Racial Bias in Healthcare and Trichology

Piece from Jacky van Driel-Nguene, Root Cause Clinical Trichologist and Board Advisor

by Hair Magazine

Knowing how to feel confident in recognising the clinical presentation of various scalp and hair conditions on clients of all racial backgrounds ensures that a healthcare provider or trichologist delivers a quality service to ALL who need help.
At Root Cause Clinical, we provide Continuing Professional Development (CPD) training to all our associate trichologists to ensure we are aware of racial bias.

Why is it essential for trichologists to recognise scalp and hair conditions on all skin tones and hair types?
It is crucial that trichologists and dermatologists are able to offer a good quality service to clients of any gender, racial background, skin colour, or hair type, as everybody deserves access to a healthy scalp and hair.
Unfortunately, most dermatology and trichology training programs are dispensed mainly with references to white or light-pigmented skin tones and straight-to-wavy hair types. When examining a client, an accurate diagnosis largely depends on the practitioner recognising clinical signs of scalp and hair conditions. This bears influence on the proposed treatment plan as well as the prognosis.

Lack of representation is part of the problem.
Representation is vital so that everybody can have access to trichology services, but having been trained only to recognise conditions on white skin tones puts non-white, afro-textured-haired clients at a disadvantage. Some conditions, such as central centrifugal cicatricial alopecia (CCCA) and acne keloidalis nuchae (AKN), are more prevalent in darker skin and may present differently than they do on whiter skin.

One example is erythema (redness), used as a hallmark sign in identifying inflammation on the scalp for conditions such as psoriasis, eczema, and some types of scarring alopecia (hair loss that can become permanent if left untreated) such as lichen planopilaris. This “redness” can look anything but red on darker skin tones, as the colour observed also depends on the background skin tone, often coming off as shades of purple, brown, and blue or grey hues.

Despite the increasing diversity of demographics in Europe and the U.K., it is still quite common for dermatologists and trichologists to have almost no experience in recognising patterns and signs of diseases on darker skin.

How can we resolve this issue, especially in trichology?
As telehealth services gain traction, it is even more critical now that trichologists and other healthcare practitioners have adequate competency in recognising and treating scalp and hair conditions in all skin and hair types.

“There are many other doctors and healthcare practitioners worldwide working towards the same goal of equality in the medical field, but it sometimes feels like one is screaming in an echo chamber. At Root Cause Clinical, we aim to empower our trichologists with the knowledge to increase their confidence in diagnosing scalp and hair conditions on all skin tones and hair types”. Jacky van Driel-Nguene, Root Cause Clinical Trichologist and Board Advisor

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