It's been just over two years since the National Occupational Standards for Hairdressing were approved – it aimed to take into account the evolving and diverse nature of the hairdressing sector and ensure that clients with all hair types are being catered for. But what about the Trichology sector? Recognising scalp and hair conditions on clients of all racial backgrounds is essential, so HJ contacted two Trichologists, Jacky van Driel-Nguene, Root Cause Clinical Trichologist and Board Advisor and Eva Proudman, Consultant Trichologist FIT IAT, to hear their thoughts.
Why is it essential for Trichologists to recognise scalp and hair conditions on all skin tones and hair types?
Jacky van Driel-Nguene, Root Cause Clinical Trichologist and Board Advisor says: It is crucial that Trichologists and Dermatologists are able to offer a good quality service to clients of any gender, racial background, skin colour, or hair type, as everybody deserves access to a healthy scalp and hair. Unfortunately, in my experience, most Dermatology and Trichology training programs are dispensed mainly with references to white or light-pigmented skin tones and straight-to-wavy hair types. When examining a client, an accurate diagnosis largely depends on the practitioner recognising clinical signs of scalp and hair conditions. This bears influence on the proposed treatment plan as well as the prognosis.
Eva Proudman, Consultant Trichologist FIT IAT says: Although diseases and disorders are fundamentally the same regardless of skin or hair tone, there are major differences in hair type and haircare, for example, Afro-textured hair curls 12 times more than Caucasian type hair as it exits the follicle. The coiling causes flattening to the cuticle making it more fragile and easier to damage and break. Different haircare practices also need to be understood and taken into account. For example, hair oiling can, in some cases, cause scalp problems and can actually leave hair in need of constant hydration, by masking the hair’s condition with oil. It’s therefore our job as Trichologists to be able to recognise this and to advise how to adopt better haircare practices. The education and qualification that the Institute of Trichologists offer covers all skin tones and hair types with clinical practice being an essential part of the training where there is a great variety of clinical cases covering the spectrum of all skin tones and hair types to ensure that when qualified you are able to offer this fully inclusive service to any patient.
Do you think there's a lack of representation in Trichology education?
Jacky: Representation is vital so that everybody can have access to Trichology services, but if you are only trained to recognise conditions on white skin tones this puts non-white, Afro-textured-haired clients at a disadvantage. Some conditions, such as central centrifugal cicatricial alopecia (CCCA) and acne keloidalis nuchae (AKN), are more prevalent in darker skin and may present differently than they do on whiter skin.
One example is erythema (redness), used as a hallmark sign in identifying inflammation on the scalp for conditions such as psoriasis, eczema, and some types of scarring alopecia (hair loss that can become permanent if left untreated) such as lichen planopilaris. This “redness” can look anything but red on darker skin tones, as the colour observed also depends on the background skin tone, often coming off as shades of purple, brown, and blue or grey hues. Despite the increasing diversity of demographics in Europe and the U.K., it is still quite common for Dermatologists and Trichologists to have almost no experience in recognising patterns and signs of diseases on darker skin.
Eva: There is a requirement to ensure that as a member of The Institute of Trichologists we continue to develop our skills with mandatory CPD hours to ensure that we keep current in an ever-changing landscape and this covers not only research but also practical clinical advice that supports an all-inclusive clinical practice. I am a member (and Fellow) of the Institute of Trichologists, International Association of Trichologists and World Trichology society and I can honestly say that in Trichology I see all skin tones and hair types represented across the world.
How can we ensure that Trichology is catering to all hair types and skin tones?
Jacky: As Telehealth services [the distribution of health-related services and information via electronic information and telecommunication technologies] gain traction, it is even more critical now that Trichologists and other healthcare practitioners have adequate competency in recognising and treating scalp and hair conditions in all skin and hair types. There are many other doctors and healthcare practitioners worldwide working towards the same goal of equality in the medical field, but it sometimes feels like one is screaming in an echo chamber. At Root Cause Clinical, we aim to empower our trichologists with the knowledge to increase their confidence in diagnosing scalp and hair conditions on all skin tones and hair types. At Root Cause Clinical provide Continuing Professional Development (CPD) training to all our associate Trichologists to ensure we are aware of racial bias.
Eva: Personally, I think there is work to be done to provide information to the public about the differences in skills and training so that they can make informed choices. I would like to see an even closer working relationship and communication between hairdressing and Trichology, with salons not afraid to refer their clients to an approved Trichologist to resolve their hair and scalp problems and to be confident that the Trichologist can work with any skin tone or hair type. I know that the three membership organisations, Institute of Trichologists, International Association of Trichologists and World Trichology Society all offer education and training that ensures that their members can offer an all-inclusive service.