Scalp Psoriasis in Women

/by William Rassman, M.D./0 /,

I have been diagnosed with scalp psoriasis. I use a variety of topical ointments to keep it under control and it seems to be doing much better. However, I have lost a lot of hair because of this condition and now have a very thin area on the side of my head near my part. My question is, will using a hair growth product like rogain for women help “jump start” new growth in this area? And I also wonder about what I have read that once you start using Rogain, you have to use it forever or the hair will just fall out agian? Thank you so much for any advice you can give me

First, a doctor should determine if you have other causes of hair loss since psoriasis, by itself, rarely causes it. Most people with hair loss and psoriasis either scratch the skin constantly, pulling out hair and that can cause traction alopecia or they may have another condition that may be the cause of hair loss.

For women, you need an accurate run down on your hormones to rule out other diseases such as thyroid disease, etc. Make sure that you are not on a bizarre diet, as weight loss is a cause of hair loss. Both men and women need to have their scalp and hair checked out for miniaturization, looking for genetic hair loss causes. Other autoimmune and inherited conditions can contribute to this as well. Never assume the obvious, for the price is too costly in non-reversible hair loss.

For information about using Rogaine with psoriasis, please see: Psoriasis and Rogaine.

17 Year Old with Hair Loss

/by William Rassman, M.D./2 /,

Hi, I’m a 17 year old male and I first noticed my hair getting thin at 15. It was a general thinning but no specific spots. I never noticed a period of shedding I went to the doctor who thought it was MPD but did a biopsy to be sure. It turned out it wasn’t MPD. I was taking minocycline for acne at the time and stoped taking it because i thoght it might be causing the thinning. At that point it got a lttle worse and then stopped getting worse. I have have all the blood tests to check for everything, hormones, thyroid, and nothing was wrong. I have had nothing out of the ordinary happen and im a normal person in every other aspect. While it hasn’t gotten worse, it hasnt gotten any better. I’m afraid its an underlieing disease. Any ideas?

Male Pattern Balding (genetic hair loss) is possible in teenagers. Did the biopsy show any inflammation? It would be a good idea to send pictures or stop by in person for me to evaluate you and I would then determine the degree of hair miniaturization at every point in your scalp. That should show patterns consistent with genetic hair loss if this is the correct diagnosis. If you are taking any medication or herbal pills, that could be a cause as well. At 17 years old, you may have accelerated MPB which might benefit from Propecia.

Does a Hair Transplant Increase the Forehead?

/by William Rassman, M.D./0 /

Your site is very helpful and is a great service to the community. I applaud your selflessness. I was motivated to check your site because I saw the Procede ads – thanks for setting us straight on that one.

I am curious, however, about Regenix and wonder if anything new in the way of clinical evidence has come your way to suggest how it works vs. something like Rogaine?

Also, is it true that hair transplant surgery, by borrowing from the back of the scalp, also serves to increase the forehead space? If so, is it advisable to have the transplants along the frontal hairline to lower the hairline and reduce this space?

Thanks for your help.

I have no information on Regenix in the way of clinical evidence (Tier 1 evidence) at the level of proven FDA approved treatments such as Minoxidil (Rogaine) or Finasteride (Propecia), nor are there any head-to-head trials comparing these sorts of treatments (who would pay for possibly proving someone else has a better treatment?). If someone tells me a certain treatment works for them, GREAT! Keep using it. However, I will not recommend treatments for which I do not have rigorous and incontrovertible scientific evidence.

As for the oft-asked question about a forehead lift from removing skin from the back of the head, I am happy to tell you that your forehead does not move, but your butt raises up two inches… I’m just kidding, you actually don’t have any change except for a little less excess skin at the back of your head because of the way the skin is attached to the skull it is loose. We have redundant tissue at the back of your head because your neck is actually a joint, like your elbow or your knee, so you need a little extra skin to allow for flexion. Thankfully for the hair surgeons, nature has provided a bit more skin there than is necessary, which is why we can take some out and not affect anything around it. Sorry for those of you who wanted a combination facelift/hair surgery!

Female Hair Loss from Prozac?

/by William Rassman, M.D./9 /,

I have been on Prozac 20+ years. Current dosage of 40 mg. per day. I am experiencing hair loss which is increasing. About half the hair on top is gone, there is stubble. Have been to dermatologist who don’t know why.Could Prozac be the reason for the hair loss? I am a caucasian female.

Prozac is known to cause hair loss, although it is rare.

Please read the other posts I’ve made in the Female Hair Loss, and consider having your scalp mapped for miniaturization, so that you have a better understanding of what you are dealing with.

Doctor Recommendation in Philadelphia?

/by William Rassman, M.D./0 /

Hello Dr. Rassman, I am a 51 year old white female who has had thinning hair for past 4 yrs when I went through menopause. All blood work is normal, even low testerone. I take Bio identical hormones (only bi-est and progesterone) and spironolactone. I would like to find a good hair loss doctor in the Philadelphia area. I know you have mentioned one in Fort Lee NJ but that is quite a distance. And do you find that propecia works for women? Thank you so much for your time.

I can not tell you the name of a particular Philadelphia based doctor, but a visit to Dr. Robert Bernstein in Fort Lee NJ or Manhattan NY via Amtrak would be a good bet. Dr. Bernstein is a real expert, and worthy of your consideration and with regard to female hair loss, you need a doctor with special expertise in knowing what to do and when (or if) to do it.

Thinning Hair Since High School

/by William Rassman, M.D./0 /, ,

Hi, Im 21 and I have had thin hair since atleast 9th grade. It has gotten progressively thinner since high school, but my hair line is not moving. Rather, I experience a general thinning all over like you see in old women. I know i get it from my mothers side because she also has really thin hair while my father has a healthy head of hair. What is my best option to stop this gradual thinning?? My dad is a doctor so he prescribed me Propecia which i used for 5 months with pretty much no results. I feel that most of the products on the market are aimed at male pattern baldness while there is nothing for men like me. Could you please recommend a course of action. Thanks alot.

You need to get a proper diagnosis. Get your head mapped out for miniaturization and determine if you have Diffuse Unpatterned Alopecia (DUPA). This is a condition that is similar to female genetic hair loss, except that it occurs in men of all ages. Rather than write a book on your management, I suggest that you get your doctor (father) to connect with us. Have him start by reading the article I wrote titled Follicular Transplantation: Patient Evaluation and Surgical Planning?” and find DUPAwithin the text of the article.

Balding Olympic Athletes Promoted

/by William Rassman, M.D./1 /, ,

Zach LundWhat are we coming to? Today’s Olympic athlete now must give up Propecia if they want to compete. According to today’s New York Times (1/19/06), Zach Lund is an Olympic athlete who is prematurely balding and he wanted hair. “So in 1999, when he was 20, he began taking Propecia. Then in 2004 he switched to Proscar. And it looks as if he grew hair, or at least stopped losing it….”

He is now faced with a choice, should he become a balding gold medal winner or a person who was eliminated from competition because he wanted a full head of hair. That is the stupid quandary that today’s potential Olympic champion must face. To be a bald champion or not an athlete at all.

The New York Times states: “At the end of 2004 the World Anti-Doping Agency added finasteride to its list of banned drugs in international sports. The agency calls finasteride a masking agent that hides the use of more nefarious drugs like the steroid nandrolone. So, one imagines, every Olympian with a spasm of hair growth must fear surprise follicle checks…. Better he should have had erectile dysfunction. The trinity of impotence relievers – Viagra, Levitra and Cialis – is not prohibited, though these drugs are performance enhancers in a certain athletic way.” Sooner or later, these three medications are bound to be added to the list of banned drugs.

What a world we live in! We may ask our athletes to give up sex to become a star. Maybe without hair, they won’t feel sexual anyway, or am I too shallow in my assessment? To see the entire article, go to: Fighting Baldness, and Now an Olympic Ban (registration required).

Hair Loss from Brow Lift

/by William Rassman, M.D./0 /,

Dr. Rassman,

On Nov. 30th I had a contour thread lift of the brows. (contour threads: barbed sutures now used to pull eyebrows up – they don’t dissolve – made of polypropelene)

The incision on the left side of my scalp (just behind the hairline) had a touch of keloid or hypertrophic scarring but the right side is awful. I have a dime sized circular bald spot – very smooth. It’s so terrible. I’m in tears almost daily. It was infected and antibiotic ointment helped flatten it out but the hair is completely gone. There are no pores or anything.

I’m writing to you to see if you know (without benefit of seeing it) whether the hypertrophic process just creates skin that is fibrous and the hair follicles are still “alive” underneath, but can’t grow through or whether it kills the follicles. My plastic surgeon said he didn’t know what it was and that he could just cut it out, but from what I’ve read, a straight line incision is not the answer —- and aside from that, I was hoping to get my hair back.

Any feedback would be appreciated

Photographs would help. I will give you some general comments about brow lifts, scars and hair loss. Scars and hair loss in brow lifts are not uncommon. My practice is skewed because I see many of these, probably a disproportionate number of them relative to what a normal plastic surgeon does. I get the complicated patients, which hopefully are only a small percentage of those that the plastic surgeon gets. Most of the time when hair is lost, the hair will return in 5-9 months. When it does not, then hair transplants can solve the problem nicely. Scars take on a series of categories, including: Hypertrophic scars (unusual in the first few weeks after surgery, keloids (very rare), widened scars (more common). Hypertrophic scars may require steroid shots and widened scars may require hair transplants if they are detectable months after the surgery. Cutting out the scar from a previous surgery often does not work, but without seeing it, if would be impossible for me to make that judgment.

Eyebrow Hair Loss

/by William Rassman, M.D./42 /,

Hi,
Please could you give me some advice on how I can encourage new eyebrow hair growth. My eyebrows have lately become very sparse. I am very concerned because no products have been working for me. I have used olive oil and bought Talika Eyebrow Lipocils and used the product, I used it for 28 days and it did not stimulate any new hair growth.
Please could you help me and send me some advice?
Thankyou.

Eyebrow hair loss can be from a series of causes. The most common is from plucking the eyebrow in women who try to shape it and eventually develop traction alopecia resulting in permanent loss of the eyebrow hair. A series of genetic and autoimmune causes also exist, so you might want to see a specialist who can look for miniaturization or the side effects from plucking which are very characteristic. There are no magic potions for stimulating eyebrow hair, though Minoxidil might help. Hair transplants work very nicely but have the disadvantage of growing longer than the normal eyebrow hair which means that they must be cut a few times a week.

Losing Hair After Spinal Injections

/by William Rassman, M.D./0 /

I am 55 year old female. I have gone through alot in the past 8 months. I have a bad back and went through 12 injections in two months in my spine. They helped but then i got fat, gained 25 months from the shots. I think they were cortisol, kenolog and lidocaine. Since August no shots but i have noticed in the past 2 months or so alot of hair coming out. When I shower there is enough there the size of a golf ball and through out the day if i comb it out, hair is in the comb. But worst of all when I just run my fingers through my hair i can take alot out. I saw an endocronogist for a diffent reason but he said i can take this medication which is good for the heart and also helps hair loss. i think its called spiranolacton 25 mg but am afraid to do so. Can you tell me or suggest which kind of dr to see dermatologist ect. I also have been under a great deal of stress. Medications i take are effexor 75mg, lipitor 10 mg, fosomax 70 mg i x weekly, voltarin for back pain

if you can contact me and giver me some advice i would appreciate it

thanks

Many medications such as cortisol and kenolog can contribute to hair loss in some patients. Stress is also a contributing factor to hair loss and it sounds like you are very stressed. Spironolactones are used by some people to treat hair loss. I would advise you to see a good family type doctor to manage all of your problems and make sure that you do not have any of the causes of female hair loss. Your problem sounds a bit complex, certainly too complex for managing you via the internet.

DHT Blocking Foods?

/by William Rassman, M.D./15 /,

You mentioned in a tidbit that there were people who blocked DHT with eating large quantities of dht blocking foods. What might those be, and could we get similar results by ingesting these foods. By the way, thanks very much for doing this blog. It is extremely interesting and informative.

To the best of my memory, the drug finasteride was derived by work done in primitives who ate a tuber that was unique to the rain forest and contained this drug. I am not familiar with other foods that contain it. The high incidence of hermaphrodites in the population is what clued explorers into the uniqueness of the foods these people ate, mainly because the food was eaten by pregnant women, blocking the effects of DHT which is required to differentiate the sex of the offspring. If you find hermaphrodites somewhere eating large amounts of some unique food, that might be a good clue.

Hair Loss from Anesthesia?

/by William Rassman, M.D./10 /

I am 27 years old and female, and I have always had really thick hair. Around 6 months ago, I started noticing my hair was coming out a lot when I washed, or brushed it. My hairstylist also noticed, and asked me if I had surgey, and if I had anestisia? I did about 10 months ago. I was wondering if that could be linked to it? I have also noticed that my eye on one side feels like it is straining if I look side to side or up or down, and I have expierinced migraines frequently lately. So, maybe it is stress. Either way, your imput would be greatly appreciated.

Yes, the stress from anesthesia and surgery itself can cause hair loss, but it is temporary most of the time, particularly for women. In term of anesthesia, I am not certain if the anesthetic chemical itself causes direct hair loss or just the stress associated with the surgery, although I think that the stress may be a more significant factor in predisposed women. You may have female genetic hair loss and mapping out your scalp and hair for miniaturization might help establish or rule out this diagnosis with objective measurements. Repeating the analysis may have value after 6 months has passed if the first measurements are not definitively able to make the diagnosis.

Just Noticing My Thinning Crown After a Haircut

/by William Rassman, M.D./0 /,

Please help. I am 26 years old and I have had long hair for about 10 years. I have been keeping my hair in a tight bun or braids all of the time. I also used to texturize and dye my hair frequently. I recently cut my hair off for a job and so now I have it kept short. For the first few months I thought my hair looked fine. Maybe I hadn’t paid much attention to it but I think I had. Now, four months since cutting my hair. I have noticed that my hair is extremely thin in the back of my head near my hairline. Its to the point where it looks bald. Will I ever be able to grow hair back there again? If I got a transplant would it leave nasty scars on my head if I wanted to shave my hair down low? Are there any treatments for me or have I damaged my hair for too long. Can I get a transplant over scar tissue? Should I be able to look at my balding spot and tell if I damaged my hair permanenly? Im not to sure how long it has been thin like this for. I have always had long hair to cover it up I guess. Do I have any hope. Thank you in advance

Your story is not unusual as denial is a common reaction to aging in the young man who believes that he is forever immune to signs of aging or balding or ill health. I generally think that young people have a concept that their bodies are their castle with high walls which protect them from every malady know to man. Now, your keen eye shows the crack in the armor. I suspect that the insidious nature of the balding process has crept up on you and when you stood back and looked, there it was. Look at the various sections in this blog (particularly the Age category) to see what you can do. Get your hair mapped out for miniaturization to make a diagnosis and then see if you may benefit from Propecia or hair transplant options. Make a Master Plan before going headlong into a panic, be methodical in doing your research, get a copy of our book to review the various options and explore our website at newhair.com.

Should I Take Propecia Before My Scalp Is Mapped for Miniaturization?

/by William Rassman, M.D./0 /

I have purchased some propecia online and I’m waiting to receive in the mail it should be here in a couple of days. Right now i’m in Iraq. After reading this site and many others I’ve decided that I want to come in and get my scalp mapped for miniturization. I should be back stateside around mid march. Should I wait to start taking propecia till my scalp has been mapped?

Ideally, you should take propecia after mapping your scalp to identify if you have male pattern baldness. The focus upon mapping for miniaturization is to (1) estimate the pattern of hair loss, and (2) measure the starting point for miniaturization so that changes caused by Propecia can be measured over time. Although it takes around 6 to 8 months before you can see the effect of Propecia visually from hair length, it is highly possible that the impact of Propecia on the emerging hair will be earier than the projected 6-8 months. The measurments are very fast and easy to get from a hair transplant physician, so I would suggest that you get the mapping done earlier and if you elect to start the Propecia before you get your scalp mapped. Keep in mind that the purpose of the mapping is to put measurements on the benefits of Propecia so you will not be working in the dark.

Rogaine Shedding, Nizoral

/by William Rassman, M.D./9 /,

Hello, I’ve never used Rogaine, in fear of the “shedding” phase I’d heard about. What exactly is the “shedding” phase, if I may ask.

And will this product cause that? And is there a list of the ingredients anywhere or should I not be asking that? I’m just very curious.

Last but not least question, if this products is discontinued, I am assuming everything on the scalp goes back to “as it was” before, and are there any products that shouldn’t be used, such as Nizoral Shampoo?

Your help is greatly appreciated. Sorry, where can I purchase only the “hair grow” product, not the cleaner etc?

To answer your question about shedding from Rogaine use, please see my past response in “Hair Loss Worse After Rogaine”.

I am not completely sold on Nizoral shampoo, although I do believe that it is a good shampoo. I do not believe it is necessarily good at regrowing hair. There is not enough scientific data to support hair growth claims. You can buy Rogaine over the counter and I doubt that minoxidil (generic form) will ever go off the market. The miniaturized hairs become dependent upon minoxidil when you take it and when it works. If you were to stop the Rogaine (minoxidil) and there was a benefit of it, you will go back to your ‘before’ status, plus losing whatever hair you would have lost prior to starting the medication. This may very well leave you worse off.