There are specific considerations for choosing a topical regimen for the treatment of scalp psoriasis, particularly for women of sub-Saharan African ancestry with Afro-textured hair, because of the structural differences of the hair and the haircare practices they may follow. It is important to get the patient’s input, says Dr. Alexis. “One has to take into account their haircare practices and come up with the regimen that is compatible. Hair washing frequency may differ — it tends to be less frequent — and the vehicle has to be compatible with their overall hairstyle and hair structure.”
For example, if daily hair washing with a medicated shampoo is recommended for someone with Afro-textured hair that has been straightened with a chemical relaxer, frequenthair washing may lead to dryness, fragility of hair, breakage or it simply may not be practical given the time-consuming after-shampoo haircare routine.
These considerations will impact choice of vehicle and dosing frequency of a topical and even the threshold for using a non-topical therapy, he says.
“I have a lower threshold for using systemic therapies because of the impact of scalp psoriasis on this cohort,” he admits, and says there is also an argument for having a lower threshold for initiating systemic therapies for plaque psoriasis.
“Given the high rate of pigmentary alterations with topicals, which can be long-lasting and disfiguring, appropriate use of systemic agents is key,” he says. “In other words, avoiding undertreatment. With undertreatment would come a greater tendency for long-standing pigmentary alterations on top of the long-standing issues of psoriasis itself.”
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