Proceedings of the Fifth SKIN SPECTRUM SUMMIT

SSS-2019 02-10-20_Layout 1 2/12/2020 5:17 PM Page 18
the style. A trichoscopy can show
specific features, but this is a clinical,
bedside diagnosis that doesn’t require
further investigation.
Male patients, who are observing
Sikhs wearing turbans, are at a
greater risk for traction alopecia.
During her talk, Dr. Beach showed
examples of a dermatologist based
in India using the process of inserting
hair grafts and hair plugs in an
attempt to cure a case of traction
alopecia in male patients.
Dr. Renée A. Beach
To avoid further hair loss, patients
need to undergo significant
modification to the way they wear
the turban so that the condition
does not recur.
“Patients who are wearing turbans
or hijabs are encouraged not
to pull them tightly along the hair,”
said Dr. Beach. “Hairstyle modification
is paramount, but there is offlabel
use of minoxidil 5 per cent
foam, which can certainly help in a
subacute situation.”
Traction alopecia is a reversible
form of hair loss; however, at later
stages, a hair transplant may be the
only option for patients.
18 • Proceedings of 2019 SKIN SPECTRUM SUMMIT
Diagnostic dilemmas and treatment
options in Afro-textured hair
Dr. Renée A. Beach
Patients with Afro-textured (AT) hair can have a
variety of issues, including seborrheic dermatitis,
traction alopecia and androgenetic alopecia.
During a talk on hair and scalp disorders at Skin
Spectrum Summit in Toronto, Dr. Beach discussed diagnostic
and treatment options for patients with
conditions related to AT hair.
Seborrheic dermatitis mainly affects the scalp, causing
scaly patches, red skin and dandruff. For treatment,
Dr. Beach recommends the use of a triple-threat therapy
including an anti-yeast, anti-inflammatory medication
and, in some cases, debris removal.
“I have a discussion with [patients] about increased
washing, at least temporarily. I ask them to wash their
scalp twice a week, which I know is really a lot for Afrotextured
hair types,” she said. “Also, [I ask them to] consider
the use of ciclopirox lotion, if they need to, a few
nights a week.”
Mometasone lotion is an option to aid with itching,
and scaling can be done with a 2% salicylic acid compound.
Although the recurrence of seborrheic dermatitis
can be limited by washing and rinsing the scalp, traction
alopecia requires patients to modify their hairstyle.
Traction alopecia is the gradual receding of the hairline.
There is hair at the front of the hairline and then
there are patches of hair with a noticeable regression.
The condition can be caused by wearing the hair in
slicked-back updos and top-knot buns.
“Patients will admit, sometimes reluctantly, to
headaches, tenderness, sometimes broken hairs with
certain hairstyles. And typically, they get a fringe sign [of
hair loss]. Patches of hair along the hairline [are] a dead
ringer for traction alopecia,” said Dr. Beach.
In addition to hairstyle modifications to reduce tension
on the scalp, Dr. Beach recommends the off-label
use of a 5% minoxidil foam. Traction alopecia is reversible
if diagnosed and treated in the early stages.
Weathering and trichorrhexis nodosa—defects in the
hair shaft—occur when there is a lack of hair growth. Hair
strands appear like broomstick hair. Patients also have
broken shafts, simple knots and complex knots throughout
the scalp. The hair has been weathered, which is
caused by heating the hair strands with a blow dryer or
ceramic straightener.
“When we heat the hair strands, they literally get air
bubbles in the shaft, and the air bubbles are tied to
breakage,” said Dr. Beach. “When patients with Afro-textured
hair dry comb their hair without any sort of product
on their hair, it can amount to a daily haircut in terms of
the breakage that they sustain.”
She suggests air-drying the hair and minimizing
the friction with a seamless comb. Products with
“slip” that contain ingredients such as glycerine, as
well as trimming off dead ends, can be helpful in
treatment.
Androgenetic alopecia is a type of hair loss common
in middle age. Affecting 40% of females and 50% of
males, androgenetic alopecia is gradual and progressive
and can be described as follicular miniaturization. Thicker
hairs turn into vellus hairs and whisk away.
This type of hair loss is a combination of genetics,
heritage and androgen activity.
Dr. Beach suggests a 5% minoxidil foam for treatment
and notes that if spironolactone is prescribed to
patients, there is a dosage difference between men and
women.