In this episode of The Spot Check, Jamie Restivo, PA-C, sits down with Erica Ramos, DMSc, PA-C, to unpack a familiar clinical frustration: scalp disease that should respond, but often doesn’t.  

Ramos traces the gap back to adherence. Patients stretch time between washes, rinse too quickly, or avoid medicated shampoos altogether, whether to preserve color, manage texture, or simply keep up with daily life. “Nobody’s leaving it on long enough,” she says. “That’s why I encourage people to use it as a mask.”  

Their conversation then moves beyond ingredients and into behavior. They explore how cultural hair practices, mobility limitations, and cosmetic priorities shape treatment success—often more than the prescription itself. The issue, as Restivo frames it, isn’t a lack of options. It’s asking patients to adopt routines they’re unlikely to follow.

Ramos’s response was to build something that fits into that reality, like a leave-on, dry formulation designed to extend contact time without disrupting hair care practices. She walks through the thinking behind the formulation—anchored by salicylic acid as a keratolytic and supported by ingredients selected for anti-inflammatory and antimicrobial effects—and why delivery matters just as much as mechanism.

The conversation broadens into a more practical philosophy of care to meet patients where they are, layer therapies when needed, and think in terms of tools rather than single solutions. Or, as Ramos puts it, “We can lead a horse to water, but we can’t make them drink.”  

It’s a grounded and nuanced look at what happens when we stop blaming the treatment and start redesigning how it’s used.

The views expressed in this episode are those of the speakers and do not necessarily reflect those of Dermsquared. This program is intended for health care professionals and is provided for educational purposes only.  

Clinicians are responsible for applying independent clinical judgment in patient care.