Having my hairdresser as part of my support team is essential. We work together for the best possible styles and tricks.

Hairstylists play an essential role in caring for and maintaining their clients’ hair. Often times, clients rely on their hairstylists to recognize changes in their hair and scalp, which may require a referral to a dermatologist. Below are a few scalp disorders that may result in permanent hair loss and what you can do to help.

LICHEN PLANOPILARIS (LPP)

  • Who is most commonly affected? Caucasian women
  • What does it look like? Patchy or diffuse hair loss with redness and scaling around the remaining hairs; Frontal fibrosing alopecia, a variant of LPP, can result in progressive hair loss of the anterior hairline and eyebrows
  • Why does this develop? This is an autoimmune condition that results in immune cells attacking the skin and hair follicles
  • How does it feel? Asymptomatic or itching and pain may be present
  • What can you do? Referral to dermatologist for further management, including scalp biopsy and treatment, such as topical corticosteroids, scalp injections or medications by mouth.

DISSECTING FOLLICULITIS

  • Who is most commonly affected? Young adult black men
  • What does it look like?  Multiple firm nodules on the posterior scalp and nape of neck that become boggy that may drain pus with resultant patchy hair loss
  • How does it feel? Typically asymptomatic, sometimes painful
  • What can you do? Referral to dermatologist for further management, including scalp biopsy and treatment, such as oral antibiotics.

CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA (CCCA)

  • Who is most commonly affected?  Black women of African-descent
  • What does it look like? Begin with breakage concentrated at the crown then progresses to a shiny patch of hair loss that gradually expands peripherally
  • Why does this develop? While there are many theories, there is no true identified cause of CCCA. It is believed to be worsened by traction styling, including braids and sew ins. There may also be a genetic component as this can affect several family members
  • How does it feel?  Often there are no symptoms but some patient experience occasional itching and pain
  • What can you do? Referral to dermatologist for further workup, including scalp biopsy and treatment, such as topical corticosteroids.

FOLLICULITIS DECALVANS

  • Who is most commonly affected? All genders, ages, and races
  • What does it look like? Redness, crusting, and pustules around the remaining hairs; multiple hairs arising from a single follicular opening
  • How does it feel?  Itching and pain
  • What can you do?  Referral to dermatologist for further management, including scalp biopsy and treatment, such as oral antibiotics.

DISCOID LUPUS ERYTHEMATOSUS

  • Who is most commonly affected? Women of all ages and races
  • What does it look like? Circular patches of hair loss with central redness or areas of increased or decreased pigmentation; there can also be lesions inside the ears
  • Why does this develop? This is an autoimmune condition that results in scarring rash involving sun exposed skin
  • How does it feel?  Itching and pain
  • What can you do?  Referral to dermatologist for further testing. Although rare, patients with discoid lupus may also have internal organ involvement that requires medication by mouth to prevent worsening disease. Sun protection is also important for these patients.

TRACTION ALOPECIA

  • Who is most commonly affected? African-American girls and women
  • What does it look like? Patch hair loss along the hairline and temples
  • Why does it develop?  Traumatic styling, including braids, curlers, extensions; Hair loss eventually becomes permanent with excessive traction
  • How does it feel?  Mild itching and pain
  • What can you do?  Minimize heat, chemicals, and traction; referral to dermatologist if hair loss appears permanent.

Besides hairdressers being a first line of defense for awareness-  they can play a huge role in is supporting patients with their special needs:

Sensitivity to emotions:

  •  Clients are sometimes uncomfortable letting their condition be seen in a public setting. Offer a salon appointment at less busy time or in private area.
  •  Suggest hair styles that could camouflage condition

Sensitive scalp, fragile hair:

  •  Use products without sulfites or harsh ingredients.
  • Use lukewarm water for rinsing, some patients like a cold water rinse at end of treatment
  • Comb hair gently as scalp can be tender
  • Teach clients how to better care for dryness, split ends, fragile thin hair. Recommend products that might help

On-going awareness

  • As you become familiar with your client’s condition over time, tell them if you notice new signs. They can’t see the top and back of their scalp

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