Dr Ingrid Wilson is an experienced GP who specialises in hair and skin conditions and is also a trichologist. Her practice, Crewe Hair and Skin Clinic, provides an oasis of high tech solutions for skin and hair problems. I was fascinated to hear about a new test for alopecia that she’s offering called TrichoTest. Using your DNA profile (obtained from a simple swab) it can provide the most likely roadmap to support your hair regrowth. This means that you don’t waste time, money and effort pursuing solutions that are unlikely to help you. I had some questions for Dr Wilson about this new technology.
Does TrichoTest work for everyone regardless of age and sex?
That’s a very good question.
The information from the company indicates that it can be used by everyone regardless of age, gender or race. I would only offer it to over 18s in the clinic though for reasons of informed consent.
There is a very helpful frequently asked questions section on the Fagron TrichoTest website which also provides a lot of helpful background information about the test https://fagrontrichotest.co.uk/faqs/
The test has been widely used across the world, including parts of Europe, the USA and Africa. It came to the UK in the autumn of 2019.
My son was first diagnosed in 2016 although he wasn’t offered any test for alopecia at that time. I think that he could potentially have avoided losing all of his hair if this test for alopecia had been available then. For example, he experienced no regrowth at all using Minoxidil, and when we were chatting you mentioned that Minoxidil will only work for 40% of people with hair loss. How can this test help both these groups of people?
The main way that Minoxidil works is by prolonging the growth phase of the hair. Topical minoxidil, which is available over the counter as Regaine is the mainstay treatment for androgenetic alopecia (balding in men and women) and is also used as an off-label treatment for other hair loss conditions such as traction alopecia. Despite its widespread application, the exact mechanism of action of minoxidil is still not fully understood.
In the past, without the test I would advise appropriate people to try Minoxidil for at least 6 months, and to give up if there is no improvement after one year. They can buy it over the counter – and there is a lovely version produced by the compounding Pharmacy I work with that supplies Minoxidil in a really pleasant foam called Foamil which supports hair growth.
I find that sometimes people give up on Minoxidil too early because they experience excess hair shedding at around the 4th month – which ironically is actually a good sign because it is transient and actually leads to better results overall!
With the Trichotest some time can be saved because it will identify whether there are alternatives to Minoxidil which are likely to be more effective based on the genetic profile.
The positive effect of Minoxidil on hair growth is mainly due to its metabolite, minoxidil sulfate, and the enzyme responsible for this conversion is sulfotransferase, which is located in hair follicles and varies in production among individuals. There are two phenol sulfotransferases responsible for minoxidil sulfation in the human scalp, and patients with higher enzyme activity respond better to topical minoxidil than those with lower enzyme activity do.
Sulfotransferase activity is one of the areas looked at in the test. However what is even more exciting is that the enzyme can actually be upregulated by a short course of topical tretinoin. Tretinoin is a prescription only medicine and cannot be used in pregnant or breastfeeding women.
I am pleased to say that I shared this research finding with the company when I first started doing the test at the clinic earlier on in the year, and they now incorporate this into their treatment algorithms. I had heard about this exciting finding at different professional conferences to do with hair over the past year: one aimed at dermatologists and one aimed at hair restoration surgeons. (St Johns Dermacademy Alopecia Masterclass and the British Association of Hair Restoration Surgery event).
When is the best time for a client to take this test for alopecia? For example, at the first hint of hair loss or after a few months when the hair loss is really visible?
It is best to do this as early as possible. This is because overall the treatments work better if started at an early stage. Your genetics are not going to change, but the appearance of your hair will if nothing is done about it.
What do you see as the main advantage of this type of DNA test for alopecia over other methods of obtaining a diagnosis (for example, a biopsy).
DNA testing should be seen as a part of the assessment of certain hair disorders. I strongly believe that it needs to take place alongside a full assessment. When I assess a hair loss patient as well as the online questionnaire that needs to be completed for the test, I ask more questions as these may have a bearing on the advice I give after the consultation.
This test is best for those with the potentially reversible and treatable disorders: androgenetic alopecia (balding), alopecia areata and telogen effluvium. As Minoxidil can be used in other conditions such as traction alopecia – patients may want to weigh up whether they want to know whether Minoxidil is likely to work for them based on their genetic profile.
I have learned that the test cannot be done in isolation. A comprehensive history needs to be taken to provide context to interpreting the result.
I am aware that some trichology clinics offer it, but the majority of trichology clinics do not have a prescriber. As the prescriber I take responsibility for the prescription and have found that it has been really important that I have undertaken a detailed assessment with the patient before recommending a prescription. Sometimes issues have been identified during the consultation which may not necessarily have been identified by the online questionnaire.
The DNA testing is pretty straightforward to do, and non invasive. The hardest thing is the wait of 2-4 weeks for the result, and then reading the detailed report that comes back! I write to the patient with a summary of the main findings.
A scalp biopsy is not something I offer at the clinic, although I was actually taught how to do it by a dermatologist at a supervised approved hair clinic session at a hospital. It is invasive as it involves cutting a small sample out of the scalp and then stitching up the small area. A biopsy needs to be done in the right setting with facilities for the correctly trained person to look at the slides under the microscope (a dermatohistopathologist)
A biopsy needs to be done for the right reasons, particularly in cases of potentially permanent (known in the profession as scarring) alopecia such as lupus or lichen planopilaris.
As for medical conditions, the type of test done will depend on the range of signs and symptoms the patient presents with.
Once you receive the test results back what would be the minimum length of time that a patient would undertake a treatment protocol?
This is a personal choice. The treatment would need to be continued for as long as one wishes to medically treat the hair loss.
Some people may decide to continue long term with the medical treatment. Others may decide to have a hair transplant for balding which using this as an adjunct. I am aware that some hair transplant surgeons are starting to use this test to help produce better long term outcomes after surgery.
For more information please do get in touch with Dr Ingrid Wilson at https://linktr.ee/CreweAnd
01270 747 393 or firstname.lastname@example.org