Do you know how to recommend a wig to your patient?

Dr Daniel Fernandes Melo

Dermatologist, Professor of Trichology at Federal University of Rio de Janeiro (UERJ), Brazil

Commentary

Nowadays, this apparently simple question is extremely important to help doctors, especially those who care for patients with hair loss complaints. Currently, patients see dermatologists as the real experts in scalp diseases but also as those responsible for aesthetic care with hair shaft. Patients with alopecia areata, scarring alopecia or even those who are using chemotherapy seek advice from their dermatologists. Therefore, the number of appointments is increasing in order to address indications and care with hair prostheses.

Introduction

Throughout history, wigs have often had a relevant cultural and social importance with correlations to wealth and position of power. Wigs help minimize the psychological consequences of different types of hair loss. They may reduce potential experiences of stigmatization, and improve social confidence and quality of life, besides enhancing self-esteem and social adjustment. In dermatology, wigs may have a positive impact on the global treatment of patients suffering from alopecia as they offer an immediate and efficient cosmetic result. However, the medical literature on wigs is not extensive.

This review aims to discuss synthetic wigs and no synthetic custom-made hair systems, highlighting different hair fibers, foundations, various types of prosthesis, and the most common methods of attachments used to make wigs.

Discussion

• Type of hair fibers

  Synthetic hair is manufactured from several fibers, including nylon acetate, and dynel. All of them are available in a wide array of colors and textures. Wigs made of synthetic fibers are long-lasting, less expensive, and easy to maintain. They are less prone to environmental factors such as rain, wind, and sun exposure. The main disadvantages of this type of wig include its unnatural look, the impossibility to style and to expose to high temperatures, like heat caused by hairdryers.

  Wigs made of human hair fibers provide a more natural appearance because of the gradual variation in color and fiber diameter. These products behave like natural hair, so they can be styled, colored, permed, and withstand high temperatures. Some disadvantages of human hair wigs include higher cost, more susceptibility to sunlight fading, and environmental damage. They also require styling and constant maintenance.

• Types of foundation

  The wig foundation or the wig "cap" is the base where the hair is fixed to apply to the patient. It can be shaped to cover the patient’s entire head or just an alopecic area. It can be made of different materials, and usually tries to simulate the scalp. It influences the hair density, the possibilities of fixation, and the natural appearance of the scalp. The main types of foundations are skin wig (made with durable materials, which provide a natural look and a long-lasting wig), net (made of a delicate mesh base with synthetic or human hair knotted by hand that can naturally camouflage with the scalp) and lace (made of a fine, transparent nylon material. Hair shafts are individually hand tied, allowing for more natural hair movement and styling flexibility).

• Types of prosthesis

  Hair system (Full cap) is a custom-made hair system designed for greater naturalness and comfort. They are made of real hair and covers the entire scalp, also called full cap. These products are suitable for patients with various types and degrees of alopecias, who request for a more natural look, virtually undetectable cranial prosthesis.

  Partial hair systems (Hairpieces) include many types of hairpieces, depending on the patient's needs and the extension of the alopecia. They are mainly designed to cover localized areas of hair loss.

  A demiwig is a hairpiece designed to cover the entire scalp except for the frontal hairline. It is a suitable option for patients with apical hair loss, as it covers just the top of the scalp. It can increase the volume and the length of hair in patients with a preserved frontal hairline.

  A toupee is a type of demiwig designed especially for male patients with androgenetic alopecia to cover the top of the scalp. It can be shaped to fit any localized hair loss as patchy alopecia.

  Lace front wigs place a lace material across the frontal hairline. Lace piece is trimmed and can be temporarily glued to the frontal scalp and/or forehead to achieve a more secure hold. It is particularly helpful for FFA patients.

  Hair integration systems are an option for patients with hair thinning, but not severe hair loss. This system integrates the patient’s hair with synthetic or natural human hair fibers that match one´s hair to add more density in the bald area. The patient wears the hair integration system over the affected area of the scalp and pulls existing hair through the fenestrations in the net. The hairpiece can be securely affixed to the scalp, allowing a natural appearance.

  Hair extensions are usually mixed strips of hair attached to the patient’s hair. They are designed to add more volume or length, and can be clipped, glued, or sewn. Hair extensions may cause extra traction on the existing hair follicles and lead to traction alopecia.

• Methods of attachment

  Some wigs have Velcro adjustable straps or an adjustable band in their perimeter to attach them to the scalp.  Newer hair systems use adhesion on the entire area of attachment to the base, allowing a steadier fixation, which is important for patient's confidence when wearing the wig.

  If a hair system that can be temporarily attached and removed is required, the use of clips would be suitable. The major advantage of using this method is that patients can maintain their treatment while using wigs. The disadvantage of this method is that clips require some hair to adhere to or clip on, and it may cause traction alopecia or hair breakage.

  Bonds or tapes are method of attachment indicated for those people who require their cranial prosthesis to adhere for longer periods. Bonds or adhesive tapes are used to fix wigs or hairpieces to the scalp, designed to be worn continuously while sleeping, showering, and practicing sports. Users feel those wigs like part of their own scalp. Bonding and taping may lead to contact dermatitis, especially from adhesives that contain cyanoacrylate. For patients suspected of allergy to glues, patch testing with specific allergens is indicated to prevent contact dermatitis. Another possible adverse effect of using glue is that it may cause hair loss because of traction and hair breakage.

  The most expensive types of wigs are custom-made ones with vacuum bases. The vacuum base is first made by creating a custom plaster mold of the individual’s scalp. The mold is used to form a silicone or polyurethane vacuum base, a process that can take long periods to be done properly. This prosthesis fits snugly on the scalp and does not need another form of adhesive for fixation.

Conclusion

Wigs may have a positive impact on the global treatment of patients suffering from alopecia, mainly in the psychological aspect. They offer an immediate and efficient cosmetic result and represent a relevant part of the treatment of various conditions that present with hair loss. This article discussed and detailed the most relevant topics of wigs, such as type of hair fiber, type of foundation, types of prosthesis, and methods of attachment. Physicians, especially those who care for patients with hair loss, should be aware of the wide variety and peculiarities of wigs and hairpieces currently available. This knowledge would be useful to provide appropriate advice for their patients as well as refer them to prosthetic professionals when needed.