BH13 Current wig prescribing practices and financial evaluation in a National Health Service foundation trust: lessons learnt and future challenges
Authors: Ross Hannah , Ong Xian Hue , Harries Matthew , Asfour Leila 
Published: June 2024

Abstract
Alopecia is classified into nonscarring, such as alopecia areata, and scarring variants, including lichen planopilaris and frontal fibrosing alopecia. Treatment options are limited and there are restrictions on what is available on the National Health Service (NHS). Therefore, many patients require wigs or hairpieces as the mainstay of their management. Significant psychological burden has been associated with alopecia, and the use of wigs can have a positive impact on patients’ wellbeing. Montgomery et al. highlighted the unequal NHS wig provision (Montgomery K, White C, Thompson A. A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia. BMJ Open 2017; 7: e015468). This has led to the recommended ‘Charter for best practice for NHS wig provision’ by Alopecia UK and the British Association of Dermatologists and British Hair and Nail Society published in June 2022. They propose that all patients with alopecia should be able to access a wig via NHS prescription that is appropriate for their skin and hair colour, age and preference. Despite this, discrepancies exist in how wigs are funded in different regions and trusts. All our wig prescriptions are incurred by each department. Due to inflation these costs are rising. This has led to our department’s review of budgets and current prescribing practices. Our hospital’s overall gross cost of wig orders was £193 403 in 1 year. Our aim was to establish the wig prescribing practices in a single centre, which also provides a specialist hair clinic service, and the costs associated with current practices. We reviewed all wig prescriptions throughout our hospital over 12 months. We collected the following parameters: prescribing department, age, sex, diagnosis, number and type of wigs per year, cost per prescription and patient’s address. Patients who were seen in our hair clinic also had psychology-related scores reviewed. In total 324 prescriptions were issued to 200 patients with a median age of 52 years (range 4–87). There was a female predominance (97.5%). Nonscarring alopecia accounted for 57.7%. Overall, 60.5% of the prescriptions issued were for acrylic wigs, with the remainder prescribed human hair wigs. Prescriptions for out-of-area patients accounted for 69.1%. Psychological assessment using validated questionnaires including Dermatology Life Quality Index, Patient Health Questionnaire-9 and General Anxiety Disorder-7 were collected from patients’ initial consultations compared with their current scores. Wigs are an essential treatment for all patients with alopecia. Our results demonstrate the level of demand, the variety in diagnoses and a vast age range. Targeted treatments for alopecia areata are currently unavailable on the NHS; therefore, access to wigs remains vital in its management. Further work is required to ensure equitable NHS wig prescribing; we support Getting it Right First Time’s ongoing review of this.