What is Trichology?
What does a Trichologist do?
A trichologist is someone who specializes in problems such as, itchy or flaky scalp, hair breakage and baldness.
In simpler terms, a trichologist is a ‘hair doctor’ whom you can consult instead of visiting your GP.
A lot of times people either feel that they would be wasting their time or feel too embarrassed to visit a GP for their hair and scalp issues and choose to see a hair specialist. Once you have decided to see a trichologist, you will have to go through a thorough consultation; the doctor will discuss different aspects of your lifestyle, including taking a full medical history, stress, your diet and any other external factors.
Trichologists are hair loss and scalp specialists who diagnose and treat many conditions of the hair and scalp (Trueb et al., 2018).
The best hair loss treatments for individuals or any hair loss treatments in general can be established during the process of consultation.
Who really is a Trichologist?
A certified trichologist is the member of a governing body, for example, the Trichological Society and the Institute of Trichologist. The institutes of trichologists were established over 100 years ago and are professional associations for trichologists throughout the world. Registered members use the suffix AIT, MIT or FIT after their names to indicate that they are registered members of the trichology institutes.
In addition to this, to protect patients from any negligence, the Institute of Trichologists publish a code of ethics that is expected to be abided by and practiced by all registered trichologists.
Moreover, the support, treatment approach and opinions via alternative medicines within the Institute of Trichologists differ. For this reason, it is important for each individual patient to look for a practitioner who is suitable for their hair and scalp needs.
How do you know if it’s time to see a trichologist?
There are a few obvious signs that warrant a trip to a qualified trichologist, these signs include:
• Excessive hair loss
• Hair breakage
• Hair loss in patches
• Excessive facial hair growth in women
• Loss of eye lashes or eyebrows
• Thinning of hair
• Scaly patches
• Burning scalp
• Itchy scalp
A trichologist can help you with a number of conditions, such as, dryness or excessive oiliness of the scalp, excessive breakage of hair after a chemical service, chronic dandruff, seborrhea dermatitis, psoriasis, trichotillomania and use of frequent medications.
Commonly Hair Loss Conditions
The common causes of hair loss include the following (Phillips et al., 2017):
• Androgen-Dependent Alopecia
• Alopecia Areata
• Traction Hair Loss
• Male Pattern Hair Loss
• Female Pattern Hair Loss / Hair Thinning
• Hair Loss After Pregnancy
• Menopause Hair Loss
• Teenage Hair Loss
What happens when you first see a trichologist?
If a patient presents with severe hair loss, a trichologist will firstly take a detailed patient history to find out if the cause could be systemic and may use a tool called a tricosope (on featured picture) to observe the area in question.
In some cases, they may ask the patient to have a blood test, which can highlight nutritional or hormonal discrepancies.
Once a diagnosis is reached, considering all of the above information collated during the discussion and testing, the patient will then be presented with a formal diagnosis and be given a prognosis with any treatments they recommend.
The treatment options are often topical (used directly on the scalp and hair) and if oral prescriptions are needed, they may refer the patient on to a Doctor.
Most trichologist formulate products which can be used to solve common occurrence such as itchy, dry or inflamed scalp. These conditions are often mild and improvement is rapid.
Other treatments include scalp stimulation via massage, laser or heat. and in some cases referral for hair transplants or wigs.
If a diagnosis cannot be reached, the Trichologist may refer the patient to other medical professionals for more extensive testing which could help to uncover the problem.
If the trichologist feels that your hair and scalp issues have an underlying cause, the doctor will advise you to visit your GP or dermatologist.
Different type of cures
Some conditions will only require one visit and have a quick course of treatment, this could be a case of Tinea Capitis or ringworm, where the diagnosis is very straightforward and the treatment would be oral antifungals.
On the other hand, some patients may have to work with the trichologist longer term. Especially in cases of hair loss like alopecia areata. In this case the aim of the treatment is to monitor the progression of the condition. Also try different option to at least halt or reverse it as much as possible.
The majority of patients will be able to work through their condition and achieve ‘normalcy’ with their hair. However for some, the damage may be permanent and the scalp may have sustained damage or the hair follicles will no longer produce viable hairs. In those type of cases can be referral for hair transplants or wigs.
This makes it extra important to see a Trichologist as soon as you notice any problems or have concerns with your hair.
List of conditions that a Trichologist can treat
It is difficult to make an exhaustive list of all the various conditions that fall under the scope of trichology but below are a few of the common complaints that many will present with:
- Alopecia Areata
- Androgenic Alopecia (male/female pattern balding)
- Bubble Hair
- Central Centrifugal Cicatricial Alopecia
- Chemical Burns
- Diffuse Hair Loss
- Discoid Lupus Erythematosus
- Folliculitis Decalvans
- Frontal Fibrosing Alopecia
- Hair Casts
- Lichen Planus
- Pili Annulati
- Pityriasis amiantacea
- Tinea Capitis
- Traction Alopecia
- Trichorrhexis Nodosa
- Seborrheic dermatitis
- Scarring Alopecia
- Syphilitic Alopecia
Doctors Vs Dermatologist Vs Trichologist
Doctors especially general practitioners do not spend more than a few weeks if any, on conditions concerning the hair and scalp. As they are a secondary sexual function, many doctors will often dismiss cases as it is not essential to health and does not take priority.
Understand, this does not mean that doctors are not qualified to treat these cases as they certainly are, however they usually do not have as in depth knowledge because they take a broader approach to healthcare.
Patients will be treated but may not get a thorough understanding of the cause and treatments available, as a doctor’s consultation usually lasts less than 15 minutes but with a trichologist you can usually expect to spend up to an hour taking a detailed history and clinical exclamation.
What can a dermatologist do about hair loss?
When it comes to hair loss, it is quite likely that a trichologist will have seen to a wide range of conditions of hair loss. For this reason, will have more experience.
However, a dermatologist specializes primarly in skin. It is not likely for a dermatologist to have the same kind of experience as a trichologist in diagnosing and treating hair loss conditions.
A trichologist is more familiar with patients suffering from hair loss since they come across them more regularly. If a dermatologist has previous knowledge, they will be able to diagnose certain conditions, for example, androgen dependent alopecia, however, are unlikely to successfully treat the condition of hair loss.
Should you see a trichologist or a dermatologist? What is the difference?
As mentioned earlier, trichologists are not medically qualified, however, they are specialists in the hair and scalp. Just like chiropodists who specialize in the feet but are not medically qualified.
A dermatologist is a medical doctor who specialized in skin, hair, nails and scalp – not just the hair and scalp.
Dermatologists are generally expected to deal with more serious cases such as suspected skin cancer patients within a short time. For this reason, you are likely to have to wait long if you wish to consult a dermatologist about your scalp problems. Moreover, to consult a dermatologist, you may need a referral from your GP, however, to consult a trichologist, you do not need a referral and can consult one immediately.
When seeking out help people often think that only a doctor or dermatologist will be able to help but this is not always correct.
There are a lot of similarities between a trichologist and a dermatologist as they are both focused on the skin.
A dermatologist is usually more costly and may not carry out some of the treatments a trichologist would as most are prescribed for self medication. While a dermatologist will have greater scope in the range of treatments they can offer and also the ability to arrange specialist testing, wait times and referral can be a barrier.
Saying all this, it is very common for a trichologist to refer patients back to a dermatologist or to the local general practitioner and vice versa as the three work very well in synergy and all have their specific niche.
You can decide to see any professional but it is imperative that you are able to get the required information and suitable aftercare.
How do you find a qualified trichologist?
You don’t necessarily have to have a hair problem to visit a trichologist; there are a number of people who choose to visit one because they want advice on how to keep their hair and scalp in perfect condition, moreover, to reduce the risk of hair loss. Doing this can save time and money in the long run because prevention is always better than cure.
However, the service has to be paid for, therefore, it is important that you look around for options near you and get the best deal before settling for one.
You need to make sure that the trichologist you are visiting is a member of the Institute of Trichologists. Those have the letters AIT, FIT or MIT following their name.
Trichology has been around for over 100 years and there are a few respected institutions which are tasked with training and overseeing people who want to become trichologist and holding them accountable once they do.
Based on your location you should be able to find a trichologist within a short distance as it is becoming a popular profession, but there are some strict requirements you should look for before you decide to book an appointment:
Check their credentials
A trichologist will spend at least two years studying rigorously whether it be distance learning or at a physical institution. Ask where they trained so you can check the company to see how they work.
Worldwide there are three main institutions that it’s best to see trichologist from
- World Trichology Society http://worldtrichologysociety.org/
- The Institute of Trichologists https://www.trichologists.org.uk/
- International Association of trichologist https://www.iattrichology.com/
All of the above hold trichologist to a very strict code of ethics and provide them with rigorous training. It produces a not only logical trichologist but also one with a clear moral code to work from. This preventing misconduct and insuring not only the well-being of the patient but also to keep the profession of trichology in high esteem.
What should you watch out
Check they are insured, as with all public companies, your safety is important and safety guidelines should be clearly displayed in the office.
If you decide to have a treatment or take any form of product or oral supplement, ask for the information sheet and be wary of any side effects they may have.
The consultation should be paid and not free. Most institutions will require that we charge for consultations, at first glance this may seem strange or completely financially focussed however it promotes honesty and transparency.
When free consultations are used, you can expect to pay dearly for any subsequent visits or be tied into a long lasting contract for multiple treatments. By paying upfront and for individual sessions, the patient is always in control and aware of the cost.
A good trichologist will do their best to give you a clear diagnosis and timeline of your condition(s), explaining the cause, prognosis and treatment if available.
If this is not possible, they will recommend you to other professionals who can help, but will not continue treating you just for the sake of it without any clear benefits.
It is common practise to work with doctors and dermatologists as mentioned above. But also some will have an array of surgeons and wig makers on a paid referral basis. Full disclosure should be given and there is no obligation on the patients end to use any of these services.
A good Trichologist WILL
- Be fully trained by a recognized institution and have all of the revlovent insurance and safety covers
- Spend time explaining the condition in as much detail as possible
- Be clear and open about pricing
- Only provide care when requested
- Suggest more suitable options if this falls outside their scope
- Work with other professional to promote the best outcome for the patient
- Treat all patients with the utmost respect and kindness
- Say when they are unable to reach a diagnosis
A good Trichologist WON’T
- Offer a free consultation or long contract based treatment plans
- Offer treatments for a condition that has no proven outcome
- Conduct themselves in an unprofessional manner
- Give false sense of hope or make promises in permanent hair loss cases
Summing it all up!
A trichologist can give advice to patients who wish to be referred for hair grafting or hair transplant when appropriate. For patients who want added hair, sometimes referred to as hair replacement in the form of weaving, extensions or wigs can also be guided and appropriate referrals can be offered. Moreover, a trichologist can also give advice to patients who have a habit of pulling their hair or give support, guidance and information to people who have lost their hair because of chemotherapy treatment.
In many cases, patients tend to contact their GP for hair loss and thinning and are referred to a dermatologist. Vital time is lost in this process; likewise, patients often become distressed after learning that the doctor or dermatologist cannot help. You can easily avoid unnecessary stress by getting in touch with an expert trichologist rather than lurking around different clinics.
Ohyama, M. (2010). Management of hair loss diseases. Dermatologica Sinica, 28(4), 139- 145.
Phillips, T. G., Slomiany, W. P., & Allison, R. (2017). Hair loss: common causes and treatment. American family physician, 96(6), 371-378.
Shapiro, J. (2007). Hair loss in women. New England Journal of Medicine, 357(16), 1620- 1630.
Trüeb, R. M., Vañó-Galván, S., Kopera, D., Jolliffe, V. M., Ioannides, D., Dias, M. F. R. G., … & Lee, W. S. (2018). Trichologist, Dermatotrichologist, or Trichiatrist? A Global Perspective on a Strictly Medical Discipline. Skin appendage disorders, 4(4), 202- 207.