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Hair Systems vs Wigs for Scarring Alopecia: Which should I consider?

Is a hair system possible for someone with active scarring alopecia?

Scarring alopecia is a form of hair loss which can lead to permanent bald areas on the scalp. Treatments focus on helping to stop hair loss but do not improve hair in most. Some individuals elect to purchase a wig, hairpiece or hair system while receiving treatment.  For the purposes of the discussion that follows, I will specifically use the term hair system to refer to a scalp camouflaging method whereby synthetic or human hair is attached to a layer of some sort and glued to the scalp with some type of adhesive. I will use the term wig or hairpiece to include a broad array of similar products that attach via clips, tape or elastic.

Two Key factors to consider

The are quite a few factors that go into deciding what type of wig, hairpiece or hair system is appropriate for someone with scarring alopecia. The two main factors to consider when I am meeting with a patient trying to decide what type of system they should purchase are the following: 

(1) How active is the scarring alopecia right now? 

(2) Does the patient need topical steroids, steroid injections or special shampoos as part of his or her ongoing management strategy? 

 

(1) How active is the scarring alopecia right now? 

If a patient has a very active scarring alopecia (with many symptoms and/or rapid hair loss), it will be important to consider choosing a hair piece or wig with clips or tape over a hair system that is attached to the scalp with adhesive. A patient with an active scarring alopecia needs to have the scalp examined often to determine if treatment is working and to modify the exact treatment.  For some scarring alopecias like folliculitis decalvans it may be important in some cases to frequently shampoo the scalp with antibacterial agents.  An easily removable wig or hairpiece is preferred.

As the scarring alopecia becomes "quieter" it may be possible to consider  shifting to a hair system and more permanent types of adhesive-based attachments. I generally ask patients to coordinate removal of the hair system at their salon on the same day as their follow up appointment with me or if that is not possible to have good pictures taken at the salon in the day that their system is removed, washed and reapplied (generally referred to as a "servicing).

 

(2) Does the patient need topical steroids, steroid injections or special shampoos as part of his or her ongoing management strategy? 

For patients who answer yes to the above question, a wig or hairpiece will be preferred over a hair system. Topical steroids and steroid injections can be the mainstay of treatment for many patients with scarring alopecia. Even in relatively quiet scarring alopecias, topical steroids may still be needed every few days. For very active scarring alopecias, steroid injections may be needed monthly. As mentioned above under point (1), for some scarring alopecias like folliculitis decalvans it may be important in some cases to frequently shampoo the scalp with antibacterial agent. Therefore, in such cases where there is active disease, a more permanent hair system becomes either impractical or inconvenient. It needs to be removed for these treatments to be properly administered and this is not easy if a hair system is glued to the scalp. 

 

Conclusion

All in all, these are the discussions that patients will want to have with their dermatologist. If topical steroids are needed daily and steroid injections are needed monthly for example (for very active disease) use of a hair system with an adhesive is less preferred over wigs or hairpieces with clip attachments or tape. If possible, these are discussions the dermatologist might have with the wig salon itself to best coordinate the proper care of the patient .


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Options for Camouflaging Hair Loss

Camouflaging Hair Loss

Individuals with hair loss may decide to pursue medical or surgical treatment for hair loss or may decide to reduce the appearance of hair loss with a variety of scalp camouflaging agents.  Some of my patients do both.

Current camouflaging agents for hair loss include:

  • wigs and hairpieces
  • keratin fibers
  • powder cakes
  • scalp camouflaging sprays
  • scalp camouflaging lotions
  • hair extensions
  • scalp tattooing and micropigmentation

We recently published a comprehensive article about all of these scalp camouflaging agents in the Dermatology Online Journal. Our hope is that this article will provide medical professionals with helpful information so that they may in turn counsel their own patients with hair loss.

A link to our article can be found here.

 

  

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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What Everyone Needs to Know about the Hair Dye Chemical PPD

 

There have been recent reports in the news of women having serious reactions to a specific ingredient found in some hair dyes.  The ingredient is paraphenylenediamine or “PPD” for short.  Many patients have asked me about these articles appearing in various newspapers reports.

PPD is commonly found in permanent and semi-permanent hair dyes. It is used to help give a hair dye a dark color that doesn’t easily wash out.  PPD also gives hair dyes a natural, realistic color. My previous blog reviewed the topic of hair dye allergy.

Despite making the news recently, there is nothing new about allergic reactions to PPD.  It is well known that PPD can cause some sort of allergic reactions in about 5% of users. These allergic reactions vary from skin rashes & blisters (a phenomenon called allergic contact dermatitis)  to hives (a phenomenon called contact urticaria) to serious anaphylactic reactions and rarely even death.  Reactions can occur as a few days to a week or more after application of a hair dye.  These reactions tend to occur on the second, third or fourth application rather than on the very first. 

Health Canada has banned the use of PPD in cosmetic products that are applied directly to the skin.  For example, PPD is banned in black henna tattoos which are sometimes known as holiday tattoos because vacationers may have these dark richly pigmented tattoos applied while enjoying a vacation.  However, PPD is not banned in hair dyes.  PPD is allowed in hair dyes provided the product labelling contains a warning about possible allergic reactions. On its website, Health Canada states

PPD is an acceptable ingredient for use in hair dyes that are rinsed off after a maximum of 30 minutes. When used correctly, hair dye does not come directly into contact with skin for prolonged periods of time.

Allergic reactions to PPD include red skin rashes, itching, blisters, open sores, and scarring within 2 to 10 days following application. These allergic reactions may also lead to sensitivities to other products such as hair dye, sun block and some types of clothing dyes.

 

My general advice for individuals considering dyeing their hair:

1) Read the instructions on the package carefully.  If there are no instructions, don't buy the product.

2) Be sure to do a "patch test". Apply a small amount (size of a penny) to an area on the skin. An area such as behind the ear or on the forearm is a particularly good spot.

3) Let it dry.

4) If immediate redness develops, the individual may be 'irritated' by the product. This usually does not indicate an allergy. 

5) Wait 72 hours (3 days) and do another check of the area where the dye was applied.

6) If there is no reaction, then the test is said to be "negative". Individuals who have a "negative" test are unlikely to develop an allergic reaction when they use a hair dye. 

7) If the individual develops redness, scaling and/or blisters in the area where the patch test was applied, they may be truly allergic to the PPD chemical.  Use of the hair dye is not recommended. Take a picture of the reaction. Make an appointment with a physician knowledgeable about hair dye allergy to discuss further.

8) In general, semi-permanent dyes have less PPD than permanent dyes, so try to use them first to see if you can achieve your desired color.  To even further reduce your exposure to PPD, try to use  the lightest color possible. Highlights or low lights can be used too because these don't touch the scalp. Consider experimenting with natural colors, which don’t contain PPD.

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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