Special Considerations for Examining Hair Loss With Tightly Coiled Hair

By Lisa Rapaport

April 16, 2021

(Reuters Health) - Physicians who examine patients with hair loss who have tightly coiled hair should take care to avoid using culturally insensitive language, especially in race and hair discordant physician-patient pairs, an essay in JAMA Dermatology suggests.

That's because when patients have tightly coiled hair, the discomfort inherent in examinations of hair loss can be exacerbated by certain language and behavior and eased by other approaches, the authors argue.

"The article really includes some practical tips that clinicians can follow to approach the hair and scalp exam with cultural humility," said essay co-author Dr. Candrice Heath of the Katz School of Medicine at Temple University in Philadelphia.

"It is my hope to continue to find ways to document and teach these approaches," Dr. Heath said by email.

Alopecia can be an emotional experience for all patients, regardless of race or hair type, the essay notes. Just by sitting down, physicians can convey that they're ready to listen to patients and empathize with their situation.

When patients have tightly coiled hair, inquiries about hair loss should be culturally sensitive and begin with questions that might be asked of all patients regardless of race or hair texture, the essay advises. This might mean, for example, asking patients if they have ever colored their hair because this is common among people with all types of hair.

Then, when physicians ask about hair care routines, they should also work to avoid sounding like they're judging patients for having dirty hair or caring for their hair improperly, the essay argues. This might mean, for example, asking whether people wash their hair monthly, weekly, or daily instead of simply asking how often they wash their hair.

Beyond this, physicians should also make an effort to include any parent or friend who accompanies the patient to the exam, the essay argues. By asking this person to join the patient at the bedside, physicians can help patients feel more at ease during exams.

In addition, physicians should choose their words carefully when asking patients with tightly coiled hair to remove hair adornments that may interfere with the exam, the essay suggests. Asking for permission before removing objects like barrettes or hair ties can help prevent the physician from pulling hair and provide an opportunity to see how gentle or rough patients are when they handle their own hair.

Many physicians may lack training and experience in caring for people with tightly coiled hair, said Dr. Stavonnie Patterson, a dermatologist with Northwest Community Hospital Medical Group in Arlington Heights, Illinois, who wasn't involved in the study.

"The take home message is that it is important for all dermatologists to make an effort to become knowledgeable with all hair types so that they can provide effective care to their patients," Dr. Patterson said by email. "If tightly coiled hair is unfamiliar to you there are opportunities to learn through conferences, webinars and articles such as this."

SOURCE: https://bit.ly/3abpdCn JAMA Dermatology, online March 31, 2021.