Patients visit dermatologists for a host of skin issues. But hair also brings many in for a consult.

At the Skin of Color Society’s 8th Annual Media Day, Dr. Victoria Barbosa MD and Dr. Prince Adotama MD discussed new research on hair loss and alopecia, including treatments that show promise, as well as pseudo folliculitis, more commonly known as razor bumps.

Hair Loss

Adotama noted that 50% of older men and 15% of post-menopausal women can be affected by hair loss.

“But that’s a small number. I’ve seen studies go up to 70 to 80%,” he said.

Technically, there are only two FDA approved treatments for hair loss. But dermatologists also rely on off label treatments, with good results. Barbosa reviewed the Hamilton-Norwood scale, which classifies the stages (1-7) of male pattern baldness.

“Patients tell me, ‘hey, you know, it’s not so bad right now. I’ll wait until stage three or stage four,” he said. “(But) it’s really important to treat hair loss early and aggressively.”

The most popular treatment is Minoxidil (Finasteride), which was developed to treat high blood pressure. But applying topical Minoxidil to treat alopecia is a lifelong commitment—some patients have a difficult time making such a commitment. Instead, dermatologists prescribe oral Minoxidil with “pretty good results,” explained Barbosa. In fact, up to 30% of patients who take oral Minoxidil can suffer from hypertrichosis, excessive hair growth.

Another option is Dutasteride, which is more potent than Finasteride. Dutasteride is injected into the scalp every three months. It treats hair loss by blocking the conversion of testosterone to dihydrotestosterone (DHT).

Adotama said platelet rich plasma (PRP) is one of his favorite hair loss treatments. RPR is also used for “vampire” facials and skin rejuvenation. PRP involves drawing the patient’s blood, spinning it in a centrifuge, siphoning out components such as growth factors and proteins, and injecting them back into the scalp every four to six weeks. To maintain benefits, patients undergo the procedure every three to four months.

Transplants are the most invasive hair loss treatments. The treatment involves taking a small graft from the back of the scalp and putting it into the hairs sitting on a frontal scalp.

“This is a great option for patients, but you want to makes sure that you’re carefully selecting it and that your patient has realistic expectations,” explained Adotama. “We don’t want to give this to a patient who has body dysmorphia, who has very extensive hair loss because they may not be happy with the results. And if you’re going to do these like a unit extraction, you want to make sure you maintain yourself on medical therapies. Do not stop any of your medical therapies when you’re getting hair transplants.”

Pseudofolliculitis barbae

Adotama shifted gears to discuss razor bumps or Pseudofolliculitis barbae (PFB). PFB is a chronic inflammatory disorder of the hair follicles and primarily impacts patients with tightly coiled hair. Up to 83% of men of African descent have some form of razor bumps. It’s usually genetically predetermined, but also can be impacted by how one shaves. Manual razors can irritate the skin in such a way that it causes these bumps. These bumps can be unsightly, painful and lead to dark marks.

When shaving becomes too painful, dermatologists recommend chemical depilatories. Or a more permanent solution—laser hair removal.

“It works really well,” said Adotama. “It’s the most effective treatment for razor bumps. Not only does it treat the bump, it treats the pigment, it treats everything, even a little bit of the scarring.”

Alopecia

Barbosa rounded out the hair report, highlighting some hot topics and pointing out some gaps.

Alopecia areata is a very common form of hair loss, impacting about 2% of the population, but presents in different ways. For most people, it’s a single spot or two here or there. The spots often show up during stressful times and sometimes go away on their own without treatment.

In the past three years, the FDA approved three JAK inhibitors to treat severe alopecia. JAK Inhibitors work by blocking inflammatory signals that attack hair follicles. One of Barbosa’s patients had 100% hair regrowth in less than a year.

“I’ve seen this type of regrowth again and again with the JAK inhibitors so it’s really exciting. And there are more coming down the pike.”

They are not new medicines. JAK Inhibitors treat other forms of autoimmune disease like atopic dermatitis, ulcerative colitis and rheumatoid arthritis, but are relatively new alopecia areata treatments.

“I’m really excited about the opportunity to raise awareness for these medications, because the sooner we get people in the door and the sooner we evaluate them for appropriateness, the sooner we get them on treatment, the better their outcomes is going to be,” said Barbosa.

Traction alopecia primarily affects Black women. Barbosa said the condition is particularly heartbreaking because it is 100% preventable. It is caused by hairstyles that put tension on the front hairline, like braids, waves or crocheted styles. The challenge is that the more traction alopecia a person has, the more they’re tempted to use these styles to conceal hair loss.

“The good news is that if we catch it early, before those follicles have seen permanent damage, we can bring some hair back, if you can get people to change their behaviors and their styling practices.”

More insight from the Skin of Color Society’s 8th Annual Media Day can be found here.