Amy McMichael, MD

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Skin of Color Savvy: Hair-Care Challenges in Dermatology With Amy McMichael, MD, and Kayla Taylor, MD

, Amy McMichael, MD, a professor in the Department of Dermatology at Wake Forest School of Medicine

sits down with guest dermatologist Kayla Taylor, MD, of Atrium Health Dermatology for an in-depth discussion on scarring alopecia, hair loss differentials, and hair-care–related challenges facing patients with skin of color. 

The conversation begins with Taylor’s background and her early research experience with McMichael, which sparked her long-term clinical and academic focus on hair loss disorders—especially scarring alopecias that disproportionately affect patients of African descent.

The episode opens with McMichael highlighting Taylor’s recent presentation at the Southeastern Consortium of Dermatology, where she addressed under-recognized forms of hair loss in men of color. Taylor expands on the topic, noting that while male-pattern hair loss (androgenetic alopecia) remains common, clinicians must stay alert for scarring conditions—such as lichen planopilaris, central centrifugal cicatricial alopecia (CCCA), folliculitis decalvans, and dissecting cellulitis—that may mimic or coexist with pattern loss.

She emphasizes the diagnostic importance of identifying symptoms such as scalp tenderness, pruritus, erythema, and perifollicular scaling, which should prompt dermoscopy and, when necessary, biopsy. The dermatologists discuss therapeutic approaches, with Taylor outlining how anti-inflammatory regimens—including topical corticosteroids, intralesional steroids, doxycycline, and occasionally dapsone—are layered onto traditional treatments like finasteride and minoxidil.

McMichael and Taylor also examine the role of isotretinoin, particularly in patients who present with severe acne alongside scalp disease. Their shared experience underscores that early intervention is critical to preventing irreversible follicular destruction.

The conversation then shifts to surgical decision-making in advanced cases, with Taylor describing referrals for excision in acne keloidalis nuchae once medical therapy has stabilized inflammation. Both dermatologists note that procedural approaches—including intralesional corticosteroids combined with cryotherapy—can significantly improve outcomes when properly timed and supported by realistic patient counseling.

A major portion of the episode addresses hair-care practices among patients of color, including the impact of locs, braiding, high-tension styles, and the cultural pressure to maintain “laid” hairstyles. Taylor highlights the misconception that locs are a “safe” alternative for those with hair loss. She emphasizes the cumulative tension from retwisting, styling, and infrequent washing—factors that can accelerate or exacerbate CCCA and traction alopecia. The pair underscore how dermoscopic imaging can be used to demonstrate subclinical inflammation to patients, helping reframe their understanding of “pain-free” styling.

The episode concludes with guidance on patient education around hair washing frequency, the risks of gels and heavy pomades, and the pitfalls of applying oils directly to the scalp. Both dermatologists emphasize the need for broader outreach to hairstylists and trichologists, noting that culturally aligned community education is crucial for meaningful change in hair health outcomes for patients of color.

This engaging Savvy Conversations episode offers clinicians nuanced, practice-ready insights into diagnosing and managing complex hair disorders in patients with skin of color—while highlighting the cultural considerations that must accompany effective dermatologic care.

To learn more about SOCS’s mentorship programs and initiatives, visit 

Editor’s note: This episode was written with the help of artificial intelligence tools.

Videos

This November 18 episode explores early detection, diagnosis, and management of scarring alopecias and hair-care–related hair loss in patients of color.

Skin of Color Savvy: Hair-Care Challenges in Dermatology, With Amy McMichael, MD, and Kayla Taylor, MD

Panelists discuss the critical role health care providers play in raising awareness about alopecia, emphasizing strategies for effectively informing patients about the importance of early diagnosis and available treatment options.

The Role of Health Care Providers in Raising Awareness About Alopecia Areata

Video content above is prompted by the following:

Increased awareness about alopecia may lead to earlier diagnosis and more effective treatment options. What role do health care providers play in raising awareness about alopecia?

How can health care providers effectively inform patients about importance of early treatment and treatment options?

Healthcare providers play a crucial role in raising awareness about alopecia by educating patients on the condition's early signs and potential treatment options. They can effectively inform patients by integrating discussions about alopecia into routine check-ups, utilizing educational materials, and leveraging digital platforms to reach a broader audience. Providers should emphasize the importance of early diagnosis and intervention, which can lead to more effective management of the condition. By fostering open communication and providing comprehensive information, healthcare professionals can empower patients to seek timely treatment and improve outcomes.

Panelists share practical tips for colleagues on the use of Janus kinase (JAK) inhibitors in clinical practice and provide final insights on the overall management and treatment of alopecia.

Future Directions in the Treatment of Alopecia Areata

What kind of tips can you offer colleagues regarding the use of JAK inhibitors in practice?

Please share final thoughts about treatment of alopecia before we conclude today’s discussion.

JAK inhibitors have emerged as a promising therapeutic option in the management of alopecia, offering targeted treatment by modulating immune pathways. Clinicians should consider patient-specific factors, such as disease severity and comorbidities, when selecting JAK inhibitors. Monitoring for potential side effects, including infections and hematologic abnormalities, is crucial. Collaboration with dermatologists can enhance treatment outcomes. As the understanding of JAK inhibitors evolves, staying informed about emerging data and guidelines will be essential for optimizing patient care in alopecia management.

Panelists discuss the challenges encountered in using oral Janus kinase (JAK) inhibitors for patients with alopecia, including issues related to treatment adherence and management of adverse effects.

Challenges With the Use of JAK Inhibitors

What challenges have you faced, if any, in using oral JAK inhibitors for patients with alopecia?

Oral JAK inhibitors have emerged as a promising treatment for alopecia, but their use is not without challenges. Clinicians often encounter issues related to patient selection, as not all individuals respond equally to these medications. Monitoring for potential side effects, such as increased risk of infections and changes in blood counts, is crucial. Additionally, long-term safety data is limited, necessitating cautious use and ongoing research. Cost and insurance coverage can also pose significant barriers, impacting patient access to these treatments.

Amy McMichael, MD

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