I Bathe Daily, But Without Washing My Scalp

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

Dear Sir,

I moved into Hyderabad about an year back. They say that the water is hard here. I take bath with hot water daily, but not on scalp.

I had always had a dandruff problem and i applied nizoral, and the problem was in control. From about 7 months back, I am experiencing hair fall, about 15-20 strands each time I brush (even with a soft comb). There are dry scales on the hair. I have tried consulting doctors who say this may be due to psoraisis, and I am taking homeopathy medicines – psornium-200 daily, besides nizoral – 2 a week, 2 a week propysalic (a steroid having salicylic acid).

There is no signficant relief. Please advise if I should go for a trichoscan, if it helps.

I used to put coconut oil on my hair earlier, but not after moving to Hyderabad. Please advise…

ElephantsIf you are not washing your hair, you are probably building up considerable dead skin (what you are calling dandruff) and waxy debris. When you brush it, this debris may be anchored to the actual hair shafts. This will result in hair appearing in the brush — more hair than one might expect if you washed and used a hair conditioner for it. This would be the most likely cause of your hair loss. When you feel the ground shaking and see a herd of charging elephants coming your way, the first thing that should not come to your mind is an upcoming thunder storm.

Tags: hairloss, hair loss, dandruff, dry skin, scalp

FUE Candidacy Just By Looking At Photos

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

Hello Dr. Rassman,
I was wondering if it’s possible for you to determine based on the photographs if I can be a candidate for FUE procedure and quote at least approximate cost of it. I’ve been slowely loosing my hair for about 10 years now, and it’s started to get quite visible in the past 3 years or so. I’ve been on Propecia for over 6 months now, but it obviously hasn’t regrown my hair back (it’s might have slowed down the process). I am considering a FUE procedure in about a year or so, but can’t locate pricing for it to estimate my budget. If that’s something that you can do, let me know what type of pictures you would need.

If you send me good digital photographs, I might be able to give you are overall estimate for FUE grafts. Candidacy depends upon the demand / supply relationship. Too much demand and not enough supply are the enemy. We are seeing that most people (95%) can have this procedure done if the clinical indications are there. See The Truth About Cheap Hair Transplants for more.

Tags: fue, follicular unit extraction, hair transplant, hairloss, hair loss

How Soon After 1st Transplant Can I Have Another?

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

after 2,360 graft transplanted . . . how soon could i have the second session. months?

I generally tell patients to wait a full 8 months so that they can see what they got. Prior to the first transplant, the patient has little real appreciation for what is going to be done and what he will look like. After 8 months (post op), the patient for the first time can appreciate what he got and what any disappointments may be. Often it is touch-ups (some want more bulk and thickness), and other times it is another area that becomes more important after the first area is hairy. Do not rush the second transplant. Take your time and now you can take control of what is happening to you

Tags: hair transplant, hairloss, hair loss

Propecia and NutraSweet Products

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

NutrasweetI am a male of 39 yrs old with Norwood scale 3 vertex. Have been prescribed propecia and am taking propecia for 8 weeks now but I see no effect.

I have read on the internet that if one is taking propecia to stop hair loss and consuming nutraweet products (artificial sweetner)at the same time than the nutrasweet makes the propecia ineffective because the nutrasweet converts to something in the body which does not allow the propecia to work. Please let me know what you think as I trust your opinion on this much discussed topic.

I looked it up and could not find anything on it. Essentially, I don’t have a clue. Can you send me a point of reference?

Tags: hairloss, hair loss, propecia, proscar, finasteride, nutrasweet

If I See White Bulb on the End of Falling Hair, Does That Mean It Is Lost Forever?

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

I am a 22 year old male. I have noticed more shedding than usual in the past months. When I look at the individual hairs, there is definitely a tiny white follicle on the end of each one. My question is, since there is a follicle on the end of the hair that has fallen out, does that mean more hair can never grow back from the location it fell out in? Thank you for your time.

The white dots you see at the end of the hair shaft do not necessarily mean your hair will never grow back. That is not the way we diagnose hair loss. When you pull on normal hairs, some will come out with a white dot on the end. This is normal, but the key is how many hairs came out with such a pull. More than 10% would be abnormal, requiring an expert to evaluate you (see FPNotebook.com – Hair Pull Test).

Tags: hair loss, hairloss, bulb, white dot

First Six Months After My Transplant Was Textbook, Then It All Thinned Out

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

Dear Dr. Rassman,

I am beside myself. I have tried everything including minox and proscar to no avail. I held out transplants as my last resort to save my hair. However, after my first transplant, though it seemed it was text book up to six mo., after this, it began to thin back out as if it were my normal scalp hair!My transplants were done by a well known surgeon here in San Diego.

My Doc had no answer. My drmatologest thought it might be inflamation but was not 100% sure. Thinking it was a fluke, I opteted for a second transplant in the same area, and the same thing happened! What is going on? Is there anything I can do?

I did have dermatitis prior, durring, and after the transplants, and was battling some infected teeth, which unbeknownst to me were sending out low level infection to the rest of my body for years.

I am in good health otherwise.

Have you seen this before? Do you have any answers, or can you recommend anyone who could address this situation?

I really do not know where to turn to next.

Thank you for your help.

Firstly, I must restate that BaldingBlog is not intended to establish a medical diagnosis or offer a second medical opinion. Furthermore, I do not have the benefit of seeing you in person. Now with that being said, I can answer this in a general way.

If a hair transplant fails or is associated with hair loss, we can attribute it to two generalized causes:

  1. Poor technique and human error (not in your case, because you reported that everything grew out and was good for 6 months).
  2. Medical conditions that you acquired or that you did not know of that contributed to the hair loss.

I often stress the importance of measuring the miniaturization of scalp hair for the correct diagnosis and quantifying the degree of miniaturization so that if something like this were to occur, another measurement would be helpful in rebuilding a picture as to what happened to cause the hair loss.

I have had one patient tell me a story like you just told, but I believe that not enough time passed for me to draw conclusions on the matter.

Tags: hair transplant, hair loss, hairloss

Adult Stem Cell Hair Restoration

/by William Rassman, M.D./5 /

I wanted to know if there have been additional advancements in somatic (adult) stem cell hair restoration, aside from the constantly echoed article from 2004 regarding Stem cell Hair Growth by the U. of PA.

“It crosses a moral boundary that our decent society needs to respect. So I vetoed it,” US President George W. Bush said of the research that involves tiny human embryos.

Hair cloning may not involve human embryos and it likely will not have any moral boundaries, but from my understanding it has not progressed to a point where you will directly benefit from it. All attempts to push human hair stem cells to invoke a new hair are inconsistent. I hear yields in the 10% range for successful hair product this way, which is much better than the 1% of olden days, but a long way for a replicable process.

Tags: hair cloning, stem cells, hair growth, hairloss, hair loss, cloned hair, somatic stem cell

How Can I Tell If My Hair Loss is MPB or from Accutane?

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

Comments of Accutane inducing hair loss raised my concern. I’ve been through two sessions of the drug, the first round 5 years ago and the latest last year, and have experienced recession of the hair-line. Attributing the hair loss to genetics, I began splitting Proscar (Finasteride) tablets 3 years ago. Since then, progression of hair loss at least isn’t significant, but may still be worsening. Photos from years ago are difficult to compare to the present. If the hair loss I’ve noticed is along temples in the normal MPB fashion, could the problem be a result of Accutane? If Accutane were the culprit, wouldn’t it cause an overall thinning of scalp and not be so localized at the temples? Further, if the balding is from Accutane, is Finasteride a proper treatment?

Thanks!

DuckIf it quacks like it duck, it probably is a duck. If your hair loss is in the pattern of Male Pattern Baldness (MPB) and there are characteristics typical of MPB miniaturization, then your hair loss is probably be due to MPB. Hair loss from Accutane may persist after stopping the drug and may precipitate patterned hair loss in men and generalized decreased hair bulk in men and women.

To have a correct diagnosis, you need your scalp hair evaluated for miniaturization and be able to quantify the “thinning” or the hair loss. It is the best way to follow the effects of finasteride.

Tags: hairloss, hair loss, accutane, finasteride, propecia, proscar, mpb

I Only Took Propecia Every Other Day for a Few Weeks

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

I have been on propecia for a little over three months. For a couple of weeks I would take it every other day? Will this effect me in any particular way?

The standard dose for Propecia (finasteride 1mg) is one pill once a day. This dosage has been shown to give the best benefit for male pattern hair loss. Propecia has a relatively short half life (the time it takes half of the drug to leave the blood stream). Thus, by the end of the first day, all of the drug should be out of your blood stream. If you take it every other day than you go one day without the effect of the drug. I cannot say how taking Propecia every other day would affect you, other than to assume that you would not benefit from the drug as originally intented.

Tags: propecia, proscar, finasteride, hairloss, hair loss

Senile Alopecia

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

I’ve been searching your wonderful blog for treatment information on what is apparently termed, “Senile Alopecia.” My still beautiful mother at 84, may be experiencing this. She has been having a rather sudden increase in overall hair loss. Her scalp is showing through mostly on top, but also in the back and sides. I’ve copied your suggestions for possible medical causes in younger women. Once those are eliminated, is there anything at all that might halt this fast progression to almost total balness? Thank you so much for your help.

Senile alopecia often refers to generalized thinning or alopecia. With women, the female hair loss that we see on over 50% of post menopausal women, is a diffuse alopecia. We see this condition in 1% of men in their 20s. If the medical causes are not there and blood testing has cleared your mom of the the various causes of hair loss, then female genetic hair loss is probably the diagnosis. When it is referred to as senile alopecia, it generally means that the victim is elderly. It’s bad terminology. In the case of your beautiful 84 year old mother, simply put, she may be outliving some of her hair. Also see NHI Frequently Asked Questions.

Tags: hair loss, hairloss, female, woman, women, senile alopecia, alopecia, senior

How Much Avodart Do I Take?

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

I am a 23 year old male and beginning to notice hair thinning and receding hairline. I have been on propecia for 8 months but my hair loss is not stopping at all. I want to switch to Avodart before it’s too late. They only sell it in 5mg. How do you prescribe it? Do you suggest one 5mg once a day? thank you.

I do not have the answer to your question, because effectiveness studies have not been done on an official scale. Also, the drug’s half life is about 5 weeks for blood levels (Propecia is 5 hours) so the drug hangs around for a long time. Those doctors who use it admit confusion over dosing, so it is a guessing game. Is 0.5mg too much? That would be my guess as the best dose, but should it be taken every day, or once a week, or once a month? Perhaps your guess is as good as mine. With Propecia, we know the answer!

Tags: hairloss, hair loss, avodart, dutasteride, propecia, finasteride

Using Mederma on Donor Scar

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

Mederma is proven to make scars softer and smoother, and I was just wondering if I used this on my donor scar, would it impact any hairs from growing through my trichophytic closure?

I know that many people believe that Mederma works well for softening scars, but I can’t say for sure as I have no direct experience with it. That being said, however, I do not see any problem with using it on any donor wound in the healing phase after a week or so.

Tags: hairloss, hair loss, mederma, trichophytic closure, hair transplant, donor scar

Heradone: Hair Growth Fertilizer or Snake Oil?

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

Can you tell me if this new Heradone product has any value? It sounds like an ad for another snake oil, but it appeared in Google News when searching for hair loss news so I wanted your opinion.

Bodybuilder / BallerinaThe claims of the producers of this product are: “New Hair Loss Solution That Promotes The Natural Balance of Your Scalp While Stimulating Blood Flow To The Root Of Your Thinning Hair!”

There has never been any evidence that increasing the circulation to the scalp increases hair volume or numbers. The reason that balder people have less circulation to the scalp is because there are less hairs and those that are there are smaller needing less blood flow, so the body only supplies what is needed to support what is there. Our body is very smart when it comes to that. The muscles of a bodybuilder have more blood supply than that skinny, flabby guy at the beach who never exercises. That is because the bodybuilder’s body (muscles) knows what is needed. The same is the situation for runners, bikers, swimmers, etc…

I find claims like ‘natural balance of your scalp’ are ridiculous. It uses that claim on the product’s website. Does that mean that the scalp is balancing something like what a ballerina would be doing when she is up on her toes? What does natural balance mean?

Just reading the press release should be enough to give you the answers you’re looking for — there’s no doctors mentioned by name, yet they exclaim “medical experts say [Heradone] is packed with natural vitamins and nutrients.” So they are experts, yet none can attach their name to the product? I guess just taking a look at the Heradone website answers the final questions I’d have —

“These products are not intended to diagnose, treat, cure, or prevent any disease.”
Yeah, that sounds about right.

“The individuals shown are paid models, and not necessarily Selmedica Healthcare customers.”
Exactly.

Remember, buyer beware.

Tags: hairloss, hair loss, heradone

Protopic Ointment for Moustache Hair Loss?

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

Hi, Recently I start having a problem of moustache hair loss. I visited a dermatologist last December and he prescribed me a topical ointment called PROTOPIC 0.1%. I’ve been applying it twice a day for the past six months but it doesn’t work all. I even discovered other new spots coming up. This week I visited the doctor again and he told me that he can not help me any longer and it is beyond his ability. Shocking! He suggested to try a medicine prescribed for a regular skull hair loss but he said it will damage your face because it is more sensitive. I did not want to take that risk and add another problem but I still feel like there should be a solution somewhere somehow. Anyway,I am so frustrated with the medical profession here in US. I found your website from the internet and I’m asking your help. How about the ointment he prescribed for me? Is it something well known and effective? If so, for how long I have to apply it before seeing results? What is exactly the cause?

The practice of medicine is not an exact science. That is why it is called a “practice”. Sometimes doctors do not have all the answers.

Protopic (tacrolimus) ointment is indicated as second-line therapy for the short-term and non-continuous chronic treatment of moderate to severe atopic dermatitis (AD) in non-immunocompromised adults and children who have failed to respond adequately to other topical prescription treatments for atopic dermatitis, or when those treatments are not advisable. [source: protopic.com] It is my opinion that Protopic will not address your hair loss unless your hair loss is related to atopic dermatitis.

If you are losing hair, you may consider visiting a doctor who can view your hair on a microscopic scale (under a densitometer) to see if there is a pattern of miniaturization. Is there hair loss in the scalp as well? Do you have spots of hair loss in the scalp or in other hairy parts of your anatomy. The presence of other such areas may indicate other local skin disorders such as alopecia areata. I can not write a text book here, as I don’t have the time — but find a good doctor. They are out there.

Tags: protopic, ointment, tacrolimus, hairloss, hair loss, moustache