Skin of Color Savvy: Hair Loss Misconceptions, Clinical Insights, and Management, with Janiene Luke, MD, and Victoria Barbosa, MD, MPH

Key Timestamps

00:05 Introductions

01:52 Misconceptions about hair loss

03:27 Protective hairstyling

05:30 Long-term commitment

09:20 Common types of alopecia

11:01 Importance of not assuming

13:30 Use of dermoscopy

19:15 Practices that exacerbate conditions

20:40 Topical treatment comparisons

25:03 Central Centrifugal Cicatricial Alopecia (CCCA)

28:00 Minoxidil practices

35:29 Advice given to patients

39:17 Final thoughts

In the latest episode of Skin of Color Savvy, Victoria Barbosa, MD, MPH, MBA, associate professor of dermatology at the University of Chicago and president of the Skin of Color Society (SOCS), is joined by Janiene Luke, MD, clinical professor of dermatology at Loma Linda University. Together, they engage in a comprehensive discussion on hair care myths, patient habits, and the management of hair loss in patients with skin of color.

The conversation begins with a deep dive into common misconceptions about alopecia, highlighting how the term is often misunderstood by patients. Luke explains that alopecia is a broad term encompassing various forms of hair loss, each requiring distinct diagnostic and treatment approaches. They discuss the challenges of educating patients who self-diagnose and stress the importance of accurate clinical evaluation. Barbosa shares that many patients assume alopecia refers to a specific condition rather than a general term for hair loss, making clear communication critical.

The discussion then shifts to protective styling, an area where many patients unknowingly engage in damaging practices. Barbosa and Luke highlight how tight hairstyles, prolonged wear, and excessive tension can lead to conditions such as traction alopecia. They emphasize patient education on safer styling techniques and discuss the difficulty of balancing these conversations within the time constraints of clinical practice. Barbosa describes her structured approach, breaking hair loss visits into multiple sessions to ensure comprehensive evaluation, while Luke shares strategies for handling these time-consuming discussions in a busy clinic setting.

Both experts outline their structured approaches to diagnosing and managing hair loss. Luke shares insights into her clinic’s thorough patient evaluation, which includes taking detailed histories, utilizing dermoscopy, and selectively performing biopsies. They stress the importance of cultural humility and patient-centered care, particularly in addressing the emotional distress often associated with hair loss. Barbosa underscores the need for dermatologists to physically examine the scalp, noting that some patients report prior experiences where their hair loss was assessed from a distance.

The conversation also covers specific types of alopecia commonly seen in patients with skin of color, including central centrifugal cicatricial alopecia (CCCA), frontal fibrosing alopecia (FFA), and lichen planopilaris (LPP). They discuss how these conditions are often misdiagnosed as traction alopecia, underscoring the need for careful clinical examination, including checking for eyebrow loss and facial pigmentation. Luke shares how dermoscopy-guided biopsies have improved diagnostic accuracy in her practice.

In terms of treatment, they discuss the role of topical and oral therapies, including corticosteroids, doxycycline, minoxidil, and platelet-rich plasma (PRP). Luke shares her experience incorporating metformin into CCCA treatment and expresses excitement about ongoing research into JAK inhibitors. They also touch on hair transplant options for patients with traction alopecia, emphasizing the importance of selecting surgeons experienced with curly and textured hair. Barbosa details how she offers patients a choice between topical and oral minoxidil, framing treatment as a collaborative process to maintain patient autonomy and adherence.

The episode concludes with a discussion on best practices in hair care, product recommendations, and the importance of partnering with knowledgeable hairstylists to support patients. Barbosa and Luke emphasize that dermatologists can enhance patient outcomes by either learning about Black hair care or establishing connections with local hairstylists specializing in textured hair. They stress the importance of recommending water-based moisturizing products, sulfate-free shampoos, and proper conditioning practices to help patients maintain healthy hair.

This episode delivers expert perspectives on diagnosing and managing hair loss in patients with skin of color, combining scientific insights with practical clinical strategies to improve patient outcomes. By fostering culturally intelligent and responsive conversations, personalizing treatment approaches, and staying informed on the latest research, dermatologists can better serve their diverse patient populations.

Barbosa has the following disclosures: Pfizer, Eli Lilly, L'Oréal, Vichy, and Beiersdorf. Luke's disclosures include Eli Lilly, Sanofi/Regeneron, and Arcutis.

Hosted by Skin of Color Society and produced by HCPLive, Skin of Color Savvy delves into the latest research, clinical insights, and culturally competent care practices in dermatology with leading experts. Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.