Cicatricial Alopecia

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

Would you please explain what Cicatricial (scarring) alopecia is? What can be done for it if lichen planus caused it? Thank you!

Cicatricial alopecia is one of the two major categories for hair loss (alopecia). It stems from an autoimmune process and is found in many types of non-genetic alopecias. The etiology for the way cicatricial alopecia works has not been well defined.

Included in this group are:

  • Lichen planopilaris: Lichen planopilaris is the name given to the skin condition lichen planus, when it occurs on the scalp. It often presents as purplish bumps or red to purple rims around hair follicles and can be associated with the skin conditions as well.
  • Frontal fibrosing alopecia: This condition is more common in postmenopausal women. It looks a little like androgenetic alopecia, but instead of lots of fine miniaturized hair there are large spaces between hair follicles of normal diameter. A scalp biopsy will reveal many immune cells around hair follicles that are in the process of destroying them.
  • Pseudopelade: This is a form of scarring alopecia that looks like alopecia areata in is general shape. It is not a specific disease but rather a pattern of any old or “burnt out” scarring alopecia, due to a variety of causes.
  • Dissecting cellulitis of the scalp: This condition is characterized by multiple pustules and large cystic nodules in the scalp and can be associated with severe facial acne. This most commonly occurs at the back of the scalp and on the vertex. It is much more common in people of African descent. After years of this condition a scarring hair loss often ensues.

A scalp biopsy can readily determine if hair loss is non-scarring or scarring and therefore permanent. However, determining exactly which scarring condition caused the hair loss can be difficult.

The bottom line is that if you are experiencing hair loss, it is important to see your doctor to determine exactly what type it is and whether it’s treatable. And if it is treatable, to start your treatment as soon as possible so that permanent hair loss may be prevented.

Tags: hairloss, hair loss, cicatricial, alopecia, scarring, lichen planus, cellulitis, pseudopelade, planopilaris

Bald Spot Growing After Getting Hit with a 2×4 Years Earlier

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

My boyfriend is 26 years old. When he was a teenager he was hit by his brother with a 2×4 on the back right side of his head. A scar was there after healing, but only about an inch long. A small bald spot remained there also. About 2-3 months ago we noticed a much larger bald spot there. It is about 2 1/2 inches across now. It is very smooth, there is no hair on it at all. Do you think he needs to see someone about this? I am worried there is something wrong. He just tries to forget about it and is hoping it does not get any worse. I cannot do that. What do you suggest? Thank you

The photo you sent is below (click to enlarge). Thank you for permitting me to post this.

 

If you or your boyfriend feel there is something wrong, then by all means go see a doctor. I viewed the photo you sent and I doubt a new bald spot like that can appear many years after a scarring injury, but it is clearly there… and there for a reason. What that reason is though, I couldn’t say. There are many other medical conditions that may be causing the balding, but a diagnosis-by-photograph is often very difficult to make. Unfortunately, my only suggestion is to have your boyfriend see a doctor for an in-person exam.

Tags: hairloss, hair loss, bald spot, injury, trauma, photo

Using Probabilities to Assess Future Hair Loss

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

Dear Dr Rassman,

Do you use probabilities when assessing future hairloss in a man who has MPB? I’m 23 and on Propecia. Men on my mothers side and fathers side are basically Norwood 7: both of my uncles were Norwood 6. My father is Norwood 7. His father was Norwood 7. My mother’s father was Norwood 7. If you had a patient that has a similar history of balding as me, what would you tell him? Would you say there is a high probability that he’ll become a Norwood 7?

To let you know how much balding I currently have:

I definitely have reduced hair density all over (not actual visible balding yet). There is some slight visible balding in my crown. My hairline is starting to recede past the “mature hairline” area. I’ve been on Propecia for about 1 1/2 years and it’s slowed down the balding significantly but it hasn’t stopped and grown hairs. I understand it might be difficult to answer my question without seeing my hair but any information you provide would be greatly appreciated. Thanks.

There is now a blood test which will look at your genetics to assess your risk for hair loss (see HairDX Genetic Hair Loss Test System). Predicting possibility through a test like this, however, has minimal value in my eyes, because it does not tell you what is happening to you, but it makes it known that you carry the genetic marker. Getting your hair mapped out for miniaturization will tell you what is happening now and it will allow you to follow your hair loss over time and judge the effectiveness of the treatments. Or, why not do both?

As hair loss can skip generations, I couldn’t say what the probability is for losing your hair without an exam.

Tags: hairdx, hair dx, miniaturization, genetic, testing, hairloss, hair loss, probability

Can Shaved Hair Grow Under a Hair System?

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

do you have to be completely bald to wear a hair system? what if you are just thinned out and have a few bald patches? when you shave your head, does it grow back under the hair peice?

Yes, your hair may grow under a hair system. The reason you wear a hair system, though, is because you are thinning or balding… and because of that you may notice less and less growth as time goes on as the natural balding process is ongoing. In addition, some hair systems that use glues or tapes to attach can put traction on your scalp that may in turn put traction to the growing hair and cause them to fall out, possibly permanently.

Tags: hair system, hairpiece, hair piece, wig, toupee, traction, alopecia, hairloss, hair loss, hair growth

In the News – Biotechnology and Hair Loss

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

I have been asked over and over again for updates on cloning and hair regeneration. This San Francisco Chronicle reference is one that reviews the status of where we are today.

But what has biotech ever done for bald people?

Some may feel sheepish raising the question, given the weightier problems needing a scientific fix. Hair loss is not a life-threatening condition, concedes Kaiser Permanente dermatologist Paradi Mirmirani. But half the population, both male and female, see their locks thinning by age 50 – and many can’t take the loss lightly, Mirmirani said.

Read the rest of the article — Biotech turns to hair-loss research

Tags: biotech, biotechnology, hairloss, hair loss, cloning, sfgate, sf chronicle

X-Rays and Hair Loss

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

can MRI or x-rays cause hair loss? i had four mri and two x-rays and full body scan with dye in the last 10 months. thanks

Nope, I don’t believe that magnetic resonance imaging (MRI), X-rays, or even CAT scans can impact your hair and produce hair loss.

Tags: x-ray, xray, hairloss, hair loss, mri, cat scan

My Crown Is Starting to Thin and I Want to Thicken It Up With a Hair Transplant

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

i know from reading your other entries that proscar doesn’t “cure” balding but i’m noticing some serious hairloss lately and i read something in the blog about a guy that “doubled” his dose to a half pill a day…. do meds work that way? will it help? could it help?

also i am thinking about getting a hair transplant. couple things i’d like to know

– i’m not really bald but my crown is thin, is it possible to just thicken it up and kind of blend it into my hairline. in otherwords anticipate the loss most likely to come.
– i keep the top of my hair longer but shave the sides to about 1/4 inch. would the scar be visible provided the job is done well.
– approximately how many graphs would i need to fill in a thin crown? I know it’s hard without seeing a pic, but just an idea..

Thanks a million your site is amazing!

Firstly, Proscar is 5mg of finasteride, Propecia is 1mg of finasteride. The recommended dosage for treating hair loss is 1mg. I would seriously consider not taking more than the 1mg dosage… 1.25mg at most. And I only say 1.25mg because some people will buy the 5mg pill and cut it into 4 parts (easier than cutting it into 5 equal pieces) to take 1.25mg daily. Taking two 5mg Proscar will likely produce substantial side effects and have no more value than the 1mg dose.

You don’t want to have hair transplant surgery without determining where your hair loss is likely to go. You have a limited donor area to harvest hair from and if you use it all up early on and continue to bald in more visible areas (such as the frontal region) then you’ll be out of luck. Miniaturization mapping over time will give a likely path to where your hair loss is at and where it is going to end up. Age plays a role as well.

If you had a FUE (follicular unit extraction) transplant, there would be small dot scars on the back of the head and keeping the hair short would not show any significant scarring. If you had a FUT (follicular unit transplant) strip procedure, you may see a linear scar in the back of the head if your hair was very short, but to what degree really depends on how you heal, skill of the surgeon, etc. Without seeing the area, I couldn’t estimate the amount of grafts; I’d need to know your hair color, hair characteristics (wavy, straight, fine, etc), and whether you’re even a candidate for hair transplantation.

Transplants should never, ever be used to build up what you may lose in the future. Plus, I need to point out that finasteride works quite well in early hair loss, particularly in the crown. It is very possible that you can avoid surgery and just take a daily pill — you will know in about 8 months if it is working. I would look into this by seeing a doctor. Propecia (finasteride 1mg) is available by prescription only.

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

Resuming Activities After FUE

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

Good site…I had a strip procedure(5080) Feb./06…Pretty good results…I recently went back for a Fue procedure(1050) to touch up the middle, temple and on a part of the scar from the previous strip…

  1. How long should I wait before working out and running?
  2. How long does it take for the newly implanted grafts to settle in their new home?

Thanks and keep up the great work in helping others..

Thank you for the compliment. Where is your doctor? He/she should’ve supplied the answers to your questions as a matter of routine. These are the most basic of questions that should have been explained to you before your surgery.

To answer your questions:

  1. You can generally resume exercise after one week and you can run a marathon without difficulty (not to say that hair transplants will help you run better, but you get the idea). I always restrict heavy lifting, weights (under 40 lbs with proper lifting techniques), sit-ups, and pull-ups.
  2. Most grafts are relatively secure after a day or two.
Tags: fue, hairloss, hair loss, hairtransplant, hair transplant, activity, running, exercise

How Merck Marketed Propecia

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

I found this article from Harvard Business School published a couple years ago about how Merck marketed Propecia to consumers. Pretty interesting stuff and thought you’d enjoy it if you haven’t seen it before.

Side Effects: The Case of Propecia

Interesting article — I don’t recall seeing it before. Thanks for sending it to us!

This illustrates the very stringent rules imposed by the government on how drugs are marketed. It is a drastic difference to the unregulated field of herbal potions and lotions that are marketed to desperate consumers looking for a quick solution to hair loss. As such, many men will have no problem spending $19.99 or $29.99 on products that “promise” to deliver hair growth, as they have nothing but a few bucks to lose (small change). Yet these non-medical supplements that do not really work bring in millions upon millions of dollars in revenue. It is a buyer beware market.

Tags: merck, marketing, market, propecia, proscar, finasteride, supplement, hairloss, hair loss

Are Propecia Side Effects Just In My Head?

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

Is it possible that the side effects from Propecia are just in my head? I was prescribed Propecia in December of 07′ and within two weeks of taking it, I began to feel a loss of libido. I decided to push on and take the medication for another month and see if the side effects. Within a month, I no longer had an erection in the morning (which was something I would experience every day prior to taking the medication) and intercourse became somewhat boring. All the while, the only information I could find was negative information about men complaining about their sexual side effects.

I stopped taking the medication, and within a week, I began to regain my libido. I did not notice any increased hair loss from stopping the medication either.

Do you think its possible that these sexual side effects were caused by my self-conscious or does that sound like the typical event of the sexual side effect one receives from Propecia.

Thanks!

The power of suggestion and the placebo effect are well documented phenomenon. If you think it is going to happen or are worried it may happen, it just might. Propecia does have a side effect of decreasing libido by 1 to 2% and increasing libido by as high as 10%. If you need to focus on something, worry about a high libido and see what happens. I can’t say for sure whether you experienced side effects form Propecia, but if you only stopped the medical for a week you will likely not see any increased hair loss just yet. With some significant time being off the medication every day, you’ll surely see the benefits disappear.

Tags: propecia, finasteride, hairloss, hair loss, libido, placebo

From the Wall Street Journal — Name Brand Pills, Placebos, and the Power of Suggestion

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

“Call it the double-placebo effect.

In a provocative 82-patient study, researchers at MIT found that a dummy pill carrying a $2.50 price tag eases pain much more effectively than an identical pill that patients believe costs just 10 cents.

The results may help explain, among other things, why some patients report worsening symptoms when they switch from a brand-name drug to a cheaper generic version of the same medicine, principal investigator Dan Ariely tells the Health Blog.“

WSJThe above is a snippet from an article in the Wall Street Journal’s Health Blog about placebos. While the article doesn’t specifically mention any hair loss medications, I think we all know that it definitely applies here. It goes to show the power of suggestion and is quite an interesting read.

Full article: Placebos Might Work Even Better With a Brand Name

Tags: wsj, health blog, placebo, pill, hairloss, hair loss, wall street journal

I’m Numb Above My Surgical Donor Site

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

please take a moment to reply? i would very much appreciate it! i had a ht and it is 3 weeks later and the area above the donor area is still devoid of ANY feeling for about 6 inches wide and 2 to 3 inches upward! i am worried that the surgeon cut too deeply or incorrectly and has damaged nerves. i can’t find anything about this on the internet which tells me i am dealing with something unusual. have you heard of this? and if so, how long before i regain feeling back there? thank you so much for your reply!..

I would think that you either have some nerve swelling or some nerve damage. Nerve swelling usually resolves in weeks and on occasion within months. Upon examination, the doctor may not be able to tell the difference, but several examinations are probably indicated. Definitely ask your operating doctor about this.

Tags: hairloss, hair loss, hair transplant, hairtransplant, donor, nerve damage, nerve swelling

Using a Conditioner the Contains Minoxidil After Hair Transplant

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

Hello,

I have heard of a hair conditioner that is good to use after hair transplant procedure. It contains 2% minoxidil along with wheat germ and jojoba oil along with other ingredients. Are you
familiar with this product and where to obtain it?

thank you

No, I am not familiar with the product. The use of minoxidil with conditioner means that much of the minoxidil will be washed away. I would suggest using a 5% minoxidil after the shower to get the best value from it.

Tags: minoxidil, conditioner, hairloss, hair loss, hairtransplant, hair transplant

LaserComb is a Direct Threat to Your Practice, Where You Charge Thousands of Dollars

/by William Rassman, M.D./7 /,

Read your blog questioning the LaserComb. I have been using it for a year and have had substantial regrowth. I can understand why you want to sow doubt in peoples’ minds. This $575 device is a direct threat to your practice where you charge each patient thousands of dollars. Why don’t you also note that there is a 20 week return privilege?

LaserCombThat’s great for you! I am publishing your comments since you claim the LaserComb had value and I believe that sharing your experience with others is important. I wish I would receive more such positive comments about this type of technology and maybe your “insightful” note will get others to write about their experiences. I don’t think that you should be angry with me for voicing my opinion, as I am not angry or threatened by yours. I find it funny that some anonymous people feel they need to attack me for voicing an opinion on my own website. Unless you’re an employee with the manufacturer or investor in the product, I don’t understand why you’d be so personally connected that you think you need to defend it.

I’m trying to keep an open mind that it may work, and if I see good firsthand scientific proof that it works, my attitude can change. I have two lasers in my Los Angeles office for patient use and I’m unfortunately just not seeing any substantial growth in those patients that use it. I am not so ready to believe in a cure that may not be there and I don’t want to produce hope that is hollow. That is why I allow my surgical patients to use the laser at no charge so I can get their feedback on its value. We take photos of some laser patients periodically to note whether it is effective or not over time. Most people are ‘iffy’ about its value as they report it to me, and the pictures I have viewed are not showing much change over time. Do you know many doctors who have a $50,000 laser in their office and do not charge for its use?

Tags: hairloss, hair loss, laser, laser comb, lasercomb, hairmax, hair growth