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
Scientific perspective, emotional perspective and what name to use…
On the other hand, hair loss is an important cause of discomfort and disability. The
general physician is not always aware of the significance of hair loss and therefore
may fail to refer patients with hair disorders to the dermatologist for appropriate
management. Too often a delay in correct diagnosis and the resultant delay in
initiation of appropriate therapy results in potentially irreversible loss of hair,
prolonged discomfort, and possible disfigurement.
As with any medical problem, the patient complaining of hair loss requires a
comprehensive medical and drug history, physical examination of the hair and
scalp, and appropriate laboratory evaluation to identify the cause. Dermatologic
conditions are satisfying to diagnose as most conditions are visibly present at the
time of consultation. Just looking would seem to be the simplest of diagnostic skills,
and yet its very simplicity can result in its being overlooked. To reach the level of
true artistry, looking must be a skillful active undertaking. The skill comes in
interpreting the visual signs and having made a diagnosis hunting for the cause.
The diagnostic process may be one of instantaneous recognition. The informed
look is the one most practiced by the knowledgeable dermatologist, and is a
combination of understanding, experience, and visual memory. If a visual diagnosis
is not possible, then diagnostic tests are needed in the forms of specific
dermatological examination techniques such as dermoscopy and laboratory evaluation (trichogram, biochemical investigations, microbiological studies, or scalp biopsy) as needed.
A prerequisite for delivering appropriate patient care is an understanding of the
underlying pathologic dynamics of hair loss and its potentially multitudinous
causes. By approaching the hair loss patient in a methodical way, commencing
with objects the simplest and easiest to recognize, and ascending step by step to
understanding the more complex aspects, an individualized treatment plan can be
designed. Once the diagnosis is established, appropriate treatment is likely to be
successful.
Alongside progress in clinical diagnosis and care, advances in the understanding
of hair growth biology and its pathologic conditions is being made at a high pace
thanks to the impetus of a generation of both astute clinicians and basic scientists
interested in the hair follicle, the sophistication of molecular biology, and new
technologies. Across the globe, Hair Research Societies have evolved such as the
Australasian Hair and Wool Research Society; the European Hair Research
Society; the North American Hair Research Society; the Society of Hair Research,
Japan; the Korean Hair Research Society; the Hair Research Society of India; the
Association of Professional Society of Trichologists, Moscow, Russia; and the
Ukrainian Hair Research Society. These communities of interest and of practice
regularly meet to bring together enthusiastic hair biologists and dermatologists for
the exchange and discussion of the advances in hair research and clinical practice
in the fields of genetics, molecular biology, immunology, aging, neurobiology,
psychosomatics, diagnostic techniques and technologies, pharmacology, hair
transplantation surgery, stem cells, and tissue-engineering research [24].
It was with the backdrop that in 2010 Dr. Patrick Yesudian, dermatologist practicing
in India and founder of the Hair Research Society of India, proposed the term
“dermatotrichologist” for board-certified dermatologists dealing with the scientific
study of the hair and scalp in health and disease to distinguish them from the
trichologist, who is not medically qualified and more involved with the cosmetic
aspects of hair, or – worse – could offer opportunities to imposters with a primary
commercial interest [25]. At the 2012 meeting of the Hair Research Society of India
in UNESCO world heritage site Mamallapuram, the theme of the meeting was “To
Abolish Quackery in Trichology,” and the consensus was that good medical
practice in clinical trichology aims at (from [26]):
Understanding the hair patient on an emotional level and the medical
problem on a technical level
Delivering sound patient education and effective trichologic therapy
Representing trichology as a discipline based on evidence from science,
engineering, and statistics
Setting standards of good medical practice in trichology
Supporting progress in trichology through continuous medical education
Abolishing quackery in trichology
The ultimate question that arises, however, is whether the term “trichiatrist” for
board-certified health care professionals (MDs) dealing with hair may be the yet
more appropriate designation than trichologist or dermatotrichologist, in analogy to
the term psychiatrist versus psychologist.
The term psychiatrist was originally coined by the German physician Johann
Christian Reil in 1808 [27] and literally means the “medical treatment of the soul”
(psych – “soul,” and –iatry – “medical treatment” from ancient Greek). Psychiatrists
differ from psychologists in that they are physicians and have postgraduate training
called residency in psychiatry (usually 4–5 years). The quality and stringency of
their graduate medical training is identical to that of all other medical disciplines.
Psychiatrists can therefore counsel patients, prescribe medication, conduct
physical examinations, and order laboratory tests.
Parallels may easily be drawn with the care of hair disorders, when the same
concept applies to the trichiatrist versus the trichologist, literally meaning the
“medical treatment of the hair” (trich – “hair” from ancient Greek) to designate the
strictly medical professional dealing with the hair and scalp in health and disease,
with the capacity to counsel patients, prescribe medication, conduct physical
examinations, and order pertinent laboratory tests as needed.
Furthermore, psychiatrists, more than other physicians, specialize in the
doctor–patient relationship and are trained in therapeutic communication
techniques [28, 29].
In very much the same manner, prerequisites for a successful management of hair
loss are twofold: on the technical and on the psychological level. On the technical
level, prerequisites are a specific diagnosis, a profound understanding of the
underlying pathophysiology, and the best available evidence gained from the
scientific method for clinical decision making. On the psychological level, one must
be sure that the patient’s key concerns have been directly and specifically solicited
and addressed: acknowledge the patient’s perspective on the hair loss problem,
explore patient’s expectations from treatment, and educate patients into the basics
of the hair cycle, and why patience is required for effective cosmetic recovery.
Physicians should recognize that alopecia goes well beyond the simple physical
aspects of hair loss and acknowledge the psychological impact of hair loss.
Ultimately, successful communication is the main reason for patient satisfaction
and treatment success, while failed communication is the main reason for patient
dissatisfaction, irrespective of treatment success [30].
In summary, as a trichiatrist, communication skills and treatment success require a
genuine interest in recognizing and treating hair loss with knowledgeability on the
scientific level and a genuine interest in supporting the patient complaining of hair
loss with compassion on the emotional and psychological level. Ideally, credentials
should include:
Statement of Ethics
-Medical degree and residency in a medical discipline relevant to the
management of the hair and scalp in health and disease (usually
dermatology)
– Certification of traineeship or fellowship in the scientific study of the hair and
scalp in health and disease with a syllabus expressing accountability and
commitment
– Membership in one of the Hair Research Societies or Societies of Hair
Restoration Surgery with regular participation at respective scientific
meetings
– Accredited CME in the respective professional activity
– Let’s welcome the trichiatrist to the list of tricky “trichs” in dermatology [31]!
Statement of Ethics
The authors have no ethical conflicts to disclose.
References:
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