Medical trichology is a branch of dermatology that focuses on hair and scalp disorders. Investigation is carried out by dermatology consultants, who specialise in this area and apply a traditional medical approach based on taking a full history, examination, investigation and treatment. Treatments are focused on the best evidence available from peer-reviewed publications in up-to-date medical literature.
Both men and women can experience hair thinning with age and this may run in families. Men typically thin in the bitemporal region (either side of the head above the temples) and the crown (top of the head). These areas sometimes join to leave a horseshoe area of hair just around the sides of the head. Women often thin over the top of the head, known as the vertex, but this does not normally affect hair at the front of the head and it is unusual for them to become completely bald.
Male pattern hair loss (MPHL) is well understood and is influenced by a hormone called dihydrotestosterone, which can make the hair follicle smaller (miniaturisation) and affect the growing structure of the hair fibre. Eventually the resulting hair fibre becomes thinner and thinner until the area becomes bald.
The miniaturisation process in women is very similar but the role of hormones in this condition is less well understood.
“I had been aware of my hair thinning on the top for some time. I could see the pink of my scalp showing through and it was really affecting my confidence. I had been to a well-known clinic in London and had been using their own (rather expensive!) treatments for some time, but wanted to get an expert opinion.
Dr Farrant took a very thorough history and then examined and photographed my hair. Dr Farrant diagnosed me with female pattern hair loss and went through the different treatments that were available and the evidence behind them. It was refreshing that there was no commercial selling of products and I was shocked that I could buy a very similar product to the one that I had been using for a fraction of the cost! Dr Farrant also went through various camouflage techniques with me, which were really useful.”
Alopecia Areata is a type of hair loss that causes bald patches, usually in the scalp. It is thought to be an autoimmune condition (where the body’s immune system mistakes a part of the body as foreign). Immune (defense) cells attack the growing hair roots, causing them to become inflamed and hair to fall out. This can become more widespread and involve the entire scalp or the whole body.
“My hairdresser had noticed a couple of patches of hair loss and advised me to see my GP. She prescribed a steroid cream to use but it was pretty messy and didn’t seem to do anything. After searching on the internet I found that Dr Farrant specialised in hair conditions and booked an appointment with him. Dr Farrant diagnosed me with alopecia. He explained the nature of the condition and the latest understanding as to why patients get it. He recommended a steroid injection into the areas of hair loss and within a few weeks there was new hair growing back. I had a repeat injection after six weeks and now the area has grown completely. Having been previously dismissed, it was wonderful to see someone really interested and generous with his time.”
Occasionally, the hair follicle structure can be destroyed by inflammation or trauma to the scalp. This results in the growing structure being replaced by scar tissue and permanent hair loss. Some inflammatory skin conditions such as discoid lupus and lichen planopilaris lead to progressive scarring hair loss. An accurate diagnosis and prompt treatment is necessary to prevent further hair loss.
“My GP had initially diagnosed me as having a fungal infection of my scalp and had given me an anti-fungal shampoo. It was clear that Dr Farrant knew something more serious was going on and he told me that some of the hairs had been destroyed. He carried out a biopsy of the scalp.
The results confirmed his initial diagnosis of a condition called lichen planopilaris. I’ve been started on a strong steroid lotion and an anti-malarial tablet and all the itching has got better and the skin is less red. I know there is no chance of the hair coming back, but I know a hair expert is looking after me and hopefully we can limit this condition so it doesn’t get any worse.”