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Cultural Considerations in Alopecia Areata Patients
Cultural Considerations in Alopecia Areata Patients
Cultural Considerations in Alopecia Areata Patients
Cultural Considerations in Alopecia Areata Patients
Announcer:
Welcome to ReachMD.
This medical industry feature, titled “Cultural Considerations in Alopecia Areata Patients” is sponsored by Pfizer Medical Affairs.
This video is for U.S. residents only and is intended to be viewed as it was originally produced by Pfizer. The information provided is for educational purposes only and is not intended to replace discussions with a healthcare provider.
Pfizer does not have an FDA approved treatment for Alopecia Areata.
Drs. King and McMichael are consultants for Pfizer.
Dr. Brett King:
Hello, everyone. I am Dr. Brett King, Associate Professor of Dermatology at the Yale School of Medicine.
In this episode, I am so excited to have Dr. Amy McMichael, a world renowned expert in hair and dermatology in patients with skin of color. We have recently become aware of the deficiencies in teaching around diagnosis and management of dermatologic disease in patients with skin of color. And so this is a really special opportunity to not only talk about alopecia areata, but to go a bit beyond alopecia areata to discuss hair loss disorders in patients with skin of color and cultural considerations therein.
Dr. McMichael, welcome. And please tell us about yourself and your clinical practice.
Dr. Amy McMichael:
It is absolutely my pleasure, Dr. King. Thank you for the invitation. As you stated, I have an interest in hair and have had for some time. I run a hair loss clinic at Wake Forest University School of Medicine, and I've run that clinic for about 28 years there now. And I have a very large interest in patients of color, as you stated, particularly those with alopecia areata.
So I think this is going to be a wonderful time to discuss this topic.
Dr. Brett King:
Wow. It's so amazing to have an expert like yourself with us. And so it's going to be really exciting to have this discussion and for everybody to have the opportunity to learn from you. So, let's get started.
We need to understand disease severity because it impacts prognosis, it impacts likelihood of treatment success. We talked in detail about different scales we use to measure severity of hair loss in another episode of the series with Dr. Brit Craiglow.
But Dr. McMichael, are there any considerations that we need to be mindful of when evaluating AA severity in patients with skin of color that is any different than in anybody else? Or is it all the same?
Dr. Amy McMichael:
You know, I think it's probably getting around that's the same, to be honest. You know, getting to the, to the, the place where the patient is comfortable with their hair growth, this is the key for everybody. And you know as well as I do with alopecia areata there are people that come in with a five millimeter patch and they are, you know, they want everything done, they're, you know, crying, they don't understand why they have to deal with this.
And then other people that have 75% of their hair affected by alopecia areata and they're like, "Well, if I could just get enough in the front so that I can wear this wig, I'd be okay." So I think you have to sit down and, and deal with what their expectations are, what their outcomes are, what they want to see as an outcome, what their goals of treatment are. And I think once you do that, it's really quite the same in every patient.
Dr. Brett King:
Yeah, no, I agree with you. I, I, I think it's important because we, it, it's funny because, because patients themselves will come in and say, oh, you know, a, a, a male patient will, will say, "Oh boy, you know, it's hard for me. I can't imagine what this is like, you know, for, for for a woman." And, and, and then sometimes, you know, we'll hear, we'll hear a woman say say, "Oh, you know, I suspect that this is, you know, more difficult for me than it is a man who could shave his head."
But I think it's really important for us as dermatologists to recognize that this affects everybody. And, and it doesn't matter who you are. It doesn't matter what sex you are. It doesn't matter what ethnicity or race you are. Hair loss affects us all very similarly. It is a part of the way we present ourselves to the world. It's a part of who we see when we look in the mirror.
And so, and so, so we should never we should never diminish that and when we're evaluating anybody. So, so, then kind of adding to that a little bit, right? But we're, we're going to think about severity the same. We're going to recognize that this impacts everybody similarly. How do you talk to your patients about the burden of alopecia areata in their lives?
Dr. Amy McMichael:
Yeah, you know, I think you have to, at an essence, and we do this as dermatologists all the time, we have to read the room, you know. Where are they on their journey? Do they need me to give them a pep talk? Do they just need the resources and they're going to go out there and work with other alopecia areata patients and an organization that supports them?
Do they need me to talk about wigs? Do they need me not to talk about wigs? I think, you know, it really is so individualized at that point that I can't even give you a very global answer for people with skin of color per se. Now, having said that, you know, I think that hair coverage or camouflage options, I think it's good to know about that.
You know, so, do they have hair that could cover their current outbreak or flare of alopecia areata if they did a crochet style or if they did a braided style? Or do they really have to wear a full wig? I mean, I think those are the, those are the concerns that maybe are more specific to a group of people with this culture.
But I think in general, you have to really sit down and say, "Okay, what is it that will make you feel the best about treatment?" Because if they feel like they need to wear something that's glued on to their head, then they cannot wear, they cannot use topical treatment because they can't take it off. So you have to say, okay, what's "What are you going to be doing when you leave here?
I know you took everything off so I can see what's happening, but what's going to happen when you go out of here and how can I help you best live in the world until we can grow your hair back with whatever treatment we decide is going to be best?"
Dr. Brett King:
I think it's interesting what you just said because it, it, it brings us back to an earlier part of our conversation about, about hairstyles and hair practices in patients with skin of color, because they're often sort of, there are more because of, of different extensions and, and wigs and again, other practices. And so here when we talk about, when we talk about somebody who comes to us with a patch or patches, it may be if I, if I heard you correctly, it may be that there are options that these patients have, that sometimes other patients do not have. Is that right?
Dr. Amy McMichael:
I think so. I think so. You know, it's culturally quite acceptable to wear hairpieces and wigs and weaves in people of African descent in this country. You know, maybe not in every country, but here it is. You know, and I think all of our stars have made it a little bit more acceptable to do that. So I think people feel comfortable doing that.
And, you know, other people may not feel comfortable. Men, for instance, often don't feel comfortable wearing a hairpiece. Children, you know, we wouldn't probably give most children hairpieces. So I think we have a little bit more option. And I think you've got to give your patients options because then they recognize that you know what you're talking about in terms of their cultural interests.
And when you are giving them that level of comfort, that's when they come back and that's when they are compliant with treatment.
Dr. Brett King:
Yeah. And so, so again, it, it highlights that, that this really is a conversation that, that we think often in dermatology, you know, we, we, we sort of enjoy often the luxury, right? Of being able to, to look and know what the diagnosis is, write down what the solution is, give the patient a prescription, and we're done. But, but this conversation and the evaluation of patients with hair loss, you're highlighting this is a conversation and we have to know what a patient's relationship is with their hair loss.
We have to know what the practices are around hair loss or, I'm sorry, around hair for them, because ultimately that can tie into the way we're going to address their hair loss. And so, so it's it's really interesting. It's, it's, you know, it makes what we do in many ways more complicated, but it also makes it a richer experience in general.
Dr. Amy McMichael:
We really have to converse with the patient and say, "What is it that's going to work with your lifestyle, your hair care practice when you leave here?" And I think ultimately wrap it all up and keep it patient centered, then we do our best work at that point.
Dr. Brett King:
Such sage advice. Again, thank you so much. It's really been a pleasure and an honor to have you here And thank you to everybody who's tuned in. We hope that you found this to be a helpful learning experience about alopecia areata in patients with skin of color. And please tune in to the next episode.
Announcer:
This program was sponsored by Pfizer Medical Affairs. If you missed any part of this discussion, visit Reachmd.com/IndustryFeature. This is ReachMD. Be part of the knowledge.
What do clinicians need to consider when discussing hair loss disorders in patients with skin of color? Here’s what you should know.
Cultural Considerations in Alopecia Areata Patients
Cultural Considerations in Alopecia Areata Patients
Cultural Considerations in Alopecia Areata Patients
Patients of color may have different perceptions about hair loss. So how can clinicians address the unique needs of patients of color? Dive in with Dr. Brett King as he is joined by Dr. Amy McMichael, Dermatologist at Wake Forest University School of Medicine.
Continuing medical education credits are not available for this program.
© 2023 Pfizer Inc. All rights reserved. PP-RIL-USA-0490 April 2023
Considering Hair Loss Disorders in Patients with Skin of Color
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