Dear readers of this blog, as you know, our articles are related to hair problems, types, treatments, care recommendations including diet and exercise. In most of our articles we have used important references from the trichology journal and many opinions from trichologists.
For this reason, it is very important for us as a blog to publish in three parts this article prepared jointly by many prestigious specialists from different countries on trichology.
It is an enjoyable read and always leaves you with knowledge and reflection. Greetings.
A Global Perspective on a Strictly Medical Discipline
Ralph Michel Trüeb , Sergio Vañó-Galván , Daisy Kopera , Vicky ML Jolliffe , Demetrios Ioannides, Maria Fernanda Reis Gavazzoni Dias , Melanie Macpherson, Javier Ruíz Ávila, Aida Gadzhigoroeva, Julya Ovcharenko, Won-Soo Lee, Sundaram Murugusundram, Sotaro Kurata, Mimi Chang, Chuchai Tanglertsampan
History…
In 1860, a quasi-scientific interest in hair loss and hair care originated in a London barbershop under a self-styled Professor Wheeler. By1902, this interest in hair disorders became known as trichology, and the first Institute of Trichologists was founded. The International Association of Trichologists (IAT) was established in California in 1974 and offers a course by home-study for the training of students internationally who desire more knowledge about hair. Registered members can use the letters IAT after their name. Other corporations that have evolved globally are the Australian Institute of Trichology, the US Trichology Institute, the Argentine Association of Trichology (AATRI), and the World Trichology Society. Trichologists themselves are not normally medically qualified, although members of the medical profession can undertake courses and/or careers within trichology. Trichologists are not medically qualified but are taught the practice of care and treatment of the human hair and scalp in health and disease within their restricted but specialized role [13]. Nevertheless, there has been criticism regarding the ability of the public to reliably differentiate nonmedical trichologists from unqualified charlatans who monopolize publicity and proliferate in the high street, and concerns have been voiced about how to educate the public in choosing appropriate practitioners [14, 15].
The dawn of the modern age of pharmacological therapy of hair loss can be traced back to the original clinical studies performed with topical minoxidil in the 1980s [16] and with oral finasteride in the 1990s [17]. For the first time in 4′000 years of history, pharmacological agents have been scientifically proven to stop hair loss and to promote hair growth. It is the introduction of these drugs into the treatment of hair loss that has heralded the emancipation of the treatment of hair loss from its age-old tradition of quackery. With respect to the study design and criteria for efficacy and safety, the respective clinical studies have set the standards for any agent with the claim of promoting hair growth.
Although testing medical interventions for efficacy had existed since the time of Avicenna’s (980–1037) “The Canon of Medicine” in the 11th century [18], it was only in the 20th century that this effort evolved to impact almost all fields of health care and policy. In 1967, the American physician and mathematician Alvan R. Feinstein (1925–2001) published his seminal work “Clinical Judgment” [19], which together with Archie Cochrane’s (1909–1988) celebrated book “Effectiveness and Efficiency” [20] led to an increasing acceptance of clinical epidemiology and controlled studies during the 1970s and 1980s and prepared the way for the institutional development of evidence-based medicine (EBM) in the 1990s. Ultimately, EBM aims for the ideal that healthcare professionals should make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of the evidence of risks and benefits of diagnostic tests and treatments, using techniques from science, engineering, and statistics, such as the systematic review of medical literature, meta-analysis, risk-benefit analysis, and randomized controlled trials.
Nonetheless, the limited success rate of evidence based therapies points to a more important complexity of hair loss and its management. Ultimately, EBM guidelines do not remove the problem of extrapolation to different populations. Even if several top-quality studies are available, questions remain as to how far and to which populations their results may be generalized. Certain groups have been historically under-researched, such as special age groups, ethnic minorities, and people with comorbid conditions. EBM applies to groups of people, but this should not preclude clinicians from using their personal experience in deciding how to treat the individual patient at hand.
For centuries, physicians propagated the viability of a complex approach in the diagnosis and treatment of disease, while modern medicine, which boasts a wide range of diagnostic methods and variety of therapeutic procedures, stresses specification. This raises the question: How does one wholly evaluate the state of a patient who suffers from a number of diseases simultaneously, where to start from and which disease(s) require(s) primary and subsequent treatment? This crucial question remained unanswered until 1970 when Alvan R. Feinstein coined the term “comorbidity” [21], which has been defined as “presence of one or more additional diseases co-occurring with a primary disease; or the effect of such additional diseases, whereby the additional disorder may also be a behavioural or mental disorder.” The effect of comorbid pathologies on clinical implications, diagnosis, prognosis, and therapy of trichologic conditions is polyhedral and patient specific. Therefore, presence of comorbidity must be taken into account when selecting the algorithm of the diagnosis and treatment plan for any given condition, including trichologic disease [22].
Ultimately, the dermatologist participates with the other medical disciplines in the diagnosis and treatment of all types of hair problems as they may relate to systemic disease [23].
Statement of Ethics
The authors have no ethical conflicts to disclose.
References:
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