Hair care practices and their association with scalp and hair disorders in African American girls

Abstract

To the Editor: We read with great interest the article by Wright et al1Wright R.D. Gathers R. Kapke A. Johnson D. Joseph D. Joseph C.L.J. Hair care practices and their association with scalp and hair disorders in African American girls.J Am Acad Dermatol. 2011; 64: 253-262Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar on the association of certain hair care practices with hair and scalp disorders in African American girls in the February 2011 issue of the Journal. The authors have made a meaningful contribution to the understanding of these conditions in an understudied demographic. We disagree, however, with some of the conclusions they come to regarding what these data suggest about seborrheic dermatitis in this population. First, the authors state that seborrheic dermatitis is described on the survey as “dandruff.” In the minds of many laypeople, dandruff describes loose flakes in the hair. Seborrheic dermatitis commonly present as a scaly plaque on the scalp. Patients surveyed may have considered this a different condition than dandruff. Also, in this population, flakes in the hair and on the scalp may be described as “dry scalp,” something thought to be distinct from “dandruff.” We also take issue with the finding that “use of hair oil/grease less often than daily” was significantly associated with seborrheic dermatitis. As mentioned above, the participants in the survey may have considered their symptoms “dry scalp” rather than dandruff or seborrheic dermatitis. Frequent application of hair oil/grease is commonly done in response to what is thought to be “dryness” and may in fact indicate that the participant is attempting to mask the signs and symptoms of seborrheic dermatitis. Many hair oil/grease products aimed at African Americans, in fact, contain sulfur (eg, Sulfur8 products), which is a treatment for seborrheic dermatitis. It follows that, in fact, with further investigation it would be found that the frequent application of these hair oil/grease products would correlate positively with the incidence of seborrheic dermatitis. Given the broad ranges taken regarding the frequency of hair washing and seborrheic dermatitis (once weekly or more vs 2 to 4 weeks), we should be conservative in concluding that frequency is irrelevant. We also cannot conclude that hair extensions are causal. The presence of the extensions may result in different grooming practices, product use, or may unmask the symptoms of seborrheic dermatitis, not cause the condition. It would be of interest to see the data regarding the frequency of hair washing, extensions, and seborrheic dermatitis that was not shown. These authors do an excellent job of uncovering the complexity of understanding hair and scalp disorders in African American girls. Although we should be conservative regarding some of the conclusions drawn from these data, this article certainly builds a foundation for further investigation. Hair care practices and their association with scalp and hair disorders in African American girlsJournal of the American Academy of DermatologyVol. 64Issue 2PreviewFew studies have extensively examined the prevalence of hair care practices and their association with scalp and hair conditions in African American girls. Full-Text PDF ReplyJournal of the American Academy of DermatologyVol. 66Issue 1PreviewTo the Editor: I would like to thank Dr. Strachan and Ms Okereke for their interest in our original research article, “Hair care practices and their association with scalp and hair disorders among African American girls.”1 In their letter to the Editor, one of the concerns was the study survey’s use of the layman’s term “dandruff” to describe seborrheic dermatitis, which they argue could have been misunderstood by participants. Non-infantile scalp seborrheic dermatitis (SD) can clinically present with ill-defined erythematous patches associated with fine scaling or with non-inflammatory fine white diffuse scale. Full-Text PDF