Essential Treatment Tips for Textured Hair

Not every patient who has hair that is textured—tightly coiled or curled— will have a dermatologist with the same hair type. Instead of focusing on the difference between races or ethnicities, dermatologists should change their mind-set and center their attention on the hair, recommended Candrice Heath, MD, FAAP, FAAD, a dermatologist and an assistant professor of dermatol- ogy at Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.

In an exclusive interview with Dermatology Times®, Heath outlined best-practice strategies for dermatologists who treat hair issues in patients with textured hair.

“Acknowledge that you may not have the same type of hair,” she said. “Then emphasize the fact [that] as a dermatologist, you have the clinical knowledge and experience to diagnose, treat, and manage hair issues for all hair types. The message should be that it’s OK that you and the patient have different hair patterns, but you are still an expert in the science of hair. Dive into the literature to illustrate that.”

Studying current literature will help phyisicianslearn more about how to conduct these conversations with cultural sensitivity, she said. In her view, communication with the patient will create the partnership that is needed.

In many cases, it helps to demonstrate a willingness to learn from the patient, Heath added. A dermatologist who feels some hesitancy about examining tightly coiled hair can always request the patient’s help. That can be as simple as asking the patient to point out the area of concern or talk about sensitivities regarding their hair or scalp.

Heath shared some tips to better help patients, both adult and pediatric, with skin or hair of color. She emphasized the importance of matching treatment recommendations to the patient’s lifestyle and work style. For example, a patient’s job or sports and other activities can affect their hair care. Dermatologists should ask if an employer requires wearing protective head coverings or pulling back hair with a wrap or elastic. Pediatric patients who have hobbies that affect their hair and may need direction on how to protect their hair. For a patient who regularly swims in a pool, using leave-in conditioner is crucial to protect the hair shafts and prevent further drying out, Heath said.

“Find out how patients cover their hair at night,” she added. Many patients wear silk bonnets to help the hair to stay hydrated. Examine the area where the band sits, and be sure to ask questions if the patient is developing acne across the forehead or losing hair across the edges. One question can open the door to many opportunities for better treatment.

Find out who is in charge of a pediatric patient’s hair care. Whether that is just one person or a team, everyone should understand the treatment plan. Dermatologists should talk about the findings of the hair examination, Heath said, and—if knowledgeable in this area—discuss potential hairstyles that may be more beneficial. “You want to make sure that [patients] keep the tension as low as possible on the hair [and] that the hair is moisturized on a daily basis,” Heath emphasized.

She warned of the conversation on social media regarding protective hairstyles—some may not be as safe as they seem. Therefore, Heath suggested that dermatologists ask for a history of their patient’s protective hairstyles. Sample questions include the following:

• Do you have a history of wearing braids or weaves?
  
• If yes, have you been wearing these hairstyles back-to-back?
  
• How frequently do you wear these styles?

Heath has found that some so-called protective styles can put extra tension on the scalp, especially when worn from months to years, and can have devasting effects. Conversations with patients should include general recommendations, such as steering clear of products that contain sulfates or other agents that can be drying. Instead, patients should use a moisturizing shampoo and conditioner, followed by a leave-in conditioner, she said.

Prioritize keeping current on research about hair and hair loss, Heath advised. She mentioned a resurgence of interest in scarring alopecias, which she described as an often overlooked yet complicated area of research. For example, many patients may not realize that they have central centrifugal cicatricial alopecia, she noted. Many patients may go through their entire life at risk for CCCA with worsening hair loss year after year.

More research is needed, she continued, because scarring and nonscarring alopecias are still not understood well enough. “From the epidemiology side, some studies have come out about [hair loss and scarring] being linked with other conditions,” Heath said. “We don’t know if there is a cause [and] effect relationship quite yet.”

There is more support in general, Heath continued, about better prevention, identification, and diagnosis of hair disorders. “The good news is that there is a movement to be more sensitive to different cultures when conducting hair exams,” she said. “There are more dermatologists working to support those who do have textured hair and approaching the field with more cultural humility.”