What is known about this subject in regard to women and their families?
- Hairstylists have a unique role as they are the first people to notice or to be told about a woman’s hair loss complaints.
What is new from this article as messages for women and their families?
- The current study shows that an educational video increases a hairstylist's knowledge regarding clinical signs and symptoms of scarring alopecias, conditions that largely impact women.
Hair loss can have a significant impact on mental health and quality of life. Early detection and treatment of alopecia can help lessen the associated emotional burden and improve patient outcomes.1 Hair stylists make frequent observations of the hair and scalp of their clients and are uniquely positioned to aid in the early detection of dermatologic conditions affecting the hair and scalp. A 2018 study using an educational video was shown to increase hairdresser knowledge and confidence in detecting melanoma in clients.2
Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA) are 3 forms of inflammatory scarring alopecia that lead to permanent hair loss.3 Early detection of these conditions and referral for diagnosis and treatment are critical. The aim of the current study is to explore whether a video-based education tool aids haircare professionals in identifying early signs of inflammatory scarring alopecia.
This institutional review board-approved study included 40 participants with a mean age of 44.1 years and an average of 20.3 years’ experience in the haircare profession. All participants completed a pretest questionnaire to evaluate their knowledge of clinical signs of scarring alopecia. Participants then watched a 15-minute educational video by the supervising author on the topic of signs and symptoms of different types of scarring alopecia with an emphasis on how to identify patients who require urgent dermatologic consultation and completed a posttest questionnaire. Paired t tests were used to measure significant differences between pretest and posttest groups.
Concerning participants’ prior hair loss training, 75% reported receiving little to no education about hair loss in their cosmetology curriculum, yet 67.5% reported being asked about hair loss by their clients on a daily or weekly basis (Table 1). Before viewing the educational video, 77.5% of participants had very little or no awareness of/exposure to LPP, FFA, or CCCA. In the post-video questionnaire, the subjects reported greater confidence in their ability to identify LPP, FFA, and CCCA (P < .001) (Table 2). The posttest group showed improvements in knowledge about all aspects of hair loss, with statistically significant improvements in identifying scalp perifollicular erythema and scale as signs of scarring alopecia (50% vs 90%, P < .001).
Table 1 -
|Female sex, N, %
|Race, N, %
| Black or African American
|Age, mean (SD) [range], y
||44.1 (10.9) [23–65]
|Length of time practicing cosmetology, mean (SD) [range], y
||20.3 (10.1) [0–38]
|In cosmetology training, how much education about hair loss, N, %
| Little or none
| Very much
|How often do clients ask about hair loss?, N, %
Table 2 -
Changes in hairdressers’ scarring alopecia
||Pre-video confidence in recognizing disorder (0–4) 0 = never heard of it 4 = extremely confident
||Post-video confidence in recognizing disorder (0–4)
P value (paired t test)
|Frontal fibrosing alopecia
|Central centrifugal cicatricial alopecia
The data demonstrate that an educational video is effective in increasing hairdressers’ knowledge about the clinical signs of inflammatory scarring alopecia. Although the generalizability of these results is limited by a small sample size, this study indicates that training hairdressers in detecting scarring alopecia is a promising avenue for possible earlier detection and improved clinical outcomes.
Conflicts of interest
SA: Performance of research, writing/editing, data analysis. MC, IPW, and DH: Writing/editing, performance of research. LB: Research design, performance of research, writing/editing. JP: Research design, writing/editing, supervision. MS: Research design, writing/editing, supervision, data analysis.
1. Hunt N, McHale S. The psychological impact of alopecia. BMJ 2005;331:951–3. doi:10.1136/bmj.331.7522.951.
2. Black NR, O’Reilly GA, Pun S, Black DS, Woodley DT. Improving hairdressers’ knowledge and self-efficacy to detect scalp and neck melanoma by use of an educational video. JAMA Dermatol 2018;154:214–6. doi:10.1001/jamadermatol.2017.4267.
3. Rigopoulos D, Stamatios G, Ioannides D. Primary scarring alopecias. Curr Probl Dermatol 2015;47:76–86. doi:10.1159/000369407.