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

Welcome to Skin of Color Savvy: The Art and Science of Treating Patients of Color!

In this Savvy Conversations episode of Skin of Color Savvy, hosted by Skin of Color Savvy (SOCS) leaders and produced by HCPLive, 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 Skin of Color Society.

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