LOSS assessors

With many female clients experiencing hair loss for a variety of reasons, we asked some trichologists how to handle the issue in the salon

Women tend to lose around 100-125 hairs per day, which is entirely normal, but some find themselves shedding more than this.

So if you have a client who is experiencing a worrying level of hair loss, it's important to know how to help them, and when it's time to consult a trichologist, who has the appropriate expertise in this area.

“Trichology is the scientific study of the structure, function and diseases of human hair,” explains Liam Byrne, a trichologist at Robert Byrne Hairdressing in Navan, Co Meath. “It comes from the Greek word ‘trikhos’, meaning hair, and the suffix ‘ology’, meaning the study of. As a trichologist, I diagnose and treat disorders and diseases of the scalp and hair.”

Byrne became a member of the Institute of Trichologists (IOT) in Ireland in 1987, when very little was known about the speciality. “For many years, no one had any idea what a trichologist was, however, helped by the internet, these days nearly everyone is aware of what we do,” he says.

Covid effect

The pandemic also helped shine a light on hair loss and the role of trichologists.

“During the first wave of Covid-19, a very high percentage of people who contracted Covid with the typical symptoms did suffer hair loss,” says Byrne. “This hair loss was very severe for those who became very ill. Thankfully, for the vast majority of sufferers, this hair loss was temporary and it has regrown. I have noticed since the vaccinations, the severity of illness is less, and the number of people suffering post-Covid hair loss has greatly diminished.”

“I think since the pandemic, hair loss has become a subject that people talk about more,” says Michelle Christle, stylist and trichologist at Cheveux Hair Salon in Tullamore, Co Offaly, which runs a hair loss and scalp clinic. Christle did her training with TrichoCare Education in the UK four years ago. “During the various lockdowns, a lot of people were stressed or ill, and many experienced temporary hair shedding. With salons closed during this time, everyone went online to find out more about the condition, which opened the market for products to help with hair loss issues.”

Of course hairdressers are in a unique position to be among the first to notice a client's hair loss, or indeed be the person a client initially confides in about their concerns.

“Most of my referrals come from hairdressers who have recommended their clients to come and see me,” says Byrne. “I also get referrals from doctors, but in general hairdressers are the first to alert their clients to any changes in their hair or scalp because they are so familiar with them.”

“With certain types of alopecia, I would have clients coming to me for a correct diagnosis, but it would have been their hairdresser that noticed the issue first,” says Christle. “Other types of hair loss are harder to spot, and can be genetic, but the client would have initially mentioned their thinning hair concerns to their hairdresser.”

Hair loss causes

While there are many causes of female hair loss, the most common is telogen effluvium, which leads to temporary hair loss due to the excessive shedding of resting or telogen hair after some shock to the system. “It can can be triggered by childbirth, weight loss associated with crash diets, medication, endocrine abnormalities, nutritional disturbances or a stressful episode,” says Byrne.

“Telogen effluvium can be defined by heavy or sudden shedding, which is very frightening for the client,” notes Christle. “They can find hair on their clothes, in the shower and in their hair brush. It’s very disturbing, but it generally rectifies itself once the trigger is established. The hair loss usually happens three months after the trigger occurred, so the client often doesn't make the connection.”

Meanwhile, among the most common types of hair loss in post-menopausal women is female patterned hair loss (FPHL), according to Byrne. “In fact, four out of 10 post-menopausal women will experience FPHL. One type of hair loss that has grown exponentially over the last number of years is a scarring hair loss called frontal fibrosing alopecia (FFA). FFA was in the past regarded as a postmenopausal hair loss, but this is no longer the case.

Trichologist referral

So when should a stylist refer a client to a trichologist? “If a client has noticed they are losing hair and the stylist knows that they have recently had a baby, or a bereavement or went on a strict diet for a special occasion, the stylist can reassure their client that, in most cases, their hair loss is self-limiting and should stop after three months on average,” explains Byrne. “But if it continues falling out after that, then it is time to refer them to a registered trichologist, particularly if there are other changes in their hair and scalp, such as eyebrow hair loss and receding of the frontal hair line.”

“The first thing to check is how long has the client been losing hair,” says Christle. “You should recommend they see a trichologist if they have hair loss patches; there's aggressive shedding, along with eyebrow hair loss from the outer edges of the eyebrows; if they feel burning or crawling sensations on their scalp; or they have nail issues, such as dents.”

Once the client attends a trichologist, a thorough consultation is the next step. “During this time the client outlines the nature of their problem,” explains Byrne. “We go through a relevant medical history, and examination of the hair and scalp. I should then be in a position to make an initial diagnosis, but sometimes may need to refer the patient back to their GP for blood tests to confirm my diagnosis. I then educate the client about their condition, and recommend treatment if necessary. If appropriate, I will refer them on to a dermatologist. We also do follow-up reviews to make sure the client is progressing as expected.”

“We check the ingredients in any products that the client may be using on their hair,” says Christle. “And we do a microscopy, which is a in-depth examination of the hair follicles under a microscope camera. While the majority of the time, the issue can be resolved by a trichologist, sometimes further investigations, such as a scalp biopsy by a dermatologist, may need to be done.”

Byrne says that ongoing training is hugely important to the profession. “As a registered trichologist, one of the most important aspects of the service I provide is knowledge. As a registered member of the IOT, I must do continuous professional development in order to maintain my membership. This means I am constantly updating my knowledge and can therefore give the client the most up-todate information about their condition and recommend the best course of treatment available. Over the years, I have built up a network of healthcare professionals with an interest in hair.”

Trichologist tips

Meanwhile, when it comes to promoting hair and scalp health, are there any dos and don'ts that clients should be aware of? “They should avoid using hair tools with high temperatures,” says Byrne. “Most tools now allow you to to control the heat settings and I always advise that 180°C should be the maximum setting, and this should be lower for chemically-treated hair.”

“They should never use elastic bands, or hair bobbins made out of plastic material, to tie their hair up as they cause friction and, in turn, damage,” says Christle. “Neither should they tie their hair up in very tight ponytails, as this leads to traction alopecia and can cause permanent hair loss on the hairline. They should also refrain from tying hair up when it's wet as this leads to breakage because the hair fibres are at their weakest when they're wet.”

Having a balanced diet and lifestyle is crucial, adds Byrne. “The hair cells are the second fastest dividing cells in your body and therefore respond very quickly to changes in your general health and wellness. As a student, it was drummed into me that your hair is a barometer of your wellbeing, and this still holds true today.”

‘For many years, no one had any idea what a trichologist was, however, helped by the internet, these days nearly everyone is aware of what we do’