Survey Shows Suboptimal Comfort in Treating Hair Among Patients With SOC

Efforts are needed to improve resident comfort in treating hair concerns among patient with skin of color (SOC), show new survey findings from dermatology residents across the country.¹

In addition to ensuring residency programs provide educational and practical opportunities for addressing SOC hair-related concerns, such as alopecia, prioritizing having residents of diverse backgrounds can help close knowledge and comfort gaps, suggest the researchers, who found that among the 121 surveyed residents, those coming from underrepresented backgrounds reported more comfort in treating afro-textured hair.

Twenty-four percent of participating residents were from underrepresented backgrounds and another 11% reported interest in SOC. The findings were published in the International Journal of Women’s Dermatology.

Of the residents surveyed, those from underrepresented backgrounds were more comfortable discussing how to treat alopecia among patients with afro-textured hair | Image Credit: Prostock-studio-stock.adobe.com

“Of note, residents from underrepresented backgrounds were more comfortable counseling on multiple aspects of healthy hair care likely due to higher community awareness of specific hair disorders and increased interest in healthy hair strategies for these common conditions,” detailed the researchers. “In the past, these attributes were not typically valued as highly as other metrics within the residency selection process. However, more recently, the field of dermatology has mitigated this problem through holistic review and diversity initiatives. Although improvements have been made, the field continues to lag when it comes to diversity in both residents and faculty of color.”

Comfort was rated on a scale of 1 to 5 in the survey, with scores ranging from 2 to 4. Some survey questions were broad, probing how comfortable respondents were with counseling on hair product use for natural hair care in patients with SOC, how well they understood the basic science of hair morphology in these patients, and how comfortable they felt creating a healthy hair regimen for these patients.

The researchers examined comfort among the collective group and then assessed differences based on resident background. Residents coming from an underrepresented background consistently reported more comfort in understanding and treatment of afro-textured hair among Black patients.

Based on resident background, there were significant differences in comfort guiding patients on protective hair practices (P = .0034) and hair product recommendations for natural hair care (P = .0006), as well as in understanding the basic science of hair morphology and its unique characteristics (P = .0011) and developing a healthy hair regimen (P = .0016).

Overall, the comfort levels were suboptimal among residents, regardless of background, which the researchers say may be attributable to several factors, including limited experience in treating patients with SOC and a lack of evidence-based management strategies. Previous research from the patient perspective has indicated that training in treating SOC during residency could improve patient satisfaction with dermatology care.²

Other questions included in the current survey were more specific, asking residents how comfortable they were prescribing treatment for specific conditions like central centrifugal cicatricial alopecia (CCCA), trichorrhexis nodosa (TN), or traction alopecia (TA), a trio of conditions more common among patients with SOC.

Among survey respondents, levels of comfort in treating CCCA and RN were statistically insignificant. This result for CCCA, suggest the researchers, may be attributable. to a greater understanding of the disease and training for recognizing and treating CCCA. It’s estimated that CCCA affects up to 15% of Black women, with a variety of underlying factors being implicated in the disease, including infections, genetics, and autoimmune disease.³

In contrast, TN as a condition has remained less understood, particularly among Black women, who are thus unlikely to consult with a dermatologist when experiencing symptoms. Notably, TN was one of few hair-related conditions that residents did not report seeing at least once a month to every 6 months. As a result, the researchers were not surprised to find that there were no differences in comfort treating the condition between the 2 groups of residents.

The group noted that their findings may be limited by the small number of survey respondents, potential lack of generalizability, potential bias in collection of the survey data, and selection bias of residents who completed the survey.

References

1. Tolliver S, Cascardo C, Wong N, Abushukur Y, Potts G. Dermatology resident comfort level treating hair conditions related to patients with skin of color. Int J Womens Dermatol. 2024;10(2):e137. doi:10.1097/JW9.0000000000000137

2. Gorbatenko-Roth K, Prose N, Kundu RV, Patterson S. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatol. 2019;155(10):1129-1134. doi:10.1001/jamadermatol.2019.2063

3. Aguh C, McMichael A. Central centrifugal cicatricial alopecia. JAMA Dermatol. 2020;156(9):1036. doi:10.1001/jamadermatol.2020.1859