HAIR+ Summit: When to Refer Clients to a Dermatologist or Trichologist with Dr. Nikki D. Hill

Humans have hair for many reasons—to provide camouflage, to protect against chemicals and physical damage, environmental reasons, even removing parasites, but, as attendees learned at MODERN SALON’s HAIR+ Summit, its primary function for most humans is for social and sexual communication, says HAIR+ speaker Dr. Nikki D. Hill, MD, a board-certified dermatologist and hair loss expert, founder of Skin of Culture and Hair Center (SOCAH). 

“While we may not be curing a terminal disease, you should all feel fantastic that you’re helping your clients maintain their social and sexual communication skills,” Hill says. “But if you know someone who has begun to lose their hair, you’ve seen how they start to lose their identity and you understand how much of a downward spiral that individual can experience. We’re here today at the HAIR+ Summit because we’ve heard those stories, we’ve seen those tears and we want to find solutions for those clients and give them hope.”

Dr. Hill kicked off the first day of the HAIR+ Summit in Atlanta, Georgia, with an informative presentation designed to get everyone on the same page about hair loss on the scientific level: anatomy, growth cycles, scarring and non-scarring hair disorders, diagnosing hair disorders and salon revenue builders, so salon professionals can develop a plan of attack.

Although there are many, many, many causes of hair loss (including Alopecia Areata, Central Centrifugal, Discoid Lupus, Hair Shaft Abnormalities, Lipedematous Alopecia, Trichorrhexis Nodosa), Hill explained some of the tell-tale signs of how to identify the forms of hair loss that your client may be suffering, and when to refer them to a dermatologist or trichologist.


Traction Alopecia is caused by tension on the hairline, and is most frequently caused by sew-ins, glue-ins, tight braids, burns.


Frontal Fibrosing Alopecia is a relatively new form of hair loss, Hill explained, and is the most common inflammatory process in Caucasian women affecting the frontal and peripheral hairline and eyebrows.

“If you have a client who shares that her forehead is looking bigger to her, or she’s penciling in her eyebrows completely, these conversations are good triggers to refer them to a dermatologist to identify their hair loss disorder and shut it down,” Hill says.


This is the most common inflammatory scalp condition in African Americans. The location of the hair loss occurs primarily in the crown, and radiates outward. This used to be related to the use of hot comps and excessive heat and oil.

TELOGEN EFFLUVIUM: Stress shed, self-limited

When your client starts to notice her hair loss, it’s generally once she’s lost 50% of her hair before she realizes and addresses it. “Some clients are very mindful of how much hair they loose on a daily basis,” Hill says. “If they collect what they’re shedding, even with 100 hairs, that looks terrifying—and the longer the hair, the larger the clump.” Telogen Effluvium can be acute or chronic, but the important part is identifying that trigger. “It’s not what happened yesterday, it’s what happened 6 months ago,” Hill says. “Was there a move, divorce, death in the family, recovering from surgery, starting or stopping a medication? Identifying what happened can give us a timeframe, timeline and start a treatment course.”


Autoimmune Smooth bald patches that can affect the scalp, eyebrows and body hair. It can be associated with a thyroid condition, and age predicts the prognosis.

But what do you do when you begin to notice these hair loss signs, and do you refer your client to a dermatologist or trichologist?


CONCERNS: Bald patches, sores on scalp, itchy scalp, tenderness of scalp, uncontrolled scaling/flaking, focal texture changes

Dermatologists will distinguish between scarring and non-scarring alopecia, assess for other medical conditions, treat scarring inflammation, assess for treatment options, consult for hair transplants, Platelet Rich Plasma, Topicals, Orals and Injectables


CONCERNS: Breakage, dry/brittle hair, mild scaling of the scalp, required scalp prothesis  

Trichologists will use products to help with breakage, offer options for low-tension styles, counsel about healthy hair habits and provide scalp-cleansing solutions.

Dr. Hill practices at Skin of Culture and Hair Center in Tucker, Georgia. She is a nationally recognized expert in the diagnosis and treatment of medical hair loss disorders. She founded her practice on the principle that a healthy lifestyle can significantly improve the overall health of an individual’s skin, hair and nails. She practices dermatology but is sensitive to those who wish to follow a more holistic path to healing. Hill offers a CEU-accredited course called the SOCAH Stylist Hair Loss Certification to bridge the gap between cosmetology and dermatology and help create a holistic approach to scalp and hair health, as well as create a platform for furthering education as a hair loss specialist. Learn more at

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