Intended for healthcare professionals

Feature Christmas 2010: Surgery

Red for danger: the effects of red hair in surgical practice

BMJ 2010; 341 doi: (Published 09 December 2010) Cite this as: BMJ 2010;341:c6931
  1. Andrew L Cunningham, foundation programme doctor, general surgery,
  2. Christopher P Jones, foundation programme doctor, general surgery,
  3. James Ansell, registrar in general surgery,
  4. Jonathan D Barry, consultant surgeon
  1. 1Welsh Institute of Metabolic and Obesity Surgery, Department of General Surgery, Morriston Hospital, Abertawe Bro Morgannwg NHS Trust, Swansea SA6 6NL, Wales, UK
  1. Correspondence to: J D Barry jbarry{at}

Jonathan D Barry and coworkers discuss the validity of the unique surgical requirements of patients with red hair

Traditionally, surgeons and anaesthetists regard red haired patients with some trepidation because of their reputation for excessive bleeding, a reduced pain threshold, and an, albeit anecdotal, increased tendency to develop hernias.

An estimated 1% to 2% of the general population worldwide has the phenotype for red hair, increasing to between 2% and 6% in the northern hemisphere.1 The typical phenotype associated with red hair is fair skin, freckles, and light coloured eyes. This colouration results from high levels of the red pigment phaeomelanin and reduced levels of the dark pigment eumelanin. Red haired people are also sensitive to ultraviolet light.2 Despite several validated methods to stratify surgical risk and outcome on the intensive care unit, such as the American Society of Anaesthesiology score3 and the acute physiological and chronic health evaluation score,4 none take into account the effect of red hair. We discuss the magnitude of risk posed to clinicians by patients with red hair.

A brief history of red hair

Red hair is referred to several times in ancient literature. Xenophanes, a Greek philosopher and poet, mentioned the blue eyes and red hair of the Thracians. Boudica, the Celtic queen of the Iceni, was described by the Roman historian Dio Cassius as “tall and terrifying in appearance . . . a great mass of red hair . . . over her shoulders.” Homer included several red haired mythical characters in his epic poem The Iliad, particularly Achilles, whose fate is the stuff of legends. …

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