Seborrheic Dermatitis on Eyebrows

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

Dear Dr. Rassman,

I have been diagnosed with seborrheic dermatitis on my eyebrow areas. My eyebrow hair are falling off all the time. They do grow back, but I notice that the texture of the hair is thinner than before I have got the problem. Does seborrheic dermatitis affect hair follicles in such a way as to cause the hair strands to get thinner?

Thank you very much for your time.

Anything is possible. If you scratch it, you may be pulling out hairs and eventually this will lead to permanent hair loss. You can treat it topically with a low dose steroid (1/2% hydrocortisone cream) about three applications a week, 12 hours apart. This can be purchased over the counter and is safe, unless you take too much of it. Try it for the short term. If it works, see a good dermatologist to consult on what is the best way to keep it under control.

ScalpMed, Diane 35, and Hair Loss

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

Hi there,

I’m a 25 year old female. Four years ago, I took Diane 35 for about 6 months. During that time, I noticed hair falling out. My doctor at the time said that it was a “normal cycle”, and not to worry. At the end of the 6 months, though, I had lost about 60% of my hair. Not in patches, luckily, but just all over my head. It hasn’t grown back. It could be genetic, cause females on my father’s side have thing hair, but it’s so frustrating having HAD it thick before.

Do you have any recommendations? I’m thinking about going on Scalp Med to sort of provide a “boost” to the hair follicles, but I’d imagine that because it’s essentially Rogaine, it will stop regrowth if I stop medication.

I appreciate any advice you can give me.

Minoxidil might help, but what are you really treating? You need to get a diagnosis to find out if you have genetic hair loss. To get that diagnosis, you need to have your scalp mapped out for miniaturization. You also need to be sure that you do not have other causes of female hair loss, which include eczema, malnutrition, autoimmune disease, drug reactions, infections, genetics, etc.

ScalpMed might help, but what is in it beyond the minoxidil? Diane 35 has hormonal effects (Antiandrogen / Estrogen) so messing around with your hormones may be positive or negative. It varies per person.

DHEA Supplementation and Hair Loss

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

Dear Sir,

I know you have touched on the efect of hormone supplementation in some earlier messages.

There are mixed views on whether DHEA supplmentation (say 25mg per day) in men leads to increased hair loss. While it certainly has made improvements to overall wellbeing, I always detect (or believe I do) increased hair loss while I am on DHEA and topical testosterone.

In your view, do these supplements increase risk of male hair loss and can this risk be minimised while using them? Thank you.

DHEA and steroids do make hair loss worse. Propecia may minimize the impact and it is doubtful that it would hurt. Check this out with the doctor who is prescribing your medications.

Unnatural Looking Balding Pattern (with Photos)

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

This appears like a hair transplant that did not grow, but it is actually a natural balding pattern in a 50 year old man with frontal balding. So why does it look so unnatural? The reason is that the hairs that remain are all healthy hairs, and the surrounding healthy hairs have disappeared (died). Most people develop miniaturized hairs, which is when the hair shafts become finer (front to back), and they just get thinner and thinner in appearance. That is what normally happens in most men. Sometimes, men have mosaic type genetic balding patterns, where some hair in the front remains for the lifetime and looks healthy (hair by hair), but the overall appearance on this type of balding pattern is particularly ‘shaggy’ and has a less-than-healthy look.




Raynaud’s Disease and Hair Loss

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

Hello. I have a rare type of mild skin condition called “Raynaud’s disease” or “Raynaud’s phenomenon”. It basically consists of a tingling sensation on the surface of my skin and scalp, in a designated area for a second or two, when I experience stress or anxiety. For a long time I have wondered if it would eventually lead to thinning or balding on my scalp. I have not experienced any bad side effects yet, but I wanted professional opinions. Do you think my condition will lead to hair-loss? Do people that lose their hair physically feel it prior? Do I have any reason to be concerned?

Raynaud’s phenomenon and Raynaud’s disease, a similar disorder, may be associated with autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma. Genetic female balding is present in 50% of women (most are past 50) and these women can get Raynaud’s disease as well. I would not focus upon hair loss that you might get. This would not be a productive exercise. People with full blown autoimmune diseases like the ones mentioned above, can experience hair loss.

Effexor and Propecia

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

Could the medication effexor interfere with propecia

All medications have the potential for cross reactivity with other medications. I do not believe Effexor or its generic form venlafaxine (which is an anti-depressant class of medication) will interfere with Propecia (finasteride).

As a disclaimer, posts on BaldingBlog are to educate the public on hair loss topics based on my personal experience and opinions. It not to be used for the purpose of medical diagnosis or treatment. Always check with your physician before starting any medication.

How Long After Transplant Can I Wear a Motorcycle Helmet?

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

HelmetI am having a transplant (strip) next week. My husband and I take frequent motorcycle trips and I am wondering when I can safely wear a helmet. They are by necessity tight fitting so they will rub while wearing them and when I put it on and take it off.

The helmet can not rub the donor area or it may cause wound problems. You might want to wait 3 or more weeks for the wound to heal and all staples or sutures to be removed. Check with your surgeon, of course.

Lose 10% of My Hair From Shock Loss After Hairline Lowering?

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

Hi, I would like your opinion on lowering my hairline (I’m female).Dr. ‘X’ in Australia stated that i may lose 10% of my hair from the shock loss due to the new implanted hairs? Why do some say there won’t be any shock loss and others say there will be? It is the only reason delaying me to proceed with the procedure. Dr do you travel to Sydney etc or could give any recommendations? Also would you suggest i get the fox procedure rather then the traditional way? Is there any benefits of this procedure over the conventional way? Thank you. Kindest Regards.

The answer is, “It depends.” If you have genetic female hair loss (which actually usually maintains the frontal hairline in women) shock loss is possible and when it occurs in women, it is rarely permanent. If you are trying to lower your hairline because you have had a forehead/brow/face lift then hair transplants work very well (see Female Hairline Restoration After Brow Lift). If you don’t like how your face is framed, because you were genetically programmed to have a high hairline and have no other underlying medical conditions, then a hairline lowering procedure is a good surgery to fix this. Shock loss is rarely a problem in this type of surgery.

As for the other, FOX/FUE may or may not be a better option for you, again just depending on your reasons for getting it done in the first place. These FOX/FUE procedures are fairly expensive. I would suggest that you send me photographs and tell me something about yourself so I can give you direct advice that fits your agenda.

What Causes a Maturing Hairline?

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

Hairlines changing to mature hairlines are still hairloss caused by DHT right? Would propecia help slow or stop the hairline moving back to a mature hairline? I see some people with no recession at all. I want to be one of those people. If propecia doesnt stop a mature hairline, then what besides DHT causes this hairloss?

Baby SealWhen baby seals (harp seals) are born, they have a beautiful white insulative coat. As they mature, they lose this coat. It’s in their genes. Likewise, for Caucasians, a maturing hairline in present in 95% of men nd it is in their genes (in part due to DHT). Thus theoretically, a DHT inhibitor like Propecia may halt the maturing hair line. You should note, however, I used the term ‘in part’ which means that there are other factors that may be responsible for the change, not just DHT.

There are few points to consider:

  1. Male pattern baldness is not a maturing hair line. Otherwise it would be called a maturing bald line.
  2. Propecia’s effect is best seen to work on the crown of the head and not the corners or the frontal hairline.

Topronil and Hair Loss

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

i am a 50 yr old women and i have just recently started loosing quite abit of hair like in groups of like 10 hairs at each stroke of comb or brush and i was wondering if it would be caused by the drug topronil? not sure if i am spelling it right. it seems that this just started about 1 month into using this drug i cant believe how much i have lost could you please help?

If you saw an increase in hair loss upon starting a medication and there is no ‘need’ for that medication, you should consult with your doctor about stopping it. Topronil, however, does not show hair loss as one of its side effects.

Stress and Propecia

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

Hi Doctor

i’ve been taking propecia for 1 year and a half with no success. But it seems that for me it’ll work in small stretches then when im feeling stressed, ill have a strange feeling in my throat, and any hair ive maintained in a short period of time will fall out. it’s very visible. This is obviously uncommon, does it make any sense? if so is there any prevention for something like this?

thank you so much.

Stress may be central to your problems, but all of what you think you are seeing may not be what is actually there. Work on the stress with some stress reduction process and stay on the Propecia if you really have male patterned balding. This is a wonderful drug to slow, stop, or reverse hair loss in men, particularly for those under the age of 30.

Dishonest Doctors and FUE

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

I have published an article recently in the Hair Transplant Forum International (an industry newsletter, see below) that warns of doctors who perform Follicular Unit Extraction and produce a Follicular Holocaust, killing off many of the hair follicles and then charging the patient as if all of the follicles were actually transplanted. This process is unfortunately more the rule rather than the exception, because doctors just do not count what they actually deliver. This is a double ‘insult’ to the patient who pays for 100% of what the doctor says he is transferring and actually receiving something in the order of 25-50% of that quantity. The second part of the insult is the loss of the hair which may be irretrievably lost from the patient’s limited donor supply for life. So, the surgeons who engage in this process are cheating the patient and at the same time destroying valuable donor hair.

I have just participated in a Regional Workshop for the International Society for Hair Restoration Surgeons where I was one of the faculty, teaching the FUE technique on patient volunteers to some 25 doctors from around the world. A few of the better known self promoted doctors were invited to attend, but they did not take up the invitation. Most of the doctors who attended the course came with an open mind to learn state of the art FUE technology from more experienced physicians who have been doing FUE successfully for years. I learned that the reports of dishonesty that I reported in the article I wrote continue to be a real problem. I received confirmation of what I discussed in the article, which appears to be widespread, over much of the world. I applaud doctors who take formal approved courses to learn or enhance their skills for new technologies by spending the time and the money to come from Korea, Japan, Western and Eastern Europe, North America and the Middle East, but I continue to be disgusted by physicians who would rather develop experience by experimenting on patients and damaging/cheating fellow human beings. I admire the courageous balding people who want to get the benefits of new technologies, but when dishonest doctors promote their expertise with no real basis, they behave like hucksters, only distinguishing themselves from other crooks selling products or services by having an M.D. after their name and a ‘doctor’ for a title. Clearly, for the FUE buyer, the buyer must beware!

Here is the editorial I wrote addressing problems of ethics in hair transplantation surgery, which was published a few months ago in the Hair Transplant Forum International, January/February 2006, Volume 16, Number 1:

Minoxidil 5% Without Propylene Glycol

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

Hi doctor
i am 23 year old, and i am started to use propecia 2 months ago. i am using 1% nizoral once a week with my mild shampoo. i want to order minoxidil 5% without propylene glycol from https://www.minoxidil.com, but is that a safe product ? and when can i be a good candidate to HT?

Minoxidil 5% is a higher concentration formulation, so it may have some side effects as stated in on the product. Minoxidil is a known weak hypotensive agent and it could drop your blood pressure. The higher the dose, possibly the higher the drop in blood pressure. leaving out the propylene glycol should not impact the value or safety of minoxidil, but this is not an area of my expertise (that formulations) so let’s say this is my medical ‘guess’.

With respect to being a “good candidate” for a hair transplantation, there is no way for me to know that without seeing you in person, taking a good medical history, examining your scalp hair for miniaturization, and understanding what your goals are (it’s the old-fashioned way of practicing medicine). Generally if we can predict your pattern of hair loss, understand what your worse case scenario for hair loss might be, and can measure your supply of hair against your worse case need for hair (from a hair transplant perspective), then we can make a recommendation and answer your question about being a “good candidate”. Stay the course on Propecia, as this is the best of the things you are presently doing while you come to other decisions about your hair loss.

Also, always consult with your doctor before starting any medical therapy. I may be a medical doctor, but I am not your doctor and BaldingBlog’s main purpose is to educate rather than providing individual medical advice — I recognize that this is sometimes a fine line.

If I Still Have My Hair By Age 33, Will It Be Unlikely to Lose It?

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

Is it true that by the age of around 33, if no genetic balding pattern has shown much of a sign of appearing it is unlikely that it will appear in a way that will result in major hairloss?

Sean Connery as James BondAlthough this is largely true, it is not a hard fast rule 100% of the time. Sean Connery had a perfect hairline (see update below) in the first of the James Bond movies (when he was in his early 30’s), yet today, his hair loss is quite advanced. His genes kicked in late enough for him to have developed that frame to his face which women find sexy. All of the James Bonds have that perfect, youthful hairline that set many standards for the sexy male image in Hollywood for years.

You need to find out what you have in terms of miniaturization. It would be unlikely that you would bald significantly if: (1) there was no miniaturization of the hair in the front, top or crown at 33, and (2) no one in your family started to bald later than 33. You can check your scalp for miniaturization by mapping it out. If none exists, the probability is that you may never bald, but nothing is ever certain, even for James Bond.

Update: A reader pointed out something I was oblivious to. Sean Connery was bald in his 20s.
From NNDB: “With an especially bad case of male pattern baldness, Connery began losing his hair at the age of 21. Without his toupee, he has been thoroughly bald for decades, except for a small ring of now-gray and thin hair above his ears”

Oops.

Rogaine, Advecia Questions

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

I am female, currently taking Diovan/hct and Synthorid. I have tried Rogaine, however I had a reaction from it (my face became very puffy and swollen). Once I stopped, the swelling stopped. Do you think I would have the same reaction with minoxidil? There is also a product called Advecia. Any feedback on this would be greatly appreciated. The hair loss is so depressing. Thank you for your time

Advecia (according to the search I performed online), contains:

  • Saw Palmetto Extract 4:1 37.5 mg
  • Green Tea Extract 600 mg
  • Phytosterol Complex
  • Beta Sitosteral 125 mg
  • L- Arginine 1500 mg
  • L-Lysine 600 mg
  • Grape Seed Extract
  • Proanthocyanidins 265 mg

Frankly, I don’t have any idea if this works. Your guess is as good as mine.

With regard to minoxidil, the symptoms you listed are known side effects possibly reflecting either an allergy to the medications or an unusual topical reaction to it.