This article was written by Dr Ingrid Wilson, a portfolio GP in Cheshire and a Trichologist. She is the Director of Crewe Hair and Skin Clinic.
Trichology is the name given to the study and practice concerned with the hair and scalp. It owes its origin to the ancient Greek word ‘thrix;’ which means hair.
In 1860 a semi-scientific interest in hair loss and hair care originated in a London barbershop under a self styled Professor Wheeler. By 1902 this interest in hair disorders became known as Trichology, and the first Institute of trichologists was founded (1).
Over the next few decades the branch started gaining momentum and in 1974 the first trichology course was developed at the University of Southern California under the tutelage of David Salinger, an office bearer of the Institute of Trichologists and the newly formed International Association of Trichologists. Both of these institutions are still active in education.
The International Association of Trichologists allows people trained by the Institute of Trichologists to be listed as one of their members.
What is The Difference Between Trichology and Dermatology?
The meaningful difference is in the routes into working in the field of dermatology and trichology.
Dermatology includes the study of skin, hair and nails. In the UK it is accepted that this is mainly done by doctors and nurses. The majority of dermatology practice in the UK involves the skin. Trichology includes the study of hair (and scalp) only.
A consultant dermatologist in the UK is a doctor specialising in dermatology. Consultant dermatologists will have completed at least 5 years of undergraduate training in Medical School, following competitive selection requiring high grade A levels. They will be able to prescribe and like all doctors their practice is regulated tightly.
In the UK, to become a consultant dermatologist (referred to elsewhere in the world as Board certified dermatologist) following the medical degree the doctor will become then complete a two-year foundation programme and then two or three years or more of core training. Successful completion of the training programme means that the doctor’s name can be entered on the Specialist Register of the General Medical Council which regulates all doctors. Entry to the speciality of dermatology is competitive, so some doctors may have additional experience in related areas genitourinary medicine, rheumatology, medical oncology and immunology.
Because of the comprehensiveness of the dermatologist’s training they are able to participate with other medical disciplines in the diagnosis and treatment of all types of hair problems as they may relate to systemic disease e.g. lupus. They are trained to recognise a much wider range of conditions than trichologists. They can take biopsies (skin samples) from the scalp to help diagnose the more challenging hair loss conditions. In addition, they are able to prescribe some medications that General Practitioners can’t e.g. Hydroxychloroquine for a hair loss condition called Lichen Planopilaris.
In the UK, dermatology is included in the syllabus at medical school where doctors complete their basic training. However a Kings Fund study published in 2013 indicated that the majority of GPs receive less than one week’s training before they qualify (2). The study of hair and scalp disorders would have only formed a small part of this. The majority of that training is likely to have taken place in medical school.
Is a Trichologist a Doctor?
In the majority of cases in the UK no. There are a handful of exceptions though.
The term Trichologist is not a protected term in the way a Doctor is. This means that it is possible for someone to call themselves a trichologist with no or minimal training. For public safety it is important to understand the difference because a doctor is trained over many years to take a comprehensive medical history including how the problem evolved, associated symptoms, drug history, family history and social history. The follow up questions asked and advice given are informed by that training.
Entry into the field of Trichology has significantly different requirements to becoming a dermatologist as described above. The entry criteria for training is significantly different. E.g. The February 2019 prospectus of the Institute of Trichologists programme, the largest UK training provider, the entry criteria states “Applicants should ideally be educated to ‘A’ level standard or higher and should have specific interests in scientific and health related subjects. The Institute of Trichologists may consider mature applicants who do not fully meet the educational entry requirements but who have gained significant relevant transferrable skills in the workplace and can demonstrate an aptitude for the profession.” Entry is at the discretion of the board of governors.
In some countries such as India where Trichology is mainly practised by dermatologists, the difficulty for members of the public distinguishing between a dermatologist and non-medically qualified trichologist has been noted as a cause for concern. In 2010 Dr Patrick Yesudian, a 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 (3) rather than with medical professionalism.
A new term ‘trichiatrist’ was proposed, literally meaning the ‘medical treatment of the hair ‘to designate the strictly medical professional dealing with the hair and scalp in health and disease.
In the UK, Trichologists are not usually medically qualified, although members of the medical profession can undertake courses and/or careers in Trichology. I understand that in the UK a handful of doctors have gone through training with the Institute of Trichologists, including myself. At the moment in the UK, there are 4 main institutions providing training. These are:
- The Institute of Trichologists. The Institute offers a two year distance learning and clinical practice course. From January 2021 a new introductory 6 month course will start which involves home study and an assessment www.trichologists.org.uk
- The Trichological Society. The Society provides distance learning trichology courses to dedicated students from medical and non-medical backgrounds. www.hairscientists.org
- The International Association of Trichologists runs an online course which covers areas including hair loss, nutrition, chemistry etc. For further detail: https://www.iattrichology.com/trichology-certificate-course
- TrichoCare offers two courses in trichology:
- Introduction to Trichology, a CPD course studied completely online.
- Level 4 Certificate in Trichology for Hairdressers is a one year Ofqual Certified iTEC course studied through distance learning, clinical observation, practical and theory examination. www.trichocare.co.uk
Of all the training providers only the Trichocare coure is iTEC and Ofqual recognised. None of the trichology qualifications are accredited as degree level courses or recognised within the National Health Service.
Compared to training to become a doctor, the amount of time taken in learning how to take a history and clinical examination is minimal. Some courses include what they describe as ‘clinical’ training which usually involves administering trichological treatments.
Additional information
All doctors are required to participate in annual appraisal which includes their providing evidence that they are up to date and fit to practice in the area in which they provide their services.
This requires an appraiser meeting with the doctor to have a focussed discussion on their learning, how it improves their practice. There has to be at least 50 hours of Continuing Professional Development each year which is evidenced by the doctor’s reflections on what they have learned. There has to be evidence of reflection and quality improvement, so a certificate of attendance for a meeting is not enough. Trichologists are not mandated to do this at present although the Institute of Trichologists has introduced a Continuing Professional Development (CPD) scheme. Their members are encouraged to attend organised member-only events to update their knowledge on the recent research and extend their knowledge-base, and to keep their practice up to date with current trichological and business issues.
The International Association of Trichologists regularly updates its members with journal articles and webinars to help keep members up to date. It recognises the qualification from the Institute of Trichologists.
What is The Difference Between Trichology and Hairdressing?
For both trichology and hairdressing there are no mandatory qualifications required to practice.
However, trichologists are taught the practice of care and treatment of the human hair and scalp in health and disease within the restricted but specialised role.
And while many trichologists come from a hairdressing background, the role of a hairdresser is hugely based on aesthetics such as cutting, styling and colouring hair.
Trichologists generally will have received training will cover the causes alopecia (hair loss), bald patches, dry or excessively greasy hair, head lice, hair breakage and scaly, flaking, greasy or itching scalps.
How Can a Trichologist Help You?
- Some trichologists supply patients with hair and scalp care products, such as medicated shampoos and conditioners, as part of the treatment process. They also provide information, practical advice and guidance about hair and scalp health, and some offer related services such as Indian head massage.
- Some trichologists may offer advice on how to camouflage hair loss with cosmetic products. Some trichologists fit hair extensions and weaves, make and supply wigs, and act as expert witnesses, for example in relation to court cases alleging hairdressing.
- Some trichologists offer scalp micropigmentation. Although it has its place, for earlier forms of hair loss a variety of approaches can help with slowing down the progression of hair loss and improving the density of the hair that is there. A minority of clinics such as mine offer Platelet Rich Plasma – so I think its main role is for advanced hair loss where someone does not wish to have a hair transplant.
When Should You See a Trichologist?
Having experienced Trichology training and GP training, I am aware of the different resources and training available, I would always recommend that if someone is concerned about the cause of their hair loss, and they don’t think it is simple balding, they should see their GP first.
The GP is in the best position to request and interpret blood tests, they can refer to a dermatologist in the NHS if necessary particularly for forms of hair loss that may be permanent and they can prescribe for some hair loss conditions.
People will seek out the services of a trichologist for a variety of reasons including scaling scalp and hair loss. Particularly during this time of social distancing people may consider this if reluctant to attend the GP.
- Time. I believe the greatest value the trichologist is able to give is time. A typical initial consultation with a trichologist is between 30-60 minutes. Hair loss can be devastating, and the typical 10 minute GP consultation does not allow enough time to discuss the full psychological impact of hair loss and hair shedding. However, given that the majority of GPs receive less than one week’s training in dermatology before they qualify – of which hair is a small part, there have been occasions where trichologists have been able to suggest a likely diagnosis that a GP may not have even heard of. An example of this is CCCA (Central Centrifugal Cicatricial Alopecia) which is the commonest cause of hair loss in women of African descent which needs a referral to a dermatologist.
- Itchy scalp. Some patients may have continually itching scalp and may approach a trichologist after having seen a GP without perhaps realising that there may be alternative treatments available. Some trichology clinics recommend their specialist shampoos or recommend specific shampoos that can be purchased from Pharmacists.
- Scaling scalp. Due to seborrheic dermatitis, psoriasis or eczema. There are a range of medications a GP can prescribe. However the trichologist may offer medicated shampoos or in-clinic treatments.
- Traction alopecia. This is hair loss due to excessively tight/pulling hair styles. It is more common in women of African descent. If caught early it is reversible. A trichologist may examine and confirm the diagnosis. Please see www.crewehairandskinclinic.uk/traction-alopecia for more information on what can be done.
- Balding. This is the type of hair loss in men and women that is due to age, sex and genetics. Trichologists will recommend Regaine (Minoxidil), but are not able to prescribe for other types of hair loss. At my clinic the TrichoTest has been introduced which allows personalised treatment recommendations for balding, alopecia areata and telogen effluvium.
What Can You Expect During a Consultation?
Before lockdown, I saw all patients for their initial consultation face to face. However as virtual consultation has become the new norm, my consultation model has changed to accommodate that.
All bookings are paid for in advance on-line via the website. There is a discounted price while social distancing is in place due to Covid-19 social distancing until the clinic re-opens physically on July 4th.
There is no charge for follow up appointments as long as the appointment is attended within one year of the initial consultation.
Once the booking has been confirmed, I send a short questionnaire which will cover some of the areas in the consultation. Follow up phone calls and face to face appointments are included within the fee so that the hair and scalp can be physically examined. I tend to use a microscope; assessment of the texture of the hair, and how easily the hair comes away from the scalp.
- Before the consultation I ask that patients send me good quality photographs of the front, sides back and top of the head before the consultation. These photos are saved in their electronic record, and are helpful for monitoring progress.
- I ask for details of their medical history, products used and supplements in a questionnaire emailed to the patient before the consultation.
- I ask for photographic ID and proof of address for verification and in case a prescription may be needed.
- A consultation then takes place via video call, where I find out detail about the history of the hair loss, history of hair shedding, associated symptoms, past medical history, drug history, family history, hair care practices, nutrition and other lifestyle factors.
- If people have a summary printout from their GP, I ask them to share it as it will have important diagnoses and the results of blood tests.
- If I think that the likely issue is balding, alopecia areata or telogen effluvium, I will suggest that the patient has a TrichoTest. This is a DNA test which looks at your genetic profile to determine which forms of treatment are more likely to work for you so that time is not wasted on treatments that are not likely to work. The clinic can then supply specialised products for topical use.
How Do I Find a Certified Trichologist?
There are several listings of Trichologists – but it is important to remember their career pathway, the limitations of what they can offer (for non prescribers) and those without medical qualifications are not regulated.
In seeking out the services of a trichologist as a potential patient it is worth looking for evidence of how they are keeping up to date in their field. This might be seen through membership of certain organisations, attending conferences on hair related subjects or writing about topical issues in hair in blogs or published media.
- British Association of Hair Restoration Surgery. Affiliate trichologist membership.
- International Association of Trichologists. Includes those members who have completed Training with the Institute of Trichologists.
- The Trichological Society. Includes trichologists who trained with them only
- The Association of Registered Trichologists
- British Hair and Nail Society. Dermatologists who specialise in hair and nail and work in the NHS are listed, here.
References:
1. Trueb RM; Vano-Galvan S; Kopera D; Jolliffe VML; Ioannides D; Gavazzoni Dias MFR; Macpherson M; Ruiz Avila J; Gadzhigoroeva A; Ovcharenko J; Lee WS; Murugusundram S; Kurata S; Chang M; Tanglertsampan C. Trichologist, Dermatotrichologist, or Trichiatrist? A Global Perspective on a Strictly Medical Discipline. Skin Appendage Disorders. 4(4):202-207, 2018 Oct.
2. The King’s Fund, How Can Dermatology Services Meet Current And Future Patient Needs While Ensuring That Quality Of Care Is Not Compromised And That Access Is Equitable Across The UK?, 2015. https://kingsfund.blogs.com/health_management/2015/05/how-can-dermatology-services-meet-current-and-future-patient-needs-while-ensuring-that-quality-of-ca.html
3. Yesudian P: Hair specialist, trichologist or dermato-trichologist? Int J Trichology 2010;2: 121.
About Dr Wilson
Dr Wilson is a portfolio GP in Cheshire and a Trichologist. She is the Director of Crewe Hair and Skin Clinic.
She completed her medical training in Liverpool, qualified as a General Practitioner in 1999, and qualified as a Consultant in Public Health Medicine in 2006. She has a Masters in Public Health and is a Fellow of the Faculty of Public Health.
Having had personal experience of hair loss she was struck by how little training GPs received in diagnosing and treating hair loss, and was aware that some hair loss conditions were more commonly experienced in black people. She struggled to find a suitable course for GPs. She decided therefore to study trichology with the Institute of Trichologists between 2010 and 2012. She gained a distinction in both years and won the John Mason Memorial prize. Upon completing the course she realised that there was a need to better connect the diagnostic, prescribing and referral resources available for hair loss by GPs and connect it with customers’ cosmetic hair care needs though camouflage and wigs. As a black woman she was aware that there was a need to create an environment that was sympathetic to their specific hair care needs and was able to give people the best chance of slowing down the progression of hair loss at an early stage.
She took voluntary redundancy from her Public Health consultant post in 2012 and since then has been working towards building her clinic while continuing as a part-time GP.
She is very aware that there are gaps in the NHS to help people tackle hair loss medically without resorting to surgery – particularly for black women. Her clinic also caters for people with cosmetic skin care concerns including unwanted hair acne, pigmentation and ageing. The clinic uses home care programmes, electrolysis and skin camouflage.
She has written articles on hair loss for a number of publications and holds memberships at:
- British Hair and Nail Society
- Affiliate Trichologist Member: British Association of Hair Restoration Surgery
- Member of the International Association of Trichologists
- Member of the Society of Cosmetic Scientists
- Medical Member of The Trichological Society
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