Why Might I Have an Itchy, Sore Scalp?

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

I am an African American woman and my scalp started itching on and off about 2 months ago mainly in the crown area and the front area, then my scalp became sore for a day or 2, then I noticed, I didnt become bald, but my hair in the crown area and certain parts of the frontal area looks like it broke all the way down and left about 1 to 2 inches of hair in certain spots. This has happened to me about 2 years ago. But the hair always grew back. Can you tell me why this happens and what I can do to prevent it?

There is no way to tell what is happening with your scalp or hair without a physical examination. Usually if you pull or scratch your hair enough it will break off at its tip. It is sometimes a compulsive act. This condition is known a trichotillomania. But if the root (pardon the pun) of your problem is an itchy scalp you may have a local dermatitis or ring worms (fungal infection) or hundreds of other causes. BaldingBlog is not meant to be a substitute for medical advice or second opinions. You should see a medical doctor if this problem persists.

Tags: scalp, itch, trichotillomania

Balding In a Young Man

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

Hey I am 18 years old male college student and have curly hair (greek Like). I have noticed of late that my hair is thinning, getting split ends, and around the left side of the crown it is noticibly thinning. This started about 8 months ago and has been getting progressivly worse. It tends to just rip out when I comb it. Also i feel a tingling where it is thinning. No balding is seen but thinning. Also I am a swimmer and that causes my hair to be thin, but not fall out and i have never had this happen before, as well as thyroid issues in my family(dad, Grandma, aunt). Could this be a factor in this balding and what can i do to stop it? Please my hair is beautiful (greek like) and one of my nicer attractive qualities. i need to stop it, regrow it and or fix it.
Thanks

Genetic hair loss is the most common cause of hair loss in men your age. You need to have your hair mapped out for miniaturization to determine if you have the early genetic hair loss starting. If so, then appropriate treatments may be drugs like Propecia. Do not pull your hair when combing it. Use wide tooth brushes that do not pull the hair out. If you have early genetic balding, rough brushing or combing will accelerate the hair loss (hair bulk) that you are experiencing.

Tags: hairloss, hair loss

Transplanting Hair Into Scar Tissue

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

If you transplant hairs into a scar, is it true that the scar gets worse before it gets better?(does the scar stretch before the scar actually has hair growing)? If so, does it eventually get better?

Disguising a scalp scar with hair transplants is an ideal procedure that is often done at NHI. There are other factors involved such as:

  • the location of the scar
  • your hair shaft thickness and the scar thickness
  • the contrast of your hair color to your skin color to minimize the appearance of the contrast
  • the character of your hair (wavy, curley, straight)
  • the length of your hair (very short hair will require more densities than longer length hair)

It is not true that the scar gets worse from a scar transplant and then gets better, nor does it stretch from getting hair placed within it.

Tags: hair transplant, scar, hairloss, hair loss

FUE vs Hair Multiplication

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

Sorry to bother you about my small scar again, but I have been doing a lot of research about Follicular Multiplication, and I have read that it is a lot like FUE, except they do not extract the whole follicle.(So the extracted hair will grow back). I was just wondering if that might be an option for me, becuase I have a very small scar on my scalp, and I would really like to fill it in with a small hair transplant, but I am afraid that the transplant will cause more damage to my hair than the scar is to begin with.

I don’t know what to do, because it is so small, but it bothers me, and I would really just like to get it repaired, but I don’t want to cause any damage to the rest of my hair.

An FUE procedure will not damage your scalp or hair. Hair multiplication is experimental and probably will not work. There are a number of companies like Aderans and Intercytex trying to induce formation of new follicles. Most researchers would accept anything, whether it be follicular neogenesis or rejuvenation or stem cell yields, or anything that will make a new hair, any way it comes. Unfortunately, this technology is probably years away, still.

Why not just fix this small scar if it is so bothering and get it behind you?

Tags: hairloss, hair loss, hair transplant, fue, scar, hair multiplication, follicular multiplication

Neurontin and Hair Loss

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

Hello,
I am female and 45. I was on Neurontin for nerve damage and most of my hair fell out quickly in clumps after being on it for about 3-4mos. I assumed the medication did it but then I had a biopsy and a diagnosis of alopecia due to either Telogen Effluvium or Andrognetic. At this point, one year later, I have very little hair and I am not sure if it is growing back or not. Do you have any thoughts on whether this is an accurate diagnosis and what my chnces are for my hair to grow back? Thanks

It is difficult to second guess your diagnosis without a proper physical examination. Neurontin may have been a factor in your hair loss. Generally when hair loss occurs due to a trigger (such as stress, hormones, drugs, age, etc) it is impossible to tell if hair will return even if the offending trigger is removed. Hair loss is not an exact science. Scientists still cannot define and pinpoint the exact cause of hair loss.

Tags: hairloss, hair loss, neurontin

Adderall and Hair Loss

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

If adderall does cause hair loss, then what is the explanation behind it? i.g. lack of blood flow to the sclap, increase in stress hormones?

Thank You

This drug is both a neuro-stimulant and an appetite depressant. When it causes hair loss (side effect) the mechanism may be related to the weight loss that follows and could be nutritional. It could also be a direct effect of the drug on hair growth.

Tags: hairloss, hair loss, adderall

Doctor Said FUE Would Leave Detectable Scars

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

Hi, I am sixteen-years-old, and I just recently went to a consoltation with my parents to address the scalp scar, (non-transplant)that I had wrote about in a previous post. The doctor has been doing hair restoration for over 30 years and he seems to know what he is talking about. Well, my question is this, I went into the office thinking that he would recommed the FUE procedure to fill in this scar, but instead he told me he would be using FUT. He said that he would use a trichophytic closure and that the small scar he would make would be virtually undetectable. I asked him why he wouldn’t use FUE, and he told me that he performs this procedure, but he said that it would cost me twice as much and it would leave me with little scars that would be even more detectible than the trichophytic-closed scar. He said that my scar would require 50 unit grafts, and that this would be no problem. I just wanted to know your opinion. Does this doctor sound correct?

-P.S. My parents and I would really like to know, because we want to get the best treatment possible, and we need some advice. Thank-you

Either FUE or FUT will do the job. This doctor may not be comfortable with FUE, but it is not a procedure that produces any socially-detectable scars. In other words, FUE will not produce a noticeable scar (less than 1 mm punctate scars), versus a small, barely noticeable linear scar with FUT. The choice is yours. Although the FUE is often more expensive, I doubt that 50 follicular units would be an appreciable difference in costs.

As you are local to my Los Angeles office, if you and your parents are looking at options and would like a free consultation with an NHI physician, you can call 800-NEW-HAIR to schedule an appointment or visit the NHI site to request more info.

Tags: fue, follicular unit extraction, scar repair, hair transplant

Miniaturization Mapping After Hair Treatments

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

I think that mapping for miniaturization, “mini mapping”, is a great idea, nevertheless, this raises a very pertinent question: Can miniaturization be accurately diagnosed if drugs such as Propecia, Avodart, and / or minoxidil have been successful in treating MPB since these drugs may have thickened the hair, thereby making the once thin hairs look more like larger terminal hairs. Thank you for your time as this blog must be quite time consuming.

Measuring miniaturization of hair is a great way to quantify the change of your scalp hairs’ health over time It is obviously best to record the degree of miniaturization before a treatment is started, but it is never too late. If you have access to mapping your scalp hair for miniaturization, then it is my opinion to have it done to keep a record of your current state of hair health. Progressive deterioration or improvement can be measured giving you an idea where you are heading.

You are correct in stating that a successful treatment for male pattern baldness should reverse some or all of the miniaturization. The more successful the treatment, the better the assurance that you are on the correct path. Wouldn’t be nice if, for example, if you had 80% miniaturization in the crown before treatment and then after treatment it dropped to 30%?

Tags: hairloss, hair loss, miniaturization

Transplant Scar Width

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

Are all the modern hair transplants now performed with a scar that is 2 to 3 mm in width? If I felt around my head for the scar, would I be able to feel it? If I used mederma for the first 3 months or so, do you think the scar would be softer and smoother, and thus less obvious when you feel around for it?

Most scars following a hair transplant in the competent hands (your doctor is in that group) will fall within the 2-3 mm width upon healing.

I am not sure if Mederma really works since I do not have direct experience, but I do not believe that there is any harm to using it. You can read previous posts on Mederma here and here.

Tags: hairloss, hair loss, hair transplant, scar, mederma

Depressed and Hopeless 21 Year Old Female Losing Hair

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

Hello,
Im a 21 year old female and I have been experiencing an excessive amount of hair loss for the past 2 and a half years. Although I’ve never had a thick head of hair, I always had just about normal hair. I never experienced so much hair loss untill I started college. It is so bad that I can see my scalp all through out the crown of my head. During the first year of experiencing this, I had a blood test by my physician, but they said everything seemed to be fine. I then began taking vitamins, such as biotin and other hair vitamins. Balding is hereditary from my moms side, she has it as well, yet she only began to experience it during her mid 30’s. I recently saw another dermatologist who told me the best thing is to use minoxidil, and I did. Still, no results and it even seems like it got worst. I feel extremely depressed and hopeless, PLEASE, HELP!

Since you have had all of the blood work that will rule out a medical cause for hair loss and you already have seen a dermatologist, your next move is to find a doctor who can map your entire scalp out to evaluate the type of hair loss pattern that you have presently. From that information one might be able to predict what may happen to you. If you are a candidate for hair transplantation, then he/she will let you know. Minoxidil takes 8-12 months to see an impact, so make sure that you wait that out.

Tags: hairloss, hair loss, female, women, woman, minixodil

Cutting Proscar

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

Dear sir,

when using proscar for hair treatment by cutting it into quarters, you will have 1.25mg per quarter, does that induce a risk of an overdose ?! and does getting the pill out of its cover affect its efficacy ??! because it will stay out for four days before taking it!

thank you

Cutting pills is not a precise science. Cutting a 5mg finasteride tablet in quarters will leave you with 1.25mg pieces if it is perfectly cut. Even if you account for the small fragments and powders that you discard, I suspect it will still be over a 1mg dose which should not have any adverse effects on its efficacy. Furthermore, cutting the pill should also not affect its efficacy. It would be ideal to cut it is 1/5ths but that is difficult and becomes impractical.

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

Sarcoidosis and Hair Loss

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

i have sarcoidosis. my hair is starting to fall out. i’m 29 male. please tell me if it will grow back

There is no way for me to know that your hair will grow back. You need a good medical examination and a correct diagnosis. Sarcoidosis is a multisystem disease of unknown causes. It affects more women than men. It affects all organ systems including the skin, which may contribute to hair loss. While sarcoidosis may be a factor in your hair loss, you may also have male pattern hair loss. There is no way to tell unless you get your hair mapped out for miniaturization and then follow-up with your doctor for his/her interpretation of that mapping pattern.

Tags: sarcoidosis, hairloss, hair loss

I’m Suddenly Losing Pubic Hair

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

I am a 58 yr old female, went thro’ menopause at 46 and have lost underarm hair for last 5yrs or so.Scalp hair has never been thick but adequate but suddenly losing pubic hair. I look quite young for my years, live quite stressfull life, eat quite healthily (protein comes from fish, eggs and cheese, not much red meat). Take minerals, antioxidants, 0mega3 oils,drink 2to3 alcaholic drinks daily and 30mins brisk walk daily. Low blood pressure, sedentary job,slight muscle weakness right side of heart, possible IBS. Any ideas?

Sometimes sudden loss of pubic hair or scalp hair may be a sign that you may have a medical condition that you are not aware of. You should see a doctor for a full medical work-up.

Tags: hairloss, hair loss, pubic

Was My Transplant a Failure?

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

Hi Doctor,

I had my transplant on 6th july this year. I managed to go through good post-operative care for ten days but on the 12th day, I started getting rid of my scabs by gently rubbing my scalp even when it was dry. That was basically because I misunderstood my doctor who actually told me to gently press scalp at times of any itching. So everytime the scab fell off I saw a hair attached to it too and in rare cases there wasn’t a hair to it. I still have many transplanted hair left on my scalp and I am currently 20 days post-op. I have doubts that I have possibly dislodged my grafts and I am afraid my transplant may result in a failure. Incase if I have dislodged some grafts, will this affect the grafts which have not been dislodged. And is the presence of graft noticable on the scalp with a naked eye?

I am well aware that I shouldn’t have done the rubbing on dry scalp but does that mean that I have made a BIG mistake and there is no point in expecting the new hair growth at all?

I believe you are overreacting. If everything was good for the first 10 days, there is little possibility that you lost any grafts/hair. What you are doing is shedding the hair that was transplanted. It will go into a hair cycle of telogen and then ‘wake-up’ and start growing at about 3-4 months. This is normal and certainly nothing that you’ve said in your email indicates that what you did will have any negative long term impact.

Tags: hair transplant, hairloss, hair loss, scab, aftercare

Taking Propecia for a Long Period of Time

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

Just out of curiosity, have many of your patients spent an extended time on the drug Propecia? For a younger man considering beginning treatment with this medication, the idea of being on it for decades can seem a bit daunting. That, and the lack of clinical studies beyond 5 years, make me a bit wary. Just curious about any personal experience you have with individuals using the drug for longer periods of time (I realize this does not have the validity of an actualy scientific study).

I have seen many patients that started taking the drug prior to its official US FDA release, as they went to Mexico to get it. They have been taking it for about 10 years with no negative impact to them. The focus on the 5 years of data that the drug company published is the wrong focus. Would you rather be bald? That may be the choice here.

There is strong evidence that this drug will reduce the incidence of Prostate cancer. That would suggest long term use is probably a good idea. Preventing prostate cancer and keeping your hair should be better than being a bald person with prostate cancer. Your choice again.

Tags: propecia, finasteride, prostate cancer, hairloss, hair loss, fda