Latest / The Science of Skin / Unlocking the Secrets of Textured Hair Care with Dr Heather Woolery-Lloyd

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Unlocking the Secrets of Textured Hair Care with Dr Heather Woolery-Lloyd · The Science of Skin

• 0:01
  SPEAKER_00: Hi, this is Patty, and I'm joined for today's podcast by Dr.
• 0:04
  SPEAKER_00: Heather Woolery Lloyd, and we're going to be talking about a subject that's of great interest, and that is the treatment of textured hair.
• 0:12
  SPEAKER_00: We're excited to drop this episode during Black History Month because we're going to be talking about some interesting pieces of Black history.
• 0:20
  SPEAKER_00: Heather, tell them what we're going to be speaking about.
• 0:23
  SPEAKER_01: So, this episode will talk about so many interesting things, lots of great pearls.
• 0:29
  SPEAKER_01: We'll talk about the first female millionaire in the United States who actually developed a process to straighten black hair.
• 0:37
  SPEAKER_01: And we'll talk about different types of hairstyles, how dermatologists can be better informed when it comes to managing textured hair.
• 0:46
  SPEAKER_01: And we'll talk about some of the newest research that has been published looking at hairstyling practices and cancers like uterine cancer and breast cancer.
• 0:56
  SPEAKER_00: I love that.
• 0:57
  SPEAKER_00: And we hope you all will join.
• 0:58
  SPEAKER_00: This is going to be an episode you don't want to miss.
• 1:09
  SPEAKER_00: Hi, I'm Dr.
• 1:10
  SPEAKER_00: Patty Ferris.
• 1:11
  SPEAKER_00: I'm a board certified dermatologist, and I'm your host for this episode of the Science of Skin Podcast.
• 1:17
  SPEAKER_00: I am very excited today to welcome a good friend, a colleague who I have tremendous respect for, Dr.
• 1:23
  SPEAKER_00: Heathery Woolery Lloyd.
• 1:26
  SPEAKER_00: Your name is always a tongue twister for me.
• 1:28
  SPEAKER_00: I want to put it a tongue twister for everyone.
• 1:30
  SPEAKER_00: It is.
• 1:44
  SPEAKER_00: No excuses.
• 1:45
  SPEAKER_00: Anyway, I'm going to read Heather's bio.
• 1:48
  SPEAKER_00: She's the director of the Skin of Color Division at the University of Miami Miller School of Medicine and founder of Derm Friends, which is a really innovative platform that is a newsletter that's focused on skincare education.
• 2:00
  SPEAKER_00: With a career spanning over two decades, that's hard for me to believe.
• 2:04
  SPEAKER_00: She has authored over 70 peer-reviewed papers and she lectures internationally.
• 2:10
  SPEAKER_00: She's an active member of the Skin of Color Society as well as the American Academy of Dermatology.
• 2:16
  SPEAKER_00: And she was honored with the AAD's presidential citation for her commitment to education and research in dermatology.
• 2:23
  SPEAKER_00: That's so well deserved.
• 2:24
  SPEAKER_00: I also want to add my own little footnote to your bio.
• 2:29
  SPEAKER_00: She has one of the best social media presents, in my opinion, of all of the derm influencers.
• 2:35
  SPEAKER_00: And Heather, you're one of the people that I go to because I learn a lot from your posts.
• 2:40
  SPEAKER_00: So thank you for that.
• 2:41
  SPEAKER_00: I really love your social media feelings.
• 2:44
  SPEAKER_01: I'm honored to hear that.
• 2:45
  SPEAKER_01: I really am.
• 2:46
  SPEAKER_01: And I love creating content online, so that makes me really happy.
• 2:49
  SPEAKER_00: I know you do, and you do such a good job at it.
• 2:51
  SPEAKER_00: You do your homework, which is what I love.
• 2:53
  SPEAKER_00: So we're going to talk about a subject that I think a lot of our listeners don't know a lot about.
• 2:58
  SPEAKER_00: And that is the sort of hair care routine, rituals, and products that surround our patients who have textured hair.
• 3:09
  SPEAKER_00: It's a subject that I realized, Heather, when you spoke at our meeting two years ago, I like knew nothing about.
• 3:15
  SPEAKER_00: And I was thinking to myself, all these years I've been treating a lot of patients with textured hair.
• 3:20
  SPEAKER_00: And I probably said a lot of things that really didn't make sense to them and clearly signaled that I knew little about what it really means to have textured hair.
• 3:30
  SPEAKER_00: So I think that this is going to be a podcast episode that so many of our Durham colleagues, as well as anybody who's listening, is going to learn a ton about.
• 3:39
  SPEAKER_00: So I can't thank you enough for sharing your expertise on this subject with us.
• 3:44
  SPEAKER_01: Well, thank you for having me.
• 3:45
  SPEAKER_01: This is one of the topics that I love to talk about.
• 3:48
  SPEAKER_01: And it is an area that we all can learn.
• 3:51
  SPEAKER_01: Even I have been talking about this topic for years, and I'm always learning something new.
• 3:57
  SPEAKER_01: So it's, I think it's a relevant topic, and I think the listeners will really enjoy learning about this, about textured hair.
• 4:04
  SPEAKER_00: For sure.
• 4:05
  SPEAKER_00: So I want you to start with a fascinating story that you told on podium in our meeting about the first woman who really successfully marketed skincare, I'm sorry, hair care for black women.
• 4:17
  SPEAKER_00: And her name, as I remember right, is Madam CJ Walker.
• 4:21
  SPEAKER_00: And I found this story so fascinating.
• 4:23
  SPEAKER_00: I want you to tell it to our listeners.
• 4:26
  SPEAKER_01: So it is an absolutely fascinating story.
• 4:29
  SPEAKER_01: So Madam C.J.
• 4:30
  SPEAKER_01: Walker basically marketed a steel hot comb to straighten hair.
• 4:36
  SPEAKER_01: And in marketing this product, she became what is considered by most people the first self-made woman millionaire in the United States.
• 4:45
  SPEAKER_01: So I always say hair is really important, right?
• 4:48
  SPEAKER_01: You can become a millionaire by marketing hair.
• 4:51
  SPEAKER_01: Just with a hot comb, right?
• 4:52
  SPEAKER_01: Right, with a hot comb.
• 4:54
  SPEAKER_01: And I think that she's really special and unique.
• 4:57
  SPEAKER_01: She was actually the first child in her family born into freedom.
• 5:01
  SPEAKER_01: Both of her parents were enslaved people.
• 5:04
  SPEAKER_01: And um she had, you know, a lot of struggles.
• 5:07
  SPEAKER_01: She was orphaned at a at a young age and then got married very young and widowed very young, and was very much a self-made woman.
• 5:15
  SPEAKER_01: I think for dermatologists, what's really interesting is she's one of the first people, considered to be one of the first people who utilize before and afters in her marketing, which of course is a huge part of what we do.
• 5:28
  SPEAKER_01: And again, it doesn't surprise me that she was the first self-made millionaire, women, female millionaire in the US.
• 5:34
  SPEAKER_01: So really just by marketing a system to make uh to straighten hair is how she gained her success.
• 5:43
  SPEAKER_01: And she ended up in the end of her life being very philanthropic and um was just overall an outstanding woman and entrepreneur.
• 5:52
  SPEAKER_01: So I love to mention her in my talks because she is so unique.
• 5:57
  SPEAKER_00: It's such a great story.
• 5:59
  SPEAKER_00: So let's start like with physiology.
• 6:02
  SPEAKER_00: What are the physiologic differences between textured hair and straighter forms of hair?
• 6:07
  SPEAKER_01: So, first of all, when we talk about textured hair, it's important for us to know that um I'm going to be talking about ethnicities, right?
• 6:16
  SPEAKER_01: So I might say Asian, Caucasian, and African hair.
• 6:19
  SPEAKER_01: But as we know, we live in this multicultural world.
• 6:23
  SPEAKER_01: So it's very possible for someone of African descent to have straight hair, someone of Asian descent to have curly hair.
• 6:30
  SPEAKER_01: A lot of people with Asian descent have curly hair, but these are just general categories.
• 6:35
  SPEAKER_01: So I always want to set that baseline that I'm going to say Asian, Caucasian, and African hair, but know that we really do live in this multicultural world.
• 6:43
  SPEAKER_01: So there's huge variations within different ethnicities.
• 6:47
  SPEAKER_01: But in general, Asian hair is large and round.
• 6:51
  SPEAKER_01: So it has it's perfectly round, has the largest cross-sectional area.
• 6:56
  SPEAKER_01: Um, and these were this this data comes from studies that were done years ago looking using you know high-powered microscopes to examine the hair.
• 7:04
  SPEAKER_01: So the hair was large, round, had the largest cross-sectional area, and in general was very smooth, didn't tend to have breakage or what they call longitudinal fissures, which are you know cracks in in the um hair.
• 7:17
  SPEAKER_01: Uh, then when we think about Caucasian hair, that's a little more elliptical, um, a little bit not as round, a little bit, I think of it as oval shaped, uh, can have occasional spontaneous knots because in this study they would have people just brush their hair and submit the hair, and then they would examine the hair and see if the hairs were had fissures or had knots or had frayed ends.
• 7:42
  SPEAKER_01: You know, they were just looking at natural untreated hair.
• 7:44
  SPEAKER_01: So Caucasian hair is, as I said, more elliptical and can spontaneously not.
• 7:50
  SPEAKER_01: And then in the African subjects who um they examine those subjects' hair, that hair is almost flat.
• 7:57
  SPEAKER_01: It's almost ribbon-like.
• 7:58
  SPEAKER_01: So think of it as a coiled ribbon.
• 8:00
  SPEAKER_01: So it's a very flat, ribbon-like hair.
• 8:03
  SPEAKER_01: That hair in those studies was much more likely to have longitudinal fissures and frayed ends versus a cut end or a natural tip end.
• 8:11
  SPEAKER_01: As far as keratin, you know, the keratin composition in the hairs are very similar, but there are some differences when it comes to how strong the hair is.
• 8:20
  SPEAKER_01: So in these studies, African hair has decreased tensile strength, so it breaks more easily when it's stretched.
• 8:28
  SPEAKER_01: And also studies suggest that people of African descent might have um less hair density and less fibers attaching the hair to the scalp, so or less elastic fibers attaching the hair to the scalp.
• 8:42
  SPEAKER_01: So, what that means in from a big picture for a dermatologist is the hair is much more fragile, easier to break, and um theoretically has a greater predisposition to many of the hair disorders that we see.
• 8:56
  SPEAKER_00: That makes total sense, and that's why we see so many women with textured hairs in our office complaining about my hair's breaking off.
• 9:04
  SPEAKER_01: Exactly.
• 9:05
  SPEAKER_00: And then and then there's all the processes, and we'll talk about that.
• 9:08
  SPEAKER_00: But let's start with sort of basic hair care, washing, conditioning.
• 9:13
  SPEAKER_00: I know this is so important when you have ethnic hair, and it's so dramatically different to the way that I might take care of my hair, which is wash and blow dry every day and like run a little conditioner through the ends.
• 9:24
  SPEAKER_00: It's a totally different process, and it's a time-consuming process.
• 9:27
  SPEAKER_00: Yes.
• 9:28
  SPEAKER_01: So basically, you know, there the wonderful thing about coily, kinky, curly, textured hair is that there are so many different ways to style.
• 9:38
  SPEAKER_01: So it's very hard to make generalizations, but I'll give basic categories of how women might style their hair.
• 9:47
  SPEAKER_01: So, first of all, as we know, their natural hairs are keeping the natural hairs texture is very, very popular right now.
• 9:55
  SPEAKER_01: So, someone with natural hair who doesn't have any chemical in the hair whatsoever may wash their hair every one to two weeks, may use a lot of conditioners and oils to help manage the hair because the hair could feel very dry.
• 10:11
  SPEAKER_01: That remember in straight hair, the oils that are produced from our scalp naturally kind of travel along that hair follicle down, and so the hair can get oily very quickly.
• 10:20
  SPEAKER_01: The reason why women with textured hair don't need to wash their hair as frequently is because their hair never really feels oily.
• 10:27
  SPEAKER_01: I have never I never understood the concept of oily hair.
• 10:31
  SPEAKER_01: I had to learn that concept because my hair was always dry.
• 10:34
  SPEAKER_01: Like if I didn't wash my hair for weeks, it didn't matter.
• 10:37
  SPEAKER_01: It was always dry.
• 10:39
  SPEAKER_01: So a lot of women with textured hair add oil to the hair, add conditioning products to the hair to improve manageability and to improve like even brushing, the ability to brush your hair when the hair, if if your hair is curly and you brush your hair.
• 10:54
  SPEAKER_01: So, and certain hair types choose you don't like at Afros, for example, you would after you style it, you don't brush it because then it would just, you know, you lose its shape.
• 11:03
  SPEAKER_01: So for people who have no chemical in their hair, they the typical hair care practice would be to wash every one to two weeks and to use oils or conditioners or leave-in conditioners to improve manageability of the hair.
• 11:20
  SPEAKER_01: And then that hairstyle could also be braided.
• 11:23
  SPEAKER_01: It could um, if the person wanted to maybe add extensions, they might braid the hair and sew in extensions, they might braid the hair and glue and extensions.
• 11:32
  SPEAKER_01: That one I don't like, no glue at all, because glue is a common cause of contact dermatitis, because some of the hair glues either have acrylates or they have rubber or they have latex, and so they tend to cause allergies in a lot of our patients.
• 11:46
  SPEAKER_01: Um glue is a no-no.
• 11:48
  SPEAKER_01: Um, and then there's braided and extensions or corn rowing.
• 11:52
  SPEAKER_01: So that is for people who have natural hair.
• 11:55
  SPEAKER_01: Then there are many different processes used to straighten the hair.
• 11:58
  SPEAKER_01: So there's chemical relaxers, that's sodium hydroxide or lye, that works by breaking the disulfide bonds.
• 12:04
  SPEAKER_01: And then that type of person, if their hair is chemically straightened, might do a wash and blow dry every one to two weeks or a wash and set where they put their hair in rollers and sit under the dryer, because the goal for that person is to have straight hair.
• 12:18
  SPEAKER_01: And then um, and the different types of chemical relaxers to straighten the hair are, like I said, sodium hydroxide, but also keratin, which is very popular for people with coily hair because they report that their hair looks smoother and there's less frizz.
• 12:33
  SPEAKER_01: Most keratin products, though, have formaldehyde.
• 12:36
  SPEAKER_01: And formaldehyde is a carcinogen and is very much regulated by the FDA.
• 12:42
  SPEAKER_01: So you've probably heard that term Brazilian blowout.
• 12:45
  SPEAKER_01: That was a popular hair straightening process that women were doing.
• 12:51
  SPEAKER_01: That used high percentages of formaldehyde to straighten the hair.
• 12:55
  SPEAKER_01: And the women who did it used to wear literally gas masks.
• 12:58
  SPEAKER_01: And the patient of the client who's getting her hair done was wearing a gas mask.
• 13:01
  SPEAKER_01: They would do it in front of a window with the fans blowing because formaldehyde is toxic, as we all know.
• 13:07
  SPEAKER_00: So toxic.
• 13:14
  SPEAKER_00: So well we remember, right?
• 13:15
  SPEAKER_01: Yeah, it's it's an you can't forget that smell.
• 13:18
  SPEAKER_01: Um, I still can't eat in the restaurant that I used to eat in when I was a first-year medical student because I have that smell of formaldehyde.
• 13:28
  SPEAKER_01: So um, so Brazilian brillats are very dangerous, the the original ones um where you needed to wear gas masks.
• 13:35
  SPEAKER_00: Do they still do those, Heather?
• 13:36
  SPEAKER_01: They still do.
• 13:37
  SPEAKER_01: I have seen um people I know personally, you know, on Instagram getting their hair done with a mask on their face, which I think is crazy.
• 13:46
  SPEAKER_01: So I tell my patients if you can smell the formaldehyde, it has formaldehyde, even it's that, even if it says it doesn't.
• 13:52
  SPEAKER_01: The FDA is trying to crack down on this, but um the formaldehyde is what straightens the hair.
• 13:57
  SPEAKER_01: So I think it's the it's the ingredient that's the magic ingredient.
• 14:01
  SPEAKER_01: So um there's keratin, and then of course there's just straightening with uh, you know, flat iron and oils and so forth.
• 14:08
  SPEAKER_01: So it's important to note that I talked about Madam CJ Walker and she used that hot comb to comb through and straighten the hair with a heated comb.
• 14:16
  SPEAKER_01: Nowadays, people tend to are much more likely to just use a flat iron to straighten the hair.
• 14:21
  SPEAKER_01: Okay.
• 14:22
  SPEAKER_01: So um, but in general, the big take home is washing and conditioning is every one to two weeks.
• 14:27
  SPEAKER_01: It is not every day because these processes take so much time.
• 14:31
  SPEAKER_01: On average, it takes hours to get your hair done.
• 14:35
  SPEAKER_01: If you have curly textured hair and you're doing a style that requires some styling.
• 14:41
  SPEAKER_01: Now, obviously, if someone has a short afro, of course they can wash their hair every day, every other day.
• 14:45
  SPEAKER_01: But most women, if they have some sort of elaborate style, it is a very long process and um they're not likely to do, you know, if you say wash your hair every day with this dandruff shampoo, they're not likely to do that.
• 14:59
  SPEAKER_01: So once a week is what I recommend for my patients.
• 15:02
  SPEAKER_00: I've made that mistake of telling patients with bad sempers, well, just wash every other day and they just look at you like, are you crazy?
• 15:07
  SPEAKER_00: Are you crazy?
• 15:08
  SPEAKER_01: That would be three hours of my life.
• 15:10
  SPEAKER_00: I was gonna say, do you think I have that kind of time?
• 15:13
  SPEAKER_00: Exactly.
• 15:14
  SPEAKER_00: That was when I was super naive.
• 15:15
  SPEAKER_00: But yeah, I understand that.
• 15:17
  SPEAKER_00: Um, talk for a minute about the things that you see from overprocessing, because I know that that's a huge problem in this patient population with textured hair.
• 15:28
  SPEAKER_01: So, what can happen is if there's and there's many different ways of overprocessing.
• 15:33
  SPEAKER_01: So there's actual heat damage.
• 15:34
  SPEAKER_01: So even if you don't have any chemicals in your hair, you when you repeatedly straighten the hair with high heat, that can damage that hair follicle, the hair cuticle, and you can have you know breakage, which is a very common complaint.
• 15:50
  SPEAKER_01: Um, so heat alone can be a source of overprocessing.
• 15:55
  SPEAKER_01: Sometimes people think only chemicals can cause overprocessing, but heat can also cause overprocessing.
• 16:00
  SPEAKER_00: Don't you get bubble hair when you heat the body?
• 16:02
  SPEAKER_00: Yeah, bubble hair with that heat.
• 16:03
  SPEAKER_01: Yeah, exactly.
• 16:04
  SPEAKER_01: And then um, when we talk about the chemicals, obviously the chemical relaxers for people who are doing these straightening processes should only be applied to the roots, the fresh growth that is unprocessed hair.
• 16:17
  SPEAKER_01: But inevitably, the relaxer does overlap with the already straightened hair.
• 16:22
  SPEAKER_01: And if the relaxer is done too frequently, or the hair straightening process is done too frequently, or left on for too long, or there's so many different variables that can happen, you can basically degrade the integrity of the hair, and then you see more breakage.
• 16:39
  SPEAKER_01: So it is really um for a from a patient perspective and a recommendation perspective.
• 16:44
  SPEAKER_01: I tell my patients, you know, find the right hairstylist because that can make a breakfast.
• 16:50
  SPEAKER_00: How do you find the right person who's really knowledgeable on using these chemicals and these treatments?
• 16:55
  SPEAKER_01: Well, you know, interestingly, there is um a network is called the Strand Network, and it's a network uh that that women who are or men who are stylists who really want to understand hair health can come and be trained by dermatologists.
• 17:10
  SPEAKER_01: And so if you can find, you know, a stylist who's in the Strand Network, that would be great because they those you will know at least those stylists have a real interest in understanding hair health.
• 17:21
  SPEAKER_01: But other than that, I think it's a little bit intuitive.
• 17:24
  SPEAKER_01: Like once you find someone who's good, you just don't leave that.
• 17:27
  SPEAKER_01: Stay with them for a long time.
• 17:27
  SPEAKER_01: Just like any other hairstylist.
• 17:29
  SPEAKER_01: Once you find one someone who's good, you just can't leave.
• 17:31
  SPEAKER_01: And if I I one of my favorite quotes is from Dr.
• 17:34
  SPEAKER_01: Delova, she's from um, she's a dermatologist in South Africa who's a leading dermatologist in hair.
• 17:41
  SPEAKER_01: And she says, if it hurts, if the hairstyle causes pain, then it's not a good thing.
• 17:47
  SPEAKER_01: You know, if the braids are too tight or you have any pain, that is a signal that, you know, if you have to take a Tylenol when you get home from getting your hair done.
• 17:57
  SPEAKER_00: Oh my gosh.
• 17:58
  SPEAKER_00: I mean, I guess they could be that painful if you're doing it.
• 18:01
  SPEAKER_00: It can be painful.
• 18:02
  SPEAKER_01: If braids are done too tightly, extensions are done too tightly.
• 18:05
  SPEAKER_01: If you put on some type of glued-in product and all of a sudden your scalp is itching and burning, you know.
• 18:11
  SPEAKER_01: So um, in general, it's pretty much intuitive.
• 18:14
  SPEAKER_01: You can tell when someone is good.
• 18:16
  SPEAKER_01: Unfortunately, you have to go through a couple bad ones to find the good ones.
• 18:19
  SPEAKER_00: But the good ones.
• 18:20
  SPEAKER_00: I I kind of wonder about putting the extensions on hair that's already so prone to fragility.
• 18:27
  SPEAKER_01: So you bring up a good point.
• 18:29
  SPEAKER_01: So they've done studies on this.
• 18:31
  SPEAKER_01: So as far as traction alopecia is concerned, applying tra if the hair is in its natural state and it's not straightened, so it's natural virgin hair growing out, then that is obviously the strongest, most robust hair.
• 18:45
  SPEAKER_01: And the rate of traction alopecia increases when the the braids are done on chemically processed hair.
• 18:53
  SPEAKER_01: So you brought up a very good point.
• 18:55
  SPEAKER_01: We absolutely do not recommend that you do braids or extensions or any type of manipulative process if your hair is chemically straightened, because then the risk of traction alopecia goes up three, four, or five times more.
• 19:10
  SPEAKER_01: So on natural virgin hair, it shouldn't be a problem if the person isn't braiding too tight.
• 19:16
  SPEAKER_01: But if uh but if the person, even if they're not braiding too tightly, if your hair is chemically straightened and you do extensions or braids, you significantly increase your risk of traction alopecia.
• 19:27
  SPEAKER_00: That makes total sense.
• 19:28
  SPEAKER_00: Oh my goodness.
• 19:29
  SPEAKER_00: We see so many patients in our practices who have traction that started when they were children, you know, especially all of this around the front.
• 19:37
  SPEAKER_00: And is there any advances that might help those patients?
• 19:41
  SPEAKER_00: And can they be transplanted?
• 19:43
  SPEAKER_01: Well, what I would say with traction, obviously prevention is key, like everything in medicine, but this is one of the diseases where if a mom comes in and I notice that her daughter's hairstyle is a little bit tight, or anyone, if it's mom or adult, you know, every time I'm seeing my patient for something else, but I notice really tight braids, I'll say, in a very, and it's you know, it's a little bit touchy to comment on people's hair.
• 20:07
  SPEAKER_01: But I what I say is um, I'll say, Oh, your hair looks a little tight.
• 20:12
  SPEAKER_01: You have to be careful because you can lose your edges.
• 20:15
  SPEAKER_01: And so, you know, and some sometimes patients will say to me, Oh, it doesn't feel tight, it really doesn't feel tight.
• 20:21
  SPEAKER_01: And sometimes we'll say, Oh, yeah, it was very, very tight.
• 20:23
  SPEAKER_01: I couldn't sleep for two days.
• 20:24
  SPEAKER_01: And I say, Don't go back to that stylist, or, you know, don't, or tell her to do it looser because you will eventually lose your edges.
• 20:32
  SPEAKER_01: So you can volunteer in this in a very culturally appropriate way, but the way I say it is it looks a little tight, you know, kind of, you know, very gentle.
• 20:41
  SPEAKER_01: Trying to try and peddle it.
• 20:43
  SPEAKER_01: Yeah.
• 20:43
  SPEAKER_01: And, you know, you have to be careful because long term you can lose your edges.
• 20:47
  SPEAKER_01: And the key is prevention.
• 20:48
  SPEAKER_01: When it comes to what's new, you know, obviously we have so many things in the hair space, it's a lot of new things that are coming out.
• 20:56
  SPEAKER_01: Um, but uh it's traction is tough because long-standing traction becomes permanent.
• 21:02
  SPEAKER_01: Uh, so for my patients who I catch it early, I'll do topical monoxidil.
• 21:07
  SPEAKER_01: Um, I might recommend a hair supplement because I think that that can just improve the overall hair health.
• 21:13
  SPEAKER_01: Um, they could do red light therapy, uh, they could do PRP, that's becoming very popular in that population.
• 21:20
  SPEAKER_01: And then long term, if it's long-standing traction, there are hair transplants that are very, very successful, very successful.
• 21:28
  SPEAKER_01: But obviously, we want to avoid the patient getting to that point.
• 21:31
  SPEAKER_00: Yeah, of course.
• 21:32
  SPEAKER_00: Where are we at with CCCA?
• 21:35
  SPEAKER_01: CCCA is interesting.
• 21:37
  SPEAKER_01: I love that there's always new research coming out in that area.
• 21:41
  SPEAKER_01: Um, a lot of the new research in CCCA is more basic science.
• 21:45
  SPEAKER_01: So, some data that's re uh has been published in the last several years shows or suggests that it's autosomal dominant.
• 21:52
  SPEAKER_01: There's some data looking at the key genes that are involved and so forth.
• 21:58
  SPEAKER_01: Um, when it comes To treatment, although we have lots of treatments, I still think it is a little bit of a challenge in your dermatology practice.
• 22:08
  SPEAKER_01: That being said, uh patients can regrow hair.
• 22:12
  SPEAKER_01: So one big take-home is whenever a dermatologist sees someone with CCCA, don't say it'll never grow back.
• 22:20
  SPEAKER_01: Because if it's in the early stages, it absolutely can grow back.
• 22:24
  SPEAKER_01: And I tell my patients around 10 to 30% regrowth and sometimes even more than that.
• 22:30
  SPEAKER_01: So I don't want you to set unrealistic expectations, but I do, I don't like when patients say, I was told it will never grow back.
• 22:38
  SPEAKER_01: Because when we I what I personally use, I use a lot of topical steroids, a lot of intralesional steroids.
• 22:44
  SPEAKER_01: Um you can use there's some newer treatments like topical metformin was reported.
• 22:51
  SPEAKER_01: Obviously, we can use minoxidyl.
• 22:53
  SPEAKER_01: There are a lot of new treatments that are coming out, and we do see regrowth.
• 22:57
  SPEAKER_01: We don't want to say, oh, 100% of your hair will grow back and it'll come back to normal, but don't say that and send them away.
• 23:05
  SPEAKER_01: And the other thing, another key clinical pearl, breakage on the crown of the scalp is early CCCA in these patients.
• 23:13
  SPEAKER_01: So if a patient says they have this good hair density, but they say they're having breakage, pay attention to that patient because that early intervention can stop this process completely with a topical cell.
• 23:25
  SPEAKER_00: That's a great pearl.
• 23:26
  SPEAKER_00: Yes.
• 23:27
  SPEAKER_00: That's a great pearl.
• 23:28
  SPEAKER_00: Yeah, it's a very challenging condition for sure.
• 23:32
  SPEAKER_00: Let's talk for a second about products because we kind of went through that quickly.
• 23:35
  SPEAKER_00: Are there certain things in, for example, shampoos or the, you know, that you may want to avoid or that are more important in textured hair?
• 23:44
  SPEAKER_01: I would say in general, from a shampoo standpoint, uh I always tell my patients that your choice of a shampoo and conditioner is a very personal decision.
• 23:56
  SPEAKER_01: And I can recommend products that I like, but if you don't like it then and it doesn't work for your hairstyle, then it doesn't really matter.
• 24:03
  SPEAKER_01: So I'd say in general, for shampoos and conditioners, people with textured hair prefer products that are don't have harsh surfactants that are gonna strip the hair.
• 24:14
  SPEAKER_01: So the old-fashioned shampoos that, you know, or if it says volumizing, that means it probably is stripping a lot of the oils off of the scalp.
• 24:22
  SPEAKER_01: So those patients are gonna be interested in conditioning shampoos, hydrating shampoos, gentle shampoos, gentle surfactants.
• 24:30
  SPEAKER_01: Those types of patients are gonna be interested in heavier conditioners that have more, that offer more hydration, but also moisturization and oils to help manage the hair.
• 24:42
  SPEAKER_01: So as I mentioned, uh in general, people with cur curly, kinky, coily hair, their number one complaint is that their hair is dry.
• 24:51
  SPEAKER_01: And so they're going to look for products that are focused on replenishing dry hair and are going to avoid products that are very harsh and are designed for oily hair.
• 25:00
  SPEAKER_01: So I can just give general recommendations, but there's no one brand or the other.
• 25:04
  SPEAKER_01: It really is a personal choice.
• 25:06
  SPEAKER_00: And and you'll look at the labeling and see which ones say they're, you know, deeply hydrating or exactly gentle.
• 25:13
  SPEAKER_00: That's that's good advice.
• 25:14
  SPEAKER_00: So, what really started me thinking about interviewing you on the subject were were the new studies that are coming out now, talking about the relationship between some of these hair treatments that we talked about and cancer in women with textured hair.
• 25:30
  SPEAKER_00: And it I think they were somewhat sensational, some of the things that came across our feeds.
• 25:37
  SPEAKER_00: But when I was reading them, I became very concerned.
• 25:40
  SPEAKER_00: So I thought you would be a great person to talk about these studies and you know, kind of give us the T on what really is the level of danger here.
• 25:49
  SPEAKER_01: So these studies are very interesting, but it's really important to understand the kind of background of the study.
• 25:56
  SPEAKER_01: So they're most of the data comes out of a study called the Sister Study.
• 25:59
  SPEAKER_01: So it's a group of over 30,000 individuals whose sister had breast cancer.
• 26:05
  SPEAKER_01: So they didn't have a history of breast cancer, but their sister had a history of breast cancer.
• 26:08
  SPEAKER_01: So they studied these women and they asked them about many different things, but one of the things that they asked them about were their hair styling practices.
• 26:16
  SPEAKER_01: So two big headlines came out.
• 26:19
  SPEAKER_01: Um one of them was talked about uterine cancer.
• 26:23
  SPEAKER_01: And it was talking about the use of it said hair straightening products.
• 26:29
  SPEAKER_01: But so when those headlines came out, they would say relaxers associated with increased use of uterine cancer.
• 26:36
  SPEAKER_01: But what did the study actually ask?
• 26:39
  SPEAKER_01: So the question they actually asked is in the last 12 months, have you used a hair straightening product, including a flat iron to straighten your hair, a uh the keratin products that we talked about, which contain formaldehyde, or chemical relaxers which contain sodium hydroxide or hydroxides in general.
• 27:00
  SPEAKER_01: And in that group of people who said, yes, in the last 12 months, I straightened my hair, essentially.
• 27:08
  SPEAKER_01: And they asked them about frequency.
• 27:09
  SPEAKER_01: So the people who said they had straightened their hair at least four times in the last 12 months were more likely.
• 27:15
  SPEAKER_01: I think I have some notes here, but I think they were twice as likely to develop uterine cancer than people who had never straightened their hair.
• 27:22
  SPEAKER_01: So um, so that's what that study looked at.
• 27:25
  SPEAKER_01: It was 33, a little over 33,000 women, their sisters had a history of cancer, and they were asked if they had straight used hair straightening products in the last year.
• 27:34
  SPEAKER_01: Now, obviously, when you know the big picture where they looked at flat irons, um, keratin, and relaxers, that kind of is a different population of people than saying chemical relaxers.
• 27:47
  SPEAKER_00: Yeah, it's not a great study design, really.
• 27:49
  SPEAKER_01: Yes, they just they just are women who have straightened their hair, basically.
• 27:53
  SPEAKER_01: And they had a higher risk.
• 27:55
  SPEAKER_01: So um, we do know for a fact, obviously, formaldehyde is a carcinogen.
• 27:59
  SPEAKER_01: So the keratin is is very the Brazilian blowout and the products that have chromaldehyde in them are actually regulated by the FDA because formaldehyde is a is a known carcinhoide.
• 28:10
  SPEAKER_01: Carcinogen, correct.
• 28:11
  SPEAKER_01: But sodium hydroxide is not a known carcinogen.
• 28:15
  SPEAKER_01: It's a product, it's an ingredient found in a lot of products, and that's the primary ingredient in chemical relaxers.
• 28:20
  SPEAKER_01: And obviously, flat ironing the hair, I can't think of a way that flat ironing the hair could be associated unless the product that you put in the hair to flat iron the hair could be associated with cancers.
• 28:34
  SPEAKER_01: So it's a complicated study.
• 28:36
  SPEAKER_01: When you know that background, it's a little bit more confusing.
• 28:40
  SPEAKER_01: Um, also, in the study of these people who frequently straighten their hair, 60% of them were black, 40% of them were white.
• 28:47
  SPEAKER_01: So it wasn't just black women had higher rates of, it was that all of the women who frequently straighten their hair had higher rates of uterine cancer compared to the women who didn't.
• 28:58
  SPEAKER_01: What can you make of that?
• 28:59
  SPEAKER_01: The only thing I could think of is that maybe people who straighten their hair use more personal care products in general, that may have hormone disruptors.
• 29:08
  SPEAKER_01: I don't know.
• 29:09
  SPEAKER_01: But the headline, relaxers in black women causes uterine cancer, is really not the uh conclusion once you understand the background of the study.
• 29:19
  SPEAKER_00: Yeah, and only 60% of the patients were patients with skin of color.
• 29:23
  SPEAKER_00: Is that what you're saying?
• 29:23
  SPEAKER_01: So 60% were black.
• 29:25
  SPEAKER_01: So I think that the big take home for us, and there was a similar study that looked at breast cancer, and um it looked at hair color, hair dye use, and they found that permanent hair color, not uh rinses, which you know, basically rinse out or semi-permanent, but permanent hair color was associated with higher rates of breast cancer.
• 29:45
  SPEAKER_01: So the it's interesting, but you kind of have to understand the background of these studies, and definitely the one that has to do with hair straightening, it's important to know that it included any type of hair straightening.
• 29:56
  SPEAKER_01: So it makes the results a little confusing.
• 29:58
  SPEAKER_01: The reason why these studies can be a little bit harmful, at least the headlines can be harmful, not the study, but the headlines, is that it kind of puts the blame on black women, like, oh, you're straightening your hair, and that's why there's an increased rate of uterine cancer in black women.
• 30:11
  SPEAKER_01: And the interesting thing, it gets even more interesting, there's two types of uterine cancer.
• 30:16
  SPEAKER_01: Type one is the one that's associated with hormones that's hormone sensitive, and type two is not hormone sensitive.
• 30:22
  SPEAKER_01: And the increase in uterine cancer overall that we're seeing in black women, because there are higher rates of uterine cancer in black women, is the type two type of uterine cancer.
• 30:31
  SPEAKER_00: So it's not hormonal.
• 30:33
  SPEAKER_01: At this time, since some of the studies suggest that.
• 30:36
  SPEAKER_01: So, and in general, women are using chemical relaxers less because, as I mentioned earlier, it's very, very popular to have natural hair.
• 30:44
  SPEAKER_01: So, um, so I think the study is a little bit confusing and those headlines are a little misleading.
• 30:50
  SPEAKER_01: It's great research.
• 30:51
  SPEAKER_01: I'm not saying it's not great research, but it's something that you really need to understand the study design in order to interpret those results.
• 31:00
  SPEAKER_00: That's a great summary of all of that because I was very concerned when I saw those headlines.
• 31:07
  SPEAKER_00: I was like, oh no, because I was familiar with the uterine cancer study.
• 31:11
  SPEAKER_00: Very interesting.
• 31:13
  SPEAKER_00: Well, I want to just thank you for sharing all of your knowledge and your expertise on this subject.
• 31:18
  SPEAKER_00: I know our listeners will love this episode.
• 31:20
  SPEAKER_00: Again, it's something that many dermatologists don't know much about.
• 31:23
  SPEAKER_00: And so I think you've really enlightened us about hair care products and the rituals that go along with having textured hair, and then also teasing out some of this interesting data that I think so many of us were concerned with.
• 31:36
  SPEAKER_00: For those of you who are listening, I want to thank you for joining us for this episode of the Science of Skin Podcast.
• 31:42
  SPEAKER_00: And if you like our podcast, please subscribe, give us a review.
• 31:45
  SPEAKER_00: We'd be most grateful.
• 31:47
  SPEAKER_00: And Heather, I look forward to seeing you at the Science of Skin Summit this year, because you're always front and center and somebody that we can depend on.
• 31:54
  SPEAKER_00: And we're so grateful again for your attendance there as well.
• 31:57
  SPEAKER_01: And looking forward to it.
• 31:59
  SPEAKER_01: As you know, one of my favorite meetings of the year.
• 32:01
  SPEAKER_01: So you'll see me front and center, as usual.
• 32:04
  SPEAKER_00: Can't wait.
• 32:05
  SPEAKER_00: Taking notes, taking notes.
• 32:07
  SPEAKER_00: Taking notes, me too.
• 32:08
  SPEAKER_00: We learn so much, don't we?
• 32:10
  SPEAKER_01: Yes.
• 32:10
  SPEAKER_00: Thanks again, everybody.