Summary

Hair loss can have a significant impact on quality of life and self-esteem. Management requires a multi-professional team approach to support not only the treatment, but also the psychological and cosmetic impact of the condition. This innovation describes one component of the holistic care offered through Northern Care Alliance NHS Foundation Trust’s specialist hair loss service at Salford, namely the nurse-led (NL) treatment and support services for topical immunotherapy, steroid injection and cosmetic camouflage. These services allow delivery of consultant-led management plans, free capacity in the main clinic and provide opportunities for informal psychological support.

Method

The service provides the only diphencyprone (DPC) referral centre in NW England, so attending treatment every week is impractical for many. A survey of existing DPC patients found people travelled, on average, 36 miles and took over two hours to attend, with many effectively missing a half or full day from work or school each week. Of those surveyed, 88% were interested in exploring home treatment. A home DPC pilot was set up, assessed by service review and user survey. In addition, patient educational videos were produced. A NL corticosteroid injection clinic for scalp and facial alopecia was created in 2019. It was recognised that pain and needle phobia were limiting factors. The team pioneered the use of vibration-assisted analgesia (VAA) as an immediate, cheap, and effective option for pain control, allowing younger people and those with needle phobia to tolerate this option. Additionally, an alopecia-focused cosmetic camouflage service was established through the nurses gaining level 3 camouflage training, supported by donations from companies that manufacture products. Referrals from the hair clinic allowed patients to ‘try before they buy’ and supported certain groups (e.g. men) who were traditionally less likely to access this type of support.

Results

The home DPC pilot was undertaken by 11 recruited patients and completed successfully. Each patient had a designated individual to apply the treatment on a weekly basis at home, reducing weekly hospital visits, travel and time off school/work. The team supported each patient with regular virtual assessments, supported by submission of a treatment diary. Effectiveness was assessed through verbal feedback and a formal questionnaire. The injection clinic was assessed as part of the departmental audit, with a focus on pain control during the procedure. The injection audit evaluating VAA showed that 85% felt their pain was improved with the use of vibration. This led to the establishment of VAA as standard practice, opening this therapy to a wider demographic and potentially avoiding an earlier transition to second-line agents. Wider applications for VAA have been identified, such as LA injections. The cosmetic clinic will be assessed by service user feedback when there are sufficient numbers for analysis.

Sustainability and Spread

The DPC education videos are available via the British Hair and Nail Society (BHNS) website. The DPC service was showcased at the BHNS UK Symposium on hair and scalp disorders in Manchester in November 2023 and shared with several centres nationally. The VAA audit won the Alopecia UK patient impact prize at the European Hair Research Society annual meeting 2023. As patients can now receive impartial advice and test different products, they can purchase appropriate ones, avoiding unnecessary cost, delivery and wastage.