When treating black patients for hair and scalp disorders, clinicians must also have an understanding of hair care practices.
"There are no good studies to show the true incidence of alopecia in black females, but from clinical experience, it is clear that we are seeing this problem more frequently than in the past," Dr. Callender explains. "Fortunately, we can be successful in helping these patients, but we must identify and aggressively treat the underlying cause and know that surgical intervention is an option."
Dr. Callender is clinical assistant professor of dermatology, Howard University College of Medicine, Washington, D.C., and director of the Callender Skin & Laser Center in Mitchellville, Md.
"Black hair is generally dry and brittle and particularly so if they are using heat or chemicals for straightening. Washing with shampoos containing keratolytic agents, such as tar or salicylic acid, will worsen the condition of the hair and may even lead to severe breakage," she says.
Dr. Callender mentioned that the product labeling for ciclopirox shampoo notes that the efficacy for black patients was not demonstrated in clinical trials. However, she says she has been using it exclusively to treat seborrheic dermatitis in blacks since it became available.
"The labeling statement reflects the fact that only a limited number of African-American patients were enrolled in the premarketing studies," Dr. Callender says. "However, as far as my practice goes, I feel satisfied that I have established its efficacy and safety."
Know hair care practices When treating black patients for hair and scalp disorders, clinicians must also have an understanding of hair care practices. They may be a factor in both the etiology of the problem and in determining the best course of therapy, she says. With respect to seborrheic dermatitis, patients who straighten their hair likely only shampoo once weekly or once every other week, and they will not be compliant with directions to shampoo daily.
"In this situation, it is important to ask patients about their usual hair grooming practice and to integrate your treatment with their regimen rather than trying to force a change," notes Dr. Callender.
New strategy Dr. Callender notes that the off-label use of oral doxycycline has been of significant benefit as part of a multimodal approach to treating inflammatory scalp disorders that lead to scarring alopecia.
For acne keloidalis, the doxycycline course begins with a dose of 100 mg twice daily for two to four weeks and then continues with a four- to six-month maintenance regimen at a lower dose of 20 mg twice daily. Both dissecting cellulitis and central cicatricial centrifugal alopecia (CCCA, formerly referred to as hot comb alopecia and follicular degeneration syndromes) are also treated with the low-dose, four- to six-month course of doxycycline, which provides anti-inflammatory action and a reduced risk of antimicrobial resistance.