Skin of Color Savvy: The Science of Curly Hair, With Crystal Aguh, MD, and Loren Krueger, 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: The Art and Science of Treating Patients of Color, dermatologists Crystal Aguh, MD, and Lauren Krueger, MD, explored the biological, cultural, and clinical considerations behind curly and coily hair patterns. This podcast by Skin of Color Society (SOCS) and produced by HCPLive, features a discussion underscoring the ways in which textured hair care represents a critical—and often overlooked—component of dermatologic expertise.

Curly hair is inherently more fragile than straight hair, with structural features that make it prone to dryness, breakage, and inflammation-related disease. According to Aguh, this fragility parallels the challenges of dry skin: without proper moisture retention and care, minor issues can progress into medical disease. For dermatologists, understanding textured hair is therefore not elective—it is essential to preventing conditions such as traction alopecia, acquired trichorrhexis nodosa, and central centrifugal cicatricial alopecia (CCCA).

Krueger emphasized that nearly every form of alopecia—from androgenetic to autoimmune variants—can present in patients with curly hair, but diagnostic precision requires recognizing when styling practices contribute to disease. She noted that effective management involves more than identifying pathology; it requires guiding patients toward healthier styling behaviors while respecting their cultural identities and lifestyle constraints.

For clinicians unfamiliar with curly hair care, Aguh recommended starting with the basics—what she calls a “soak and smear” method for the hair, analogous to the technique used for eczema management. Patients should be advised to cleanse weekly with a non-drying shampoo, condition regularly, and seal in moisture with a leave-in product, oil, or emollient. These steps help reinforce the hair cuticle and prevent cumulative damage that predisposes to breakage.

The conversation also addressed styling practices frequently described as “protective,” such as braids, twists, and sew-in weaves. Both dermatologists noted that these should instead be viewed as “styles of convenience”—useful in moderation but potentially harmful if worn too tightly or for extended periods. Appropriate guidance includes limiting braided styles to six to eight weeks, avoiding back-to-back installations, and recognizing that tightness and scalp pain are early indicators of follicular injury.

Age-related hair fragility and chemical exposure further complicate outcomes. Patients accustomed to long-standing styling routines often underestimate how aging, coloring, or relaxing can weaken the hair over time. Dermatologists must therefore distinguish between true hair loss and breakage-related thinning to prevent unnecessary laboratory testing or scalp biopsies.

Ultimately, the “science of curls” reflects the intersection of biology, identity, and daily care. By integrating practical knowledge of hair texture into routine dermatologic evaluation, clinicians can enhance outcomes, foster trust, and deliver more culturally responsive care for all patients.

To learn more about SOCS’s mentorship programs and initiatives, visit Skin of Color Society.