Hair Care, Hair Loss and the Overall Health of Black Women

There are special considerations a clinician must take when diagnosing and managing alopecia areata in Black women. At the 2023 American Academy of Dermatology (AAD) Annual Meeting in New Orleans, Louisiana, Victoria Barbosa, MD, FAAD, will provide clinical insights on this topic as well as provide a foundation for diagnosing and managing alopecia, and review hair care practices and products.

Barbosa is the director of the Hair Loss Program at the University of Chicago. She will be joined at her session by Oluwakemi Onajin, MD, FAAD, assistant professor of medicine in the Section of Dermatology at the University of Chicago. Together they will present "Hair Care, Hair Loss, and Health In Black Women" on Saturday, March 18 at 4:30 PM at AAD in room 354.

Transcript

Victoria Barbosa, MD, FAAD: Hi my name is Victoria Barbosa. I am an associate professor of dermatology at the University of Chicago. I specialize in hair and scalp disorders. As many of you know, there are special properties of highly textured hair that contribute to different hairstyles, hair care products that we use, and hair styling practices that are different from people of other ethnicities. And it's really important to understand those hairstyles and the haircare practices, both so that we have the right language to talk to our patients about what they're doing, but also to understand the role that some of those products and practices play in hair loss and health. I'll also be talking about 3 forms of hair loss that we think disproportionately affect Black women, including traction alopecia, alopecia areata, and, of course, central centrifugal cicatricial alopecia (CCCA). I am really excited that I will be joined by my colleague and friend, Oluwakemi Onajin, MD, FAAD. She is a dermatologist and dermatopathologist. As we talk about the forms of alopecia that are disproportionate in Black women, she will give us pearls and pitfalls of dermatopathology. And finally, we will wrap up by talking about the different ways that haircare and hair loss can impact the health of black women.

Dermatology Times: How do you diagnose these specific hair loss disorders?

Barbosa: When a Black woman comes in with a concern for her hair loss, it's really important to get a great history. The patient will often help guide you toward a differential diagnosis with her history. And this really comes back to why it's so important to be comfortable with and knowledgeable about haircare styling products and practices, so that as a dermatologist, you can ask about the history of wearing braids. And were they individual braids or were they cornrows? Because it makes a difference. Do they shampoo once a week or every other week, or less frequently? So taking a good history is the first step. Of course, then a good physical examination is the important second step. I like to remind people that even when people come in for a full body skin exam, that needs to include the scalp, because countless times women will come in with other dermatological concerns, and I always say "Hey, can I have a look at your scalp while you're here", because so often women are in the early phases of scarring alopecia, and they don't even know it. So I always ask for a scalp exam, even if Black women are coming in for a different concern, because again, particularly CCCA, is just extremely common. The scalp exam should involve the entire scalp, including the front hairline, the occipital hairline, the crown, and everywhere in between to make sure that you're not missing anything, because sometimes people have more than one thing going on. Sometimes a patient will come in for concern of marginal traction alopecia at the front. And many dermatologists have added trichoscopy to their armamentarium of diagnostic procedures. And so I encourage people to develop those skills. I want to remind people that when in doubt, you do a biopsy, and sometimes even when you think you know, you still do a biopsy, particularly with the scarring alopecia because sometimes it can be difficult to differentiate between CCCA and lichen planopilaris. And our management might be a little different, and our expectations for the clinical progression might be a little different. You know, similarly, at the front hairline with someone comes in for marginal traction alopecia, you can't just assume that because she's a black woman, she has traction, especially if she told you that she hasn't been wearing tight hairstyles. Maybe she has frontal fibrosing alopecia or maybe she has ophiasis pattern alopecia areata. So don't be afraid to do a biopsy to help you make a diagnosis or to confirm your clinical impression. And finally, choosing a therapeutic regimen for patients really has to be customized both for the patient's level of disease and severity, but also has to factor in those other haircare products and practices, so that you can tailor a treatment regimen that she will be able to adhere to, and that will maximize the likelihood of efficacy.

This transcript has been edited for clarity and length.