Trichology and Trichiatry; Etymological and Terminological Considerations.

In 1958, Voina originally commented on cosmetics, cosmetology, and cosmiatry in terms of their etymological and terminological qualities.[1] The word cosmetics derives from the Greek κόσμος (kosmos), meaning “order” and “ornament,” κοσμητικὴ τέχνη (kosmetikē tekhnē), meaning “technique of dress and ornament,” and κοσμητικός (kosmētikos), meaning “skilled in ordering or arranging.” Meanwhile, cosmetology, a word composed of the two Greek radicals κοσμητικός (kosmētikos) + λογία (logia), meaning “a branch of learning,” is the study and application of beauty treatment. Finally, cosmiatria is composed of the three Greek radicals κοσμητικός (kosmētikos) + ιατρικός (iātrikos), meaning “medical” + ια (ia), meaning “employment, craft, profession, art, or science,” and indicating a medical science that studies and treats human beauty in all of its aspects and conceptions.

COSMIATRY

Cosmetic procedures have aroused the interest of dermatologists for many centuries. In 1882, Paul Gerson Unna (1850–1929) presented in his publications the applications of desquamating agents such as phenol, trichloroacetic acid, resorcinol, and salicylic acid for chemical peels.[2] The term cosmiatry was recognized by the medical community in 1959 on the occasion of the World Congress of Dermatology in Stockholm (Sweden), gaining greater consciousness among dermatologists.[3] From 1992 onward, cosmiatry was intensely boosted in dermatology, since the description of the use of botulinum toxin (BTX) for the treatment of expression wrinkles by the Carruthers and Carruthers,[4] though in 1989 Richard Clark, was the first to document a cosmetic use for BTX while treating forehead asymmetry caused by left-sided forehead nerve paralysis that occurred during a cosmetic facelift.[5] In addition to BTX, other treatments for skin beautification have been adopted by dermatologists, such as the use of fillers, chemical peelings, and light-and laser-based technologies.

The professional market for cosmetic interventions into the skin has preceded those into the hair for a number of reasons: first, the market for facial rejuvenation has been dominated by the plastic surgeons, until BTX and the fillers were introduced. Second, investigative dermatology found a profound interest in the study of skin aging, particularly as it relates to ultraviolet exposure, and exposed mechanisms at the level of the DNA and repair mechanisms, opening venues for effective preventive measures and pharmacological treatments of aging-related conditions of the skin. Finally, at the level of the health professional, the condition of the skin has been overrated in relation to the hair, mostly due to economic reasons. Nevertheless, the hair represents an integral part of our appearance, with culture-bound, sex-and age-dependent grooming habits.[6]

TRICHOLOGY

Indeed, in 1860, a quasi-scientific interest in hair loss and hair care originated in a London barbershop under a self-styled Professor Wheeler. By 1902, this interest in hair disorders became known as trichology, and the first Institute of Trichologists was founded, offering courses by home study for training of students internationally who desire more knowledge about hair. Trichologists are not medically qualified but are taught the practice of care and treatment of the human hair and scalp in health and disease within their restricted but specialized role.[7]

Nevertheless, as with any other medical problem, the patient complaining of hair loss requires a comprehensive medical and drug history, physical examination of the hair and scalp, and appropriate laboratory evaluation to identify the cause. It was only in 2010 that Patrick Yesudian [Figure 1] proposed the term dermato-trichology for board-certified dermatologists dealing with the hair and scalp in health and disease, to distinguish them from the trichologists, who are not medically qualified, and in many jurisdictions are considered a para-medical discipline.[8]

Figure 1

Patrick Yesudian, M. D. (left) with Ralph M. Trüeb, M. D., and Sundaram Murugusundram, M. D. (right) in Chennai, India 2014

TRICHIATRY

Eventually, we proposed the term trichiatry, a word composed of the three Greek radicals θρίξ (thríx), meaning “hair” + ιατρικός (iātrikos) + ια (ia) to describe the strictly medical professional dealing with the hair and scalp in health and disease. The quality and stringency of the trichiatrist's graduate medical training are identical to that of fellow physicians of any other discipline, allowing the trichiatrist to be comprehensive in counseling patients, prescribing medication, conducting physical examinations, ordering laboratory tests, and participating with the other medical disciplines in the diagnosis and treatment of hair problems as they may relate to systemic disease.[9]

By definition, a dermatologist is a physician who specializes in the identification and treatment of pathologic conditions involving the skin, hair, and nails. Dermatologic disorders are a significant portion of the global total of diseases, affecting millions of people worldwide. These involve more than 3000 conditions with a wide range of morbidity and mortality and accounting for 15%–30% of outpatient medical care in health systems. The study of skin diseases has been linked to general medicine for centuries. Driven by the advancement of science and taxonomy in the fields of knowledge, the first texts and works dedicated specifically to the study of skin diseases emerged, significantly transforming the face of dermatology throughout the centuries.[10]

Today, an increasing number of dermatologists are reducing their practice to the cosmetic aspects of the skin at the cost of their medical education. Disinterest, misdiagnosis, or negligence is the risks. To maintain the dignity of our specialty, we should recollect our true values.

CONCLUSION

Ultimately, cosmiatry is the term to legitimate physicians to practice cosmetic procedures, while trichiatry should be the term to distinguish trichology as a genuinely medical discipline.