Hairy Concerns: Use of Instructional/Informational Sheets for Assistance with Disorders of Hair

Hair serves as a social sign of gender, age, status, values, and group membership. Hair is a major part of one's self-identity, and central to one's feeling of personal attractiveness. Treating a patient with hair loss and/or hair issues is not easy because of psychosocial overtones and patients' distress and body image concerns. In this paper, several common hair diseases will be discussed in consort with sample patient instructional sheets. They include trichorrhexis nodosa, telogen effluvium, pattern alopecia, alopecia areata, excess facial hair in females, and male pattern baldness. This paper therefore presents a template from which individual physicians can assess whether any portion of the material is worth being incorporated into their individual practices. Scalp hair has been endowed with greater social and psychological significance than biological importance. Medically, it merely provides some shielding from ultraviolet rays and some cushioning of the cranium from head gear. Historically and culturally, hair serves as a social sign of gender, age, status, values, and group membership. As stated previously, "from monks to skinheads, prisoners of war to warriors, bigwig European aristocrats to mop top Beatles, and hippies to head-shaven celebrity athletes, hair makes a statement whether chosen or imposed [1]". Hair is a major part of one's self-identity, and central to one's feeling of personal attractiveness. Physical appearance symbolizes one's perceptions, thoughts, feelings, and behaviors. People use this physical attribute to express one's individuality. Hair styling is a major part of one's daily grooming ritual. Quoting a psychologist, "Preparing one's hair is preparation to face one's social world. The expression 'bad hair day' is testimony to the psychological importance of hair. Hair loss can turn every day into a bad hair day [1]". Treating a patient with hair loss and/or hair issues is not easy because of psychosocial overtones and patients' distress and body image concerns. These patients often require considerable support. They need education on their condition as well as a realistic appraisal of possible treatments, length of time before resolution, and alternatives in terms of hair replacement. After discussing the 'hairy' situation, patients who remain greatly distressed and/or are totally unrealistic with expectations of magical cures, one might ask them to go to the internet or book store and research their stated hair disease as well as the topic of 'body image.' In short, for some individuals, the loss of hair represents a body image impairment which can undermine self-esteem and quality of life. *Address correspondence to this author at the University of Toledo College of Medicine, 5600 Monroe Street, Suite 106B, Sylvania, OH 43560, USA; Tel: 419-885-3403; Fax: 419-885-3401; E-mail: [email protected] In this paper, several common hair diseases will be discussed in consort with sample patient instructional sheets. This paper therefore presents a template from which individual physicians can assess whether any portion of the material is worth being incorporated into their individual practices. One option is to allow patients time to read the informational sheet after completing the history and physical, and therefore, before outlining the treatment program. TRICHORRHEXIS NODOSA Unlike most physical characteristics, hair can be altered and manipulated to the dictates of culture and fashion. The chemical reactions from coloring, perming, and straightening hair affect the normal structure of the hair shaft. Many hair cosmetics are used without any visual effects on the integrity of hair, they nonetheless cause microscopic weathering rendering the hair structure weaker and more prone to breakage. When hair breakage occurs with visible hair loss, the term that is utilized is ‘trichorrhexis nodosa [2]’. The trichorrhexis nodosa sheet (informational sheet 1) is very informative as patients with this entity often question the validity of this disease entity. Hair styling and hair cosmetic habits are hard to change, but after reading through this synopsis, my patients are more receptive to considering altering their hair style and using fewer chemicals.