Hair and scalp-related disorders are a trending topic in dermatology, with a significant increase in number of consultations in the last decade.

Hair and scalp-related disorders (HSRDs) seem to be a trending topic among dermatologists. Trichology is a field of dermatology that is currently experiencing a rise in the number of patients consulting, research and teaching. Hair is a cause for concern in the society, affecting all kinds of people. The dermatology community has the perception that more and more patients are consulting for hair loss, a fact that has been accentuated during and after the COVID-19 pandemic. There must be several reasons for this increase. Some alopecias have undoubtedly increased their incidence, such as frontal fibrosing alopecia.1, 2 In other forms of alopecia, it remains to be clarified whether we are experiencing a real increase in incidence or whether patients are consulting more when they learn that new therapies are available. With respect to research, the number of scientific publications related to trichology has almost doubled in the last decade: 1456 in 2011, compared with 2780 in 2021, according to PubMed data (Figure 1). In addition, several new therapies for different types of alopecia have emerged in recent years: low-dose oral minoxidil, platelet-rich plasma, oral dutasteride, mesotherapy with dutasteride or topical finasteride for androgenetic alopecia, JAK inhibitors for alopecia areata, etc. Regarding teaching activities, in recent years, the training offer in trichology for dermatologists has increased, with the development of masters in trichology, stays in research centres and courses of scientific societies. Examples of these teaching activities include the European Academy of Dermatology courses about trichoscopy by Dr. Rudnicka and hair diseases by Dr. Piraccini (more info: https://eadv.org/education/face-to-face) or the webinars of the European Hair Research Society (more info: https://ehrs.org/). In our dermatological environment, there is a growing interest for training in trichology even from the residency period itself. The excellent article of Lyakhovitsky et al.3 provides valuable information on the frequency of HSRDs at a tertiary dermatology outpatient clinic in Israel over a 10-year period (2010–2020). Interestingly, they showed that the annual number of HSRDs and their proportion with all dermatological outpatient visits have significantly increased from 1.24% in 2010 to 9.44% in 2020. There was a growing predominance of women with an average female-to-male ratio of 2:1, in concordance with previous epidemiological studies.1 The greater psychological and social impact of hair loss in women4 may explain why women tend to consult for HSRDs more than men. The most prevalent HSRDs included androgenetic alopecia (30.6%), alopecia areata (19.3%), telogen effluvium (15.4%), nonscarring folliculitis (15.4%), seborrheic dermatitis (14.9%), lichen planopilaris (7.1%) and folliculitis decalvans (6.6%). Interestingly, two hair loss disorders presented a significant increase in frequency over time: androgenetic alopecia (AGA) and frontal fibrosing alopecia (FFA). In the first case, as discussed by the authors, this absolute and proportional increase may be attributed to advances in the diagnosis and treatment of hair diseases and to improve access to skilled specialists, rather than to a marked increase in the incidence of AGA. On the contrary, the build-up in the frequency of FFA probably represents a real increase in the incidence of the disease, as previously shown in other studies.1, 2 The pathogenesis of FFA remains unknown. Besides the genetic background and a probable hormonal mechanism, it has been proposed that environmental variables may play a role.5 It is noteworthy that the number of HSRDs visits sharply increased during the COVID-19 pandemic, while the total number of dermatological outpatient visits decreased. This is probably due to the relationship between COVID-19 and some hair problems, like acute telogen effluvium.6 In conclusion, this article confirms that HSRDs represent a considerable proportion of disease burden presenting to tertiary outpatient centres, with a high frequency of AGA among HSRD patients. This reflects the growing need for training in trichology, especially for dermatologists working in ambulatory outpatient care. I confirm that I don't have any conflict of interest regarding this article. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.