Ethically conducting hair examinations among individuals with hijabs

To the Editor: We read with interest the article by Abdi et al, “Ethically conducting hair examinations among individuals with hijabs.” We value the authors' suggestions for general practices during a clinical encounter for women wearing hijab.1Abdi W. Sow Y.N. Blalock T.W. Ethically conducting hair examinations among individuals with hijabs.J Am Acad Dermatol. 2023; https://doi.org/10.1016/j.jaad.2023.05.020Abstract Full Text Full Text PDF Scopus (0) Google Scholar Determining each patient's unique preferences prior to beginning a visit is recommended as there is significant variation in the level of comfort Muslim patients express with removing hijab.1Abdi W. Sow Y.N. Blalock T.W. Ethically conducting hair examinations among individuals with hijabs.J Am Acad Dermatol. 2023; https://doi.org/10.1016/j.jaad.2023.05.020Abstract Full Text Full Text PDF Scopus (0) Google Scholar,2Rehman R. Chabaan A. Hamzavi I. Fahs F. Mohammad T.F. The etiquette of hijab: recommendations to improve care in dermatology clinics.Br J Dermatol. 2022; 186: 176-177https://doi.org/10.1111/bjd.20665Crossref Scopus (4) Google Scholar In our experience, some female patients are comfortable removing hijab in the presence of a male provider. However, most female patients of the Islamic faith are more comfortable receiving care from gender-concordant teams, which our clinical workflows address. Additionally, providers always verify consent before taking clinical images and offer to remove any identifying features. These ethical guidelines may also be helpful in the setting of clinical research. There is limited data regarding the recruitment of women wearing hijab in alopecia studies; however, Muslim women enrolled in clinical research likely experience similar concerns to those observed in clinical care. This subgroup of the population is likely underrepresented in alopecia studies, thus restricting demographic inclusion of minorities in research. This has harmful implications for the generalizability of findings and may impact clinical recommendations. Research teams should strongly consider the recommendations presented by Abdi et al, to alleviate any apprehension patients may experience with participation and enrollment. Modified health-seeking behaviors also create challenges for documenting and monitoring hijab-related dermatoses. Nearly half of Muslim women living in the United States report wearing hijab,3Dahak S. Koblinski J.E. Krueger L.D. An approach to hair loss in hijab-wearing individuals in primary care.J Am Board Fam Med. 2023; 36: 186-187https://doi.org/10.3122/jabfm.2022.220250R2Crossref Scopus (1) Google Scholar yet a current literature search including the terms “hijab” and “alopecia” yields just 5 articles, suggesting underlying limitations for conducting research on this topic. The prevalence of hijab-related dermatoses in the population is unknown,4Dahak S. Fernandez J.M. Educational resources for patients and physicians on hijab-related traction alopecia.Int J Dermatol. 2023; 62: e361-e363https://doi.org/10.1111/ijd.16357Crossref Scopus (0) Google Scholar although some articles imply underreporting of these conditions. Patient discomfort with seeking care for concerns associated with wearing hijab or insufficient patient education on associated dermatoses may be contributing factors. Therefore, incorporating patient centered communication is important to improve these barriers.1Abdi W. Sow Y.N. Blalock T.W. Ethically conducting hair examinations among individuals with hijabs.J Am Acad Dermatol. 2023; https://doi.org/10.1016/j.jaad.2023.05.020Abstract Full Text Full Text PDF Scopus (0) Google Scholar,2Rehman R. Chabaan A. Hamzavi I. Fahs F. Mohammad T.F. The etiquette of hijab: recommendations to improve care in dermatology clinics.Br J Dermatol. 2022; 186: 176-177https://doi.org/10.1111/bjd.20665Crossref Scopus (4) Google Scholar In an effort to enhance equity in alopecia research, we propose clinicians avoid assumptions that patients wearing hijab would be unwilling to participate in research or are less concerned with skin and scalp dermatoses. Additionally, we encourage recruiting medical students and residents of diverse backgrounds to dermatology, which increases cultural awareness and understanding that all specialists can benefit from. However, as with other diversity, equity, and inclusion initiatives, dermatologists should be careful to avoid placing the burden of education on affected individuals within the community. In addition to developing skills surrounding cultural competency, dermatology trainees should receive relevant clinical exposure as well as didactic opportunities on hijab-related dermatoses to close existing knowledge gaps.5Rehman R. Haque M. Ceresnie M. Hamzavi I.H. Fahs F. Mohammad T.F. Dermatological considerations and culturally sensitive recommendations for women who wear the hijab.Br J Dermatol. 2022; 187: 1003-1004https://doi.org/10.1111/bjd.21795Crossref Scopus (3) Google Scholar We applaud the authors for highlighting this important issue. None disclosed. Response to ethically conducting hair examinations among individuals with hijabsJournal of the American Academy of DermatologyPreviewWe applaud the engagement of Gadre et al,1 highlighting salient points that cultural humility and ethics must transcend direct patient care and be considered for clinical research. Full-Text PDF