Dermatology Weekly

There is a consumer trend to avoid additives in hair care products and consider natural alternatives. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks with Dr. Amy McMichael about shampoo ingredients and the importance of cleansing the scalp in the skin of color population. Dr. McMichael also discusses how hairstyling practices in this population can lead to hair loss and damage to the hair shaft. “We just have to be more healthy in our choices of how we do those styles and how we cleanse our scalp and our hair when we’re wearing those styles,” advises Dr. McMichael.

We bring you the latest in dermatology news and research:

1. Psoriasis registry data provide evidence that adalimumab reduces mortality

2. Tape strips useful to identify biomarkers in skin of young children with atopic dermatitis

3. Short-term statin use linked to risk of skin and soft tissue infections

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Things you will learn in this episode:

• Do patients need to avoid shampoos containing sulfates and parabens? “Sulfates are just one of the many ways that we can cleanse the scalp and the hair. It is a detergent, and when that detergent is removed, in order to cleanse the hair another detergent has to be put into its place,” explains Dr. McMichael There are "no data to suggest that these other detergents are better or safer or even helpful for our hair shaft.” Only patients with a true allergic contact sensitization to parabens need to avoid products with this ingredient.
• Patients need to understand that the “no-poo” method and dry shampoos are not cleansing the scalp. “There’s an idea that you can shampoo as infrequently as you want,” says Dr. McMichael. “That’s really not true. In order for your scalp to be healthy and to grow healthy hair, you need to have it cleansed. And once weekly is preferred but certainly every 2 weeks is reasonable.”
• Patients may rinse their hair with water and baking soda, apple cider vinegar, and tea tree oil without knowing how they interact with the bacterial and yeast components on the scalp. “And they can be bad for the hair shaft,” Dr. McMichael adds.
• Conditioners are not a good replacement for shampoo, especially for patients with a scalp condition. “Conditioners alone are not meant to cleanse,” Dr. McMichael explains.
• For women of African descent, consider dandruff shampoo products that are manufactured and tested for this patient population.
• Central centrifugal cicatricial alopecia (CCCA) is the most prominent form of hair loss in the United States in women of African descent. Clinicians should help patients with or who are at risk for CCCA to minimize traction, tension, and trauma to the scalp caused by some hair care practices.
• In a recent study of more than 5,000 patients, CCCA seems to have an association with type 2 diabetes mellitus. “As we move forward, we need to start thinking about the whole patient,” Dr. McMichael advises. “It’s not just the scalp that we’re dealing with. It’s not just the hairstyle. But what is the health and underlying metabolism issue of some of these patients and can we as dermatologists be helpful in getting them to better health.”
• Dermatologists in residency need more training in hair care practices of patients with skin of color that encompasses the wide cultural differences in hairstyling methods and scalp conditions across different populations.

Host: Lynn McKinley-Grant, MD (Howard University, Washington)

Guest: Amy McMichael, MD (Wake Forest University, Winston-Salem, N.C.)

Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie

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