“Why are we talking about pediatric skin of color?” asked Candrice Heath, MD, at the top of her lecture at the Society of Dermatology Physician Assistants 19th Annual Fall Dermatology Conference in Los Angeles, CA. “Well,” she continued, “by 2023, over half of the children in the United States will be people of color, so that’s why it is really important to dive into this topic.”

Dr Heath laid the foundation for the focus of her lecture on hair practices for children with skin of color by first describing a common hair care routine for tightly curled hair. First, children have their current hair style removed (a 30-minute to 3-hour process depending on the style), then it is washed, conditioned, detangled with a large-tooth comb (15 minutes due to the conditioner), rinsed, conditioned again with leave-in conditioner, detangled again (1 hour), and styled (1 to 3 hours). It is important to understand this process as children (and adults) are committing to a full-day activity, therefore prescribing topical treatments that require daily application can be difficult to use for a patient.

To examine a child with tightly coiled hair, Dr Heath stressed that simply leaning over the patient is an inadequate practice. She proposed that providers ask the parent to join in the examination and use that as an opportunity to see how the parent/caregiver handles the hair for any clues to medical history and diagnosis.

In a series of case reports, Dr Heath highlighted various diagnoses to watch for, including tinea capitis, traction alopecia, acropustulosis of infancy, hyperpigmentation, atopic dermatitis, eczema herpeticum, and pomade acne.

Notably, Dr Heath shared how children with tightly coiled hair often do not do their hairstyles, and culturally, the child’s hair is seen as a reflection of the parent/caregiver’s skills. So, it is important for dermatology providers to explain to the hair caregiver that “kids may not dictate hairstyles, but they do yell ouch when the hair is pulled too tightly…so, if the child is moving around, fidgeting too much, or crying, it might be a little too tight of a style,” said Dr Heath.

Reference
Heath C. Pediatric dermatology in skin of color. Presented at: Society of Dermatology Physician Assistants 19th Annual Fall Dermatology Conference; November 4-7, 2021; Los Angeles, CA.