Page 34 - Flipmag-02

C L I N I C A L

HAIR RESTORATION aestheticmed.co.uk

hair using the comb and your hand. This is very important –
unfortunately patients with Afro-textured hair often report
a reluctance by the clinician to actually examine the hair,
which is needed to help to assess dryness, fragility and how
easily the hair comes away from the scalp (hair pull test).
If sufficiently skilled, trichoscopy or dermoscopy can
be useful, particularly in areas of scarring. Scarring may
not always be appreciated clinically. For this reason, there
should be a low threshold for performing scalp biopsies,
preferably by a pathologist or dermatopathologist trained
in the histopathological interpretation of scalp biopsies. 15

SUMMARY
There is an unmet need for the care of patients with
Figure 6. Hair loss patient with hair thinning at the front diagnosed by
dermatologist as lichen planopilaris skin of colour experiencing hair loss in the UK, so it is
important that a non-judgemental approach is taken which
traditional press acknowledges that. Thorough assessment and knowledge
• Brazilian keratin treatments/ formaldehyde-based of hair care practices will help to improve the confidence
straightening: The hair is washed and then the of practitioners. However, if unsure about assessment it
formaldehyde/ keratin solution is applied throughout is important to ensure that the patient is assessed by an
the hair with a comb. The hair is then blow-dried and flat- appropriately knowledgeable professional. AM
ironed at elevated temperatures of 400 to 450°F which
helps to seal the cuticle after straightening. Formaldehyde REFERENCES
treatments are now banned in the EU, but it is possible 1. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin
that these products may have been used. of color: a comparative practice survey. Cutis. 2007;80:387–394.
2. Gathers RC, Mahan MG. African american women, hair care, and health
Styles that can cause chemical damage barriers. J Clin Aesthet Dermatol. 2014;7(9):26-29.
3. Akintilo L; Hahn EA; Yu JMA; Patterson SSL. Health care barriers and
• Chemical relaxers: These produce permanent hair
quality of life in central centrifugal cicatricial alopecia patients. Cutis.
straightening by rearranging disulfide bonds within 102(6):427-432, 2018 Dec.
the shaft; using sodium hydroxide in lye relaxers, and 4. Dadzie OE; Salam A. Correlates of hair loss in adult women of African
guanidine hydroxide in no-lye relaxers. These often result descent in London, U.K.: findings of a cross-sectional study. British
Journal of Dermatology. 173(5):1301-4, 2015 Nov.
in irritant contact dermatitis, trichorrhexis nodosa,
5. Salam A, Dadzie O. Dermatology training in the U.K.: does it reflect
and fragile, easily-damaged hair. 10 It may be worthwhile the changing demographics of our population? Br J Dermatol. 2013
asking where the relaxer was purchased as incorrect Dec;169(6):1360-2.
formulations 11 are associated with alopecia. When used 6. The King’s Fund, How Can Dermatology Services Meet Current And
Future Patient Needs While Ensuring That Quality Of Care Is Not
improperly they can also cause local irritant contact
Compromised And That Access Is Equitable Across The UK?, 2015.
dermatitis and chemical burns to the scalp and hairline <https://kingsfund.blogs.com/health_management/2015/05/how-can-
12
that can potentially lead to a scarring alopecia. Relaxers dermatology-services-meet-current-and-future-patient-needs-while-
ensuring-that-quality-of-ca.html>
are associated with reduced cystine content consistent
7. https://blackhairmagazine.co.uk/hair/opinion-why-black-women-being-
with fragile, damaged hair. 13 vocal-is-imperative-in-driving-diversity-in-the-hair-industry
8. Textured hair care retail squeeze. Globa cosmetic industry, 2019, 187,
The use of relaxers has been steadily declining. In the US Daily newsletter, February 10
the black hair-care market has evolved to include protective 9. Mintel report. Black Haircare – US – August 2019
styling where the ends of the hair are tucked away to 10. Khumalo NP; Stone J; Gumedze F; McGrath E; Ngwanya MR; de Berker
protect against wear. 14 D.’Relaxers’ damage hair: evidence from amino acid analysis. Journal of
the American Academy of Dermatology. 62(3):402-8, 2010 Mar.
11. Swee W, Klontz KC, Lamber LA. A nationwide outbreak of alopecia
Physical examination associated with the use of a hair-relaxing formulation. Arch Dermatol
The hair and scalp should be examined under good lighting. 2000;136:1104-8
Sometimes when people attend clinic they have covered 12. Richardson V, MD, Agidi A, Eaddy A, Davis L. Ten pearls every
dermatologist should know about the appropriate use of relaxers.
their hair with wigs or hair pieces, which can affect the Journal of Cosmetic Dermatology, 16, 9--11
ability to make a full assessment. It is helpful to ask before 13. Khumalo N, Stone J, Gumedze F, McGrath E,. Ngwanya M, de Berker
the consultation that they send in good quality photographs D‘Relaxers’ damage hair: Evidence from amino acid analysis
of their hair from the vertex, parietal, occipital and frontal 14. August 2019 Mintel report
views, as mentioned earlier. 15. Salam A, Aryiku S, Dadzie O. Hair and Scalp disorders in women of
Part the hair using a wide-tooth comb, as this will be African descent: an overview. British Jornal of Dermatology (2013) 169
(Suppl 3). Pp19-32
kinder to the hair and minimise breakage. Examine the

>> Dr Ingrid Wilson is a portfolio GP and trichologist in Cheshire and has been on the Specialist Register
for Public Health since 2006. She is also director of Crewe Hair and Skin Clinic. She gained a distinction
in both years of study at the Institute of Trichologists between 2010 and 2012 and won the John
Mason Memorial prize. She is a Member of the International Association of Trichologists and affiliate
trichologist Member of The British Association Of Hair Restoration Surgery.

32 Aesthetic Medicine • June 2020