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What effect do wigs have on patients' mind?

When patients with alopecia areata or androgenic alopecia wear a wig, their quality of work or life can be improved because their appearance becomes better and they can think positively. This is what is commonly said, but there is no scientific data showing this effect. It is Dr. Shigeki Inui, Associate Professor of Osaka University Graduate School of Medicine who addressed this challenge. He conducted the world's first survey with statistical analysis on wig's effect on psychological QOL in wig wearers and elucidated the role of psychological factors of wigs.

There was no medial data on usefulness of wigs

What made you interested in wigs?

The Japanese Dermatological Association published the Clini- cal Practice Guideline for Alopecia in 2010. The Guideline Committee members intended to give the grade of recom- mendation to wigs. Then, the members investigated whether there were data showing that wigs were medically useful and found none. It is generally said that if patients with alopecia wear a wig, they can live positively because their psychological complex will be eliminated. However, there was no data obtained based on investigations from a medical point of view.
The Guideline is not allowed to recommend wigs unless they show positive effects on patient's psychology.

Has nobody so far investigated?

I found only one article which evaluated psychology of patients with alopecia areata in Japan. However, as no statistical analysis was performed in this study, it is difficult to evaluate the study result as evidence. We needed data performing proper statistical analysis in light of EBM(evidence-based medicine).

So, you performed this survey study, didn't you?

We conducted a questionnaire survey in patients using the "Psychosocial Impact of Assistive Devices Scales (PIADS)" which is designed to assess the psychological effects of an assistive device in patients using an assistive device. We conducted an interview survey in around 100 three types of patients, female patients with alopecia areata, female patients with androgenic alopecia and male patients with androgenic alopecia. The PIADS consist of 26 items for each of which patients need to answer "It becomes better or worse".

Have wig manufacturers conduct- ed this sort of survey?

They conduct a survey to investigate the difference from the conventional products and something like a monitoring survey before the launch of a new product. As the survey they perform is a marketing one, it cannot be said medical survey using an evidence-based approach.

Patients' motivation and self-esteem are associated with satisfaction about physical appearance when wearing a wig

What results did you have?

This questionnaire survey evaluated on how the following three items were improved by wearing a wig: 1) feelings of efficacy (people's capabilities to perform something, 12 items), 2) active adaptability (people's abilities to adapt themselves to a variety of works, 6 items) and 3) feelings of self-esteem (a person's overall sense of self-worth, 8 items). To come right to the point, wearing a wig improved all three items: feelings of efficacy, active adaptability and feelings of self-esteem. Also, it has been found that the effects correlated with satisfaction about physical appearance when wearing a wig. In short, the study showed the more satisfied a person was with his or her appearance, the better QOL he or she got. Thus, the less satisfied a person was with his or her appearance, the worse QOL he or she tended to get.

If a person is satisfied with his or her appearance, he or she will gain confidence and vice versa. So, you mean that it is important for a product to increase satisfaction about appearance.

Yes. There is one more thing that I should mention. The more severe alopecia a person has, the more improvement in feelings of efficacy and active adaptability he or she has. Thus, the study result also has demonstrated that wig's effect on QOL varies depending on the magnitude of change in the patient's appearance. However, feelings of self-esteem do not differ between patients with severe alopecia and those with mild one, which makes me feel strange. When a person suffers from severe alopecia, his or her appearance will change greatly. Isn't it true that a great change of the patient's appearance improves self-esteem? I am wondering whether it is severe or mild is not strongly related to their QOL because their self-esteem can be increased even with mild disease. It is difficult to make a judgment.

You mean that the more severe alopecia a patient suffers from, the more motivated the patient gets. How will these study results be used in clinical practice in the future?

In conclusion, it is obvious that wigs change a wearer's appearance, which leads to better patient's psychology. This is what we have found. Now that we have evidence drawn by performing proper statistical analysis, you can tell patients that wigs are a useful item based on the evidence. This is an extreme example, but we had so far no choice but to answer, "You can do so if you like", when asked from a patient, "Should I purchase a wig". Because we did not have any evidence sufficient to recommend the use of a wig. Of course, it does not matter if you recommend. However, whether it has any evidence is related to the confidence or conviction of a healthcare professional when he or she recommends a wig.

Data help add to physicians' confidence, do they? What response did you receive internationally and domestically?

I had a lot of responses from West- ern countries, especially European countries. As in northern European countries, wigs for alopecia areata are covered by health insurance, many researchers are interested in effects of wigs on patients' QOL. In May, the 8th World Congress for Hair Research (WCHR 2014) was held in South Korea where I gave a presentation under the theme of "Evidence on effects of wigs on QOL in patients with alopecia". As my presentation was the only one which theme was wig, every audi- ence listened hard to my presentation so I had a good reaction. A South Korean experienced physician praised me saying, "I have attended the annual meeting of medical society for a long time. Although wigs are an important item for patients, nobody has covered this theme. You are the first person who talked about wigs".

Wearing a wig improved psychological QOL (motivation, willingness . confidence, self-esteem and overall QOL). The more satisfied a person was with his or her appearance, the better QOL he or she got. Thus, the study result indicates that a factor related to the patient's appearance (how natural he or she looks) is associated with the improvement of psychological QOL (this study was published in an internationally renowned medical journal "Journal of Dermatology" (March, 2012) and was later presented at the 112th Annual Meeting of the Japanese Dermatological Association held between June 14 and 16, 2013).

Interviewer/writer: Takaki Hiroshige Photographer: Naoyuki Tamura

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