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Some diseases, conditions and treatments are different in patients with skin of color as compared to Caucasian patients, and understanding these differences is essential in choosing appropriate therapy, according to Heather Woolery-Lloyd, M.D.
Heather Woolery-Lloyd, M.D.Miami - Some diseases, conditions and treatments are different in patients with skin of color as compared to Caucasian patients, and understanding these differences is essential in choosing appropriate therapy, according to Heather Woolery-Lloyd, M.D.
“Though there aren’t any differences in the type of keratin or amino acid composition in Asian, Caucasian or African hair, there are fundamental differences in the hair structure of African hair compared to that of other ethnic groups,” says Dr. Woolery-Lloyd, director of ethnic skincare and voluntary assistant professor, department of dermatology and cutaneous surgery, University of Miami Miller School of Medicine.
Compared to Caucasian hair, African hair has fewer elastic fibers anchoring the follicles to the dermis. African hair also has a decreased density and tensile strength, Dr. Woolery-Lloyd says, as well as a lower resistance to breakage compared to Caucasian and Asian hair.
One of the most common hair disorders in African hair is traction alopecia, typically characterized by hair loss on the frontal and/or temporal scalp with a rim of short hairs at the hairline.
This condition occurs when the hair is pulled too tightly, a practice commonly seen with certain hair styles such as multitufted braids, tight twists, tight cornrows and extensions, as well as with some hair management and care practices including the use of chemical relaxers, Dr. Woolery-Lloyd says.
“Physicians need to educate the parent in a culturally sensitive approach and advise against tighter hairstyles, particularly in children. When necessary, local inflammation could be treated with topical steroids,” she says.
Due to the tightly coiled nature and fragility of African hair, many different haircare practices are used to improve manageability. According to Dr. Woolery-Lloyd, chemical relaxers such as sodium hydroxide and guanidine hydroxide are commonly used, but they can cause superficial, self-limited chemical burns if left on the scalp for too long.
In addition, Dr. Woolery-Lloyd says that “chemical alopecia” can result following the improper use of these chemical relaxers.
Tinea capitis is another condition often seen in African-American children, most commonly caused by Trichophyton tonsurans. The diagnosis of this condition is based on clinical findings including scales on the scalp and cervical lymphadenopathy.
In the past, Dr. Woolery-Lloyd says, some dermatologists incorrectly believed that frequency of shampooing and oil use caused tinea capitis, but studies show this is not the case. Researchers have postulated that perhaps the structural properties of African hair predispose patients to tinea capitis, Dr. Woolery-Lloyd says.
“Cultures should always be performed to confirm the diagnosis. However, physicians should not wait for culture-positive results before initiating treatment, particularly when the clinical presentation is clear,” she says.
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Treatments commonly used for tinea capitis include griseofulvin or terbinafine (Lamisil, Novartis). According to Dr. Woolery-Lloyd, a two- to four-week course of terbinafine can be at least as effective as a six- to eight-week course of griseofulvin for the treatment of Trichophyton infections of the scalp.
Antifungal shampoos and topical antifungal lotions and creams can also be used alone or in combination with oral griseofulvin or terbinafine therapy.
“The newer systemic antifungal agents such as terbinafine can have a similar efficacy to griseofulvin and at times can even be more effective when Trichophyton is the cause. Though both terbinafine and griseofulvin are used to treat tinea capitis, griseofulvin can be the superior choice of therapy, particularly in rare cases of tinea capitis caused by Microsporum species,” Dr. Woolery-Lloyd says. DT
Disclosures: Dr. Woolery-Lloyd reports no relevant financial interests.