Wigs and hair prosthetics

Background, definitions, and history

Wigs and hair prosthetics have been used for centuries to conceal hair disorders and to enhance existing hair. The earliest wigs date back to Ancient Egypt, where they were worn by nobility to dually signify elite social status and confer sun protection. Since then, they have been worn as status symbols throughout history by Roman emperors and European royalty. The word “wig” derives from the word “periwig,” which first came into use in the English language in the 1670s. King Louis XIII of France, who reportedly wore a wig to cover his premature balding, is credited with popularizing the wearing of powdered wigs, which were dusted with white starch to combat odor and parasites. During the late 18th century, wealthy women in Western Europe fashioned their hair in elaborate arrangements with decorations that sometimes even included birdcages.

Wigs may also have religious significance, as is the case with sheitels for married women in Orthodox Jewish communities. Today, the wigs and hair prosthetics market forms a multimillion-dollar industry. Hair prosthetics include, but are not limited to, wefted wigs, netted wigs, integration wigs, partial hair pieces, and hair extensions or weaves.

Patients with androgenetic alopecia (AGA) and inflammatory alopecia may turn to hair prosthetics when other medical and procedural interventions have been aesthetically unsatisfying and hair loss negatively affects their quality of life. Therefore, it is critical that dermatologists are aware of characteristics and variations of wigs and hair prosthetics.

Indications and patient selection

Rather than a mere cosmetic accessory, wigs and hair prosthetics should be considered important therapeutic treatment options for many diagnoses and severities of scarring and nonscarring alopecia. The recommendation of a hair prosthetic is not mutually exclusive of continuing medical or procedural therapy for hair loss. Some patients may want to save wispy strands even as they realize that hope for regrowth to the effect of a socially acceptable natural hairstyle is unattainable.

Many patients may initially present with personal experience of using hair prosthetics prior to any prescribed medical or procedural intervention for hair loss. Providers should feel comfortable asking about a history of prior wig or hair prosthetic use when considering adding a hair prosthetic to the treatment plan for hair loss.

Some patients may use hair prosthetics as a bridge until medical or procedural therapies for their alopecia take effect. In the case of chemotherapy-induced hair loss, wigs typically serve as a temporary solution to alopecia during treatment.

When recommending a wig style to a patient, it is important to consider the patient’s face shape, lifestyle, goals, and even environment. For example, patients living in a warmer climate may be best suited with lower-density and shorter wigs to avoid overheating and perspiration of the scalp under the wig. Patients with drug-induced hair loss and progressive hair loss disorders may often want to recapitulate the texture, color, and length of their natural hair style. Human hair wigs can be dyed, cut, and styled, while synthetic hair wigs may have more limited flexibility of daily styling.

Wig cap sizing is also important, and the authors recommend patients have measurements of head circumference, frontal hairline to occiput, and coronally from ear to ear to ensure a proper fit. The typical wig cap size is about 22 inches for an adult.

Patients with chronic and progressive forms of hair loss, such as AGA, may view wigs and hair prosthetics as a sign of giving up on treating their hair loss, and the contrary should be emphasized. Initiating a discussion on wigs and hair prosthetics early on in the course of disease is important, as end-stage scarring alopecia or severe AGA may progress to a state where there is little hope for aesthetically acceptable regrowth, despite maximizing medical and procedural therapy.

Just like any other medical or dermatologic treatment, dermatologists recommending wigs and hair prosthetics must take into account a patient’s natural anatomy, lifestyle, goals, and profession, and ensure that the patient is happy with the treatment, that the treatment is effective, and, most of all, that the treatment fits seamlessly into their life.