washing the hair every single day would not be aligned with this patient’s normal hair-care practices, so we have to come up with a regimen that involves a good compromise.” 

He said that this compromise could be something such as once- weekly washing with a medicated shampoo and using potent topical leave-on products on the scalp for the rest of the week. 

It is best to get the patient’s feedback on what they would prefer as far as dosing regimen and vehicle, whether they prefer a water-based, an oil-based, or some other formulation, said Dr. Alexis.

“Breaking down various options and getting the patient’s own input on the selection goes a long way for adherence and better outcomes,” he said. 

One product that is particularly well suited for treating scalp psoriasis in this population, he said, is a fixed-combination formulation of calcipotriene and betamethasone. Among its advantages is that it does not dry out the hair and is easy to leave without washing. 

“However, particularly in more severe cases of scalp psoriasis, we may need to consider non-topical therapies,” he said.

One treatment that is particularly effective against scalp psoriasis is secukinumab, he noted.

“Take into account hair-care practices and query patients about traditional cultural practices that may influence the presentation of their disease,” he said. 

The takeaway: Dr. Alexis said that he advises doctors not to forget to convey to the patient that “you are in with them for the long haul” and provide realistic timelines. 

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Thank you to our panellists and delegates for making the Indigenous Skin Spectrum Summit a great success. As always, we welcome your questions and comments on topics in Ethnodermatology.

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