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C L I N I C A L

HAIR RESTORATION aestheticmed.co.uk

Professional expertise
The clinical management of hair loss has traditionally
been the realm of the dermatologist. However, there are
only a handful of dedicated NHS hair-loss clinics – even
fewer specifically for “ethnic” hair, and a recognition
that higher specialist training may result in a lack of
5
confidence in managing ethnic skin and hair conditions. A
survey of dermatology trainees and junior consultants in
2013 indicated that only 38 out of 78 respondents (49%)
thought they were/would become competent in treating
conditions pertinent to the UK’s ethnic population following
completion of the training programme.
Figure 1. Advanced hair loss. Patient should have been referred much
Extrapolating this finding to hair loss conditions,
earlier for a biopsy from a dermatologist
the pool of expertise is likely to be even smaller. In the
NHS, patients will have been referred by their GP, who
themselves is likely to have received minimal training
in hair loss conditions before they qualify. 6 This was my
personal experience as a GP; I struggled to find a course
that would help to meet my educational needs for hair loss.
So, between 2010 and 2012 I completed a course of training
with the Institute of Trichologists which helped to broaden
my knowledge of diagnosing hair loss conditions in Afro-
textured hair.
To compound the situation there is a lack of UK studies
pertaining to hair loss in women of African descent. Most
of the current published data originates primarily from the
US and South Africa. There will of course be differences
in genetics and environmental factors when this data is
applied to patients in the UK.
APPROACH TO CONSULTATIONS
Regrettably, a significant proportion of patients may
be seeking help late on in the hair-loss process, but
an overall positive approach should be taken in terms
of advising about the cosmetic as well as medical
approaches. Practitioners should develop an awareness
of dermatologists specialising in Afro-textured hair loss,
as well as hair stylists who are able to safely style and care Figure 2. Hair pull test. Evidence of hair loss at the vertex/ crown
for natural Afro-textured hair. Patients will be prepared to
travel for a good quality service. consultation. A significant advantage to this approach is
Patients may have already seen a variety of high street that hairstyles which can be used to cover hair loss can
or holistic practitioners or trichologists, after perhaps not take up to several hours to remove at the clinic. As with all
feeling confident to approach their GP. They may feel clients, photography is essential to monitor progression
relieved that they now have permission to discuss of the hair-loss condition.
their hair loss, so additional time needs to be
factored into the consultation to allow for Clinic environment
this discussion. Relationships should The consultation environment should
be developed with good-quality wig “Hair loss is be private and free from interruptions,
suppliers or hair-replacement system the fourth most away from the view of the public and
suppliers if this is not supplied in clinic. common reason for other clients. Patients are likely to feel
Clinics should also develop knowledge self-conscious about their hair-loss
about the common methods of scalp African-Americans to condition and may have taken a long
camouflage. see a dermatologist” time to prepare to go out.
It can also be helpful for the clinic to
Photography carry stock of stylish head coverings for
Since covid-19 social restrictions were women with alopecia, and to ensure that a
introduced in the UK in March 2020, large, well-lit mirror is available to enable clients
remote consultations have become more to adjust their hair after the appointment.
commonplace. As part of this, it is helpful for patients to It is important to conduct a general assessment of the
send in photographs from the front, back, side and top hair loss to include:
views of their head (frontal, occipital and parietal). Most • The duration and progression of hair loss – Is the hair loss
patients have smartphones that can take good-quality progressing or has it become stable?
photographs that can be helpful to review before the • The history, pattern and site of hair loss and thinning –

30 Aesthetic Medicine • June 2020