Nurses' Role in Management
In addition to disease-specific treatments, several measures apply to management of all forms of cicatricial alopecia. First, in sun-exposed areas of scarring, patients should be instructed to apply a broad-spectrum sunblock (gel form) and to wear a tightly woven hat when outdoors. Second, treatment with topical minoxidil twice daily may be instituted by the physician to help thicken hairs in those with coexisting androgenetic alopecia, and to potentially prolong the growing phase in others; instructions on use should be reviewed to optimize benefit (Ross & Shapiro, 2005). Third, methods of cosmetic camouflage should be discussed to help ease the discomfort or embarrassment that patients feel who have lost their hair. These include (a) use of a partial or complete hairpiece, (b) cosmetic creams and fibers that match the hair color (c) highlighting darker hair with tones that more closely match scalp skin color so as to reduce the color contrast, and (d) alternative coiffures. Although a hairpiece is not always covered by insurance companies, a prescription from the physician for a "full scalp prosthesis" will usually avoid tax on the purchase. Significant restoration of self-esteem and confidence can result from all these measures. Provision of printed information on reputable local carriers of these products can be of tremendous help. Finally, patients should be referred to the Cicatricial Alopecia Research Foundation (C.A.R.F.) (www.carfintl. org), an excellent resource for individuals with primary cicatricial alopecia to learn more about their disease, research efforts, and upcoming patient-focused and scientific meetings on the subject. An informative medical pamphlet is also available from the foundation. An additional helpful resource is the North American Hair Research Society (www.nahrsmembers.org).
Nurses are essential team members in the delivery of care to those with hair loss. This is particularly true in the case of the primary cicatricial alopecias, as these entities require prompt diagnosis and immediate treatment if the disease is active. Most patients are unaware of the existence of these entities when they arrive for their first clinic visit, and are shocked to learn from their physician that their hair loss is permanent in nature and, if clinically active, may worsen. It is important to explain at the outset that the aim of current treatments is to stop any symptoms and signs, and to arrest progression of hair loss. It is not possible to regrow the hair that is already lost. The good news is that these conditions do not affect general health, are usually limited to the scalp, and are not contagious.
Within the time constraints of a typical general dermatology visit, nurses can help both the physician and the patient in several important ways. Nurses can facilitate accurate diagnosis by obtaining careful and directed initial histories. They can also answer the myriad questions that arise after the clinic visit with the physician is over, which may include providing more information about the general nature of their condition, correct use of their prescribed medications, camouflage methods, sun-protection measures, and referral to support services. Patients leave the office feeling shored by both the physician and nurse's efforts to help them, and their ability to cope with their hair loss is made easier.
The print version of this article was originally certified for CE (continuing education) credit. For accreditation details, please contact the publisher, Anthony J. Jannetti, Inc., East Holly Avenue Box 56, Pitman, New Jersey 08071-0056
The author would like to thank Dr. Vera Price for her thoughtful commentary and editorial review of this manuscript. Both she and Dr. Paradi Mirmirani were generous in their provision of patient photographs, without which this article would be incomplete. Lastly, the author gratefully acknowledges Dr. Jerry Shapiro for introducing her to the world of hair and scalp disorders and for his continued support and encouragement in her clinical and research endeavors.
Dermatology Nursing. 2007;19(2):137-143. © 2007 Jannetti Publications, Inc.