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Scalp and Hair Disorders in Patients With Skin of Color
On the second day of the APP Institute Dermatology 2024, Andrea Nguyen, DMSc, MPAS, PA-C, and Candrice Heath, MD, FAAP, FAAD, discussed differentials, workups, and treatment options for patients with skin of color experiencing scalp and hair disorders.
Dr Nguyen, a physician assistant at First OC Dermatology in Irvine, CA, presented several cases to illustrate potential differentials. The differentials for case #1 included female patter hair loss, lichen planopilaris, discoid lupus erythematous, and central centrifugal cicatricial alopecia (CCCA). She emphasized that dermoscopy is a useful tool for helping to differentiate scalp disorders, as well as guiding biopsy location. Direct immunofluorescence may also be considered as a diagnostic tool.
The patient in case #1 was diagnosed with CCCA. Treatment options include avoidance of heat, excessive traction, and chemical straighteners or relaxants; intralesional steroid injections; topical corticosteroids, calcineurin inhibitors, minoxidil, or metformin; and potentially systemic medications.
For case #2, the differentials included seborrheic dermatitis, tinea, psoriasis, and contact dermatitis. The workup options were clinical diagnosis, biopsy, culture, and Wood’s lamp. This patient was diagnosed with seborrheic dermatitis, which can negatively affect quality of life as it tends to be chronic and recurring. Treatment options include topical antifungals, corticosteroids, calcineurin inhibitors, or roflumilast. Systemic therapies, such as an oral antifungal, may be considered in more severe cases. Over-the-counter shampoos can also be used.
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Reference
Nguyen A, Heath C. Scalp and hair disorders in skin of color patients. Presented at: APP Institute Dermatology; Aug 16–17, 2024; Virtual.
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