Pseudopelade Remission?

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

How can one tell if pseudopelade is in remission ? If in remission, must medication continue ?

I would imagine that you are being treated by a doctor and this is a question that you should ask him/her. I would need to know what medications you’ve been prescribed. Is it topical steroids? The question you asked is complex and for me to start probing what I need to know here on the BaldingBlog is not appropriate. I can not contribute much, as I know very little about you, your disease, and the course of it over time.

Tags: pseudopelade, medication, hairloss, hair loss, scarring alopecia

Burning Scalp After Using Hair Relaxer — What Can a Dermatologist Do?

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

Hi,
one week after relaxing my hair my scalp is still itching and burning. It seems as if the burning spot is getting bigger. Even my forehead, neck and shoulder is now burning. And it seems to react to heat. I have read some of your comments and you keep advising to go to a dermatologist. But do you also know what the dermatologist can perscribe to stop this chemical process? Here the Dutch doctors have never heard of Hair relaxers, so they do not reconise this problem and don’t even see it as a problem. They advise to use a body lotion to cool the itching/burning spot.

Can you please help me?

A good doctor should be able to make a diagnosis on the degree of balding. For chemical burns, hair loss can be permanent so I would imagine you would want to know. Maybe topical steroids can help reduce the degree of burn, but I don’t have experience with them in this situation. I’m not a dermatologist, so all the possible methods of treatment aren’t known to me.

Tags: dermatology, chemical burn, hair relaxer, hairloss, hair loss, burn, itch

Would Zinc, Magnesium, and Vitamin B6 Counteract Finasteride?

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

Dear Doctor,

i started using ZMA, a supplement which contains zinc, magnesium and vitamin B6. It is considered to be helpful for athletes, as it increases muscle strength. It is also claimed, that it increases testosterone levels. Since i take 1/4 proscar daily,i would like to ask you if it is possible possible to counteract with finasteride.( dht etc)

i thank you in advance.

With a good finasteride block and your adherence to daily use, the supplements you are talking about should not impact the value of the finasteride.

Tags: zinc, magnesium, vitamin, hairloss, hair loss, propecia, finasteride

I Heard My Surgeon Discuss Mistakes Made During My Surgery!

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

hi Dr,
i just had a FUE procedurefor 1500 grafts a few days ago. I am very worried now because of some mistakes that took place during the surgery. I overheard the surgeon making comments like ” How come i insert in follicle with 3 hairs, but 1 hair is left outside?” Eventually, the problem is caused by her assistant failing to insert the graft properly into the special insertion tool. I think the affected grafts are quite an an amount cause she took some time to find out the cause of the problem. I dont dare to question her as i am scared she might be offended. I also didnt know if the surgeon did took out the “wrongly inserted” grafts and reinsert it back properly. If that is case, how much will it affect the grafts survival rate??

Thanks a million!!

Choi ImplanterIt sounds like the team used the Choi Implanter, which is as instrument that makes the recipient site and puts in the hair at the time the instrument is withdrawn (see image at right). It requires proper insertion of the graft into the instrument and it takes considerable dexterity to do this. These instruments are used throughout Asia and Europe, and in the hands of many doctors, the grafts often do not grow for a number of reasons, including:

  1. Improper insertion of the hair graft into the instrument
  2. Placing the grafts too deeply into the recipient area
  3. Trimming problems in preparing the grafts for the instrument with removal of the hair growth centers
  4. Graft drying, as it may be in the air for more than the 10-20 seconds it takes to kill the graft

I have seen a fair number of failures in this technique. I never understood why the surgical teams in these countries did not develop the ‘manual’ skills used in the United States, where the results may be more predictable. This instruments work in the hands of a few who developed the needed skills to overcome the above problems, but the use of these instruments suggests to the novice doctor that placing grafts into the recipient site is very, very, very simple.

I always say that doing a hair transplant is conceptually simple, but getting a successful hair transplant whatever technique or instrument the doctor uses will be seen in 8 months when the results are evident, one way or the other. A successful transplant is the sum of a whole ‘lot of steps and techniques’. The picture of the instrument shown here suggests simplicity, but by the time 8 months have gone elapsed and if there is poor graft growth, the doctor has your money and the rest can be just a nightmare of dashed hopes.

With regard to your other points, you can be meek and take the failures that may occur, or you can be proactively aggressive and let the doctor know of your dissatisfaction or your concerns. Be direct with your doctor and his/her answers should likewise be direct and to the points of your concern. In California, the state medical board or the courts protect patients. You indicated that you live in Singapore, and because I’m not familiar with the laws there, I don’t know what recourse you have.

Tags: choi, implanter, hairloss, hair loss, hair transplant, mistake, problem

Finasteride, DHT, and Temple Hair Loss

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

I have read that finasteride is successful in slowing/stopping hair loss in the crown and mid-anterior scalp areas of the head and in some instances stimulating regrowth. I notice that there are many statements saying that there is no statisitcally significant evidence in showing that finasteride works in the temple area of the scalp. Why is this? Don’t these follicles miniaturize as an effect of DHT in these areas as well? Thanks for your time.

I do not believe that the drug companies have studied the frontal area with enough effort to help us define what you are talking about. Why? I have no idea. But just because there are no studies, it does not mean that the medication is not helping in the frontal area. I believe that reversal of miniaturization does occur in the front, as well as the more frequent observation that hair loss slows or stops in the front with finasteride. Most of the time the hair that is saved with finasteride is in the crown where early thinning starts and has more miniaturization than frontal hair, but I’ve seen hair reverse in the frontal area as well.

With regard to the temple prominences on the side of the head, I suspect that a prevention of hair loss occurs there, but there is no evidence one way or the other to back up my suspicion that I can point you to.

Tags: hairloss, hair loss, finasteride, propecia, temples, temple, medication

Why Does Catch-Up Hair Loss Occur When Stopping Propecia?

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

Hey Doc.,

I have a question regarding the shedding after quitting propecia. Why is it that when one quits propecia the shedding occurs much more rapidly then the natural progression of hair loss? That is, why don’t we go through the same “minituarization” that normally occurs with hair loss?

You cannot escape genetic balding. Hair has a normal life expectancy (see this post) so when the Propecia is withdrawn, the apototic process kicks in. Medications such as Propecia slow this process down by preserving or strengthening the dying miniaturized hairs (the hairs that are genetically programmed to die and fall out). When you no longer take the medication, all the genetically predisposed hairs that should have fallen out naturally will no longer be supported by Propecia. As such, they will fall out. That is a simple way of thinking about catch-up hair loss. In other words, you didn’t stop the time line of genetic hair loss by taking Propecia.

Tags: finasteride, propecia, hairloss, hair loss, catch up hair loss

Natural Radial Inclination?

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

I have a NATURAL RADIAL INCLINATION of my hairs and i’d like to “fill” some low density areas. Could it be a problem with a transplant or any skilled doctor should be able to match the inclination of my hairs?

I am not sure what you mean by a natural radial inclination. The only place where one has hair that points in a radial type of direction is the crown or vertex area. If this is the case you need to have a Master Plan of what you want accomplished with hair restoration surgery. If the area of low density is only in the crown area you may benefit from Propecia or minoxidil and may not need hair transplant surgery initially.

Tags: radial, hairloss, hair loss, density, hair translant, crown, vertex

Laser Assisted Hair Transplants?

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

Need your comments on laser assisted hair transplant: https://www.hairscalplaserclinic.com

I had an opportunity to review this technology and in my opinion it is a bogus technology looking for Star Wars type recognition. This also reflects comments on the website for stem cells doubling hair somehow magically achieved from the donor area.

In his video on the website he talks about stem cell for doubling hairs with limited donor hairs. Need your thoughts about that.

There used to be a laser sold which made holes in the head for graft placement and most competent doctors have abandoned it. I never used it because it produced more damage than benefits. The procedure that is defined at the website you linked to, defies medical common sense. Seems to be more science fiction than science fact. As far as I’m aware, there is no such thing as laser assisted hair transplantation and certaintly I am not aware of any competent doctor who uses the laser.

Tags: laser hair transplant, laser, hair transplant, hairloss, hair loss

I Have Alopecia Universalis, But Also Have 3 Faint Tufts of Hair On My Scalp

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

Hey,

I have alopecia universalis. My doctor stated that alopecia universalis makes every hair on your body fall out, however on my head i have spikes all over it and about 3 tufts of hair, not noticable by the eye but by touch. I was wondering if anyone out there has the same question as me, is this a good sign?

I have just this week begun being treated with Topical Immunotherapy but i havent started with it being placed on my head, i have it on my arm to get me allergic to the stuff before i have it put on my head. Has anyone recovered from alopecia universalis who had the same questions as me? with the little spikes of hair all over my head. If there is anyone out there who knows something about this, please answer :D !

Thanks

Alopecia universalis is extremely rare (less than 1% of all cases of alopecia areata), and unfortunately I’m not an expert on the disease or the treatments. I will forward your message to anyone that I know that could possibly help. If any readers have anything to add, please leave a comment below. You might be able to find more information at the NAAF.org site.

Tags: alopecia universalis, hairloss, hair loss, alopecia areata, universalis

Why Will The Propecia Libido Problems Will Subside?

/by William Rassman, M.D./3 /

Hi Doctor,

I’m a 23 y/o male with hairloss beginning from the age of 20.

I’ve been on Generic Propecia (Finpecia) for aboout 4 months now and have noticed a gradual depletion of my libido to the point now where it is at absolute zero! There are a lot of sources saying that I will have difficulty regaining any form of sex drive for quite sometime (years!?) and obviously your response ‘that it should subside within several months’. I understand you’ve answered this question before, however you haven’t given a medical explanation as to why it should subside and considering I’ve had a gradual decrease in my libido for several months I’m simply not sure what I should believe.

Loss of libido at such a young stage of life is obviously very concerning to me and to many of your readers. I beg you to shed some light about this problem.

There is no medical explanation to why you will have a prolonged (several months?) residual side effect after stopping finasteride. Finasteride lasts in your blood stream for about a day. After a couple of days, it is essentially gone, but there is some tissue fixation which may keep it in some of your body tissues for about a week or so. The short duration for blood levels is why you need to take it every day for it to work. So if you had a side effect, it will likely subside within a few days (not months or years) after stopping the medication. Of note, side effects can go away even if you continue taking the medication.

I realize people write about libido issues related to finasteride (Propecia) and post concerns on the Internet. While I believe these people are having libido issues, I have a hard time believing that there is a direct correlation between finasteride (Propecia) and its long term side effects on libido. As a physician, I have followed and seen many patients over the last 10+ years who have been taking finasteride (Propecia) and I do not see the long term libido problem that people write about on the Internet. Yes, a small percentage of my patients (1 to 2 percent) may complain of sexual side effects, but the side effects usually go away after a few days or weeks (not months or years) and it is not permanent and a few canm not tolerate the drug for this reason. If there was such a long term or permanent problem with Propecia, I am sure I would have seen at least one patient in the last 10+ years describe this to me, and that has not been the case.

I strongly urge you to talk to the doctor that prescribed you the medication. The most important thing that people do not consider is that it may NOT be the medication that is causing a low sex drive. Many men (even in their 20’s) have sexual problems, but there’s not a great percentage of them that would admit it. While it may be easy to just blame the problem to a side effect from a drug, it can be a sign of a serious undiagnosed medical condition (such as high blood pressure, diabetes, depression, low testosterone, the presence of other diseases, etc). So although I appreciate the overall confidence many people have in me because I listen to (or read) what they are saying, you need a doctor willing to take you on as a patient — someone to meet with in person, not just communicate via email.

Tags: libido, sexual, propecia, finasteride, hairloss, hair loss, finpecia

I’d Think A Trained Eye Would Be Necessary to Determine Miniaturization

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

Doc

If a layperson tries mapping out their scalp for miniaturization are they really going to be able to tell the difference from a hair in a certain stage of miniaturization and a new hair growing in? Or from a miniaturized hair getting thicker. I would think it would take a trained professional eye. Especially if someone has already started treatment.

Thanks.

If you follow the tutorials on mapping your own scalp (see BaldingForum) some of this information is not difficult to get as long as you have the proper tool. Using a video microscope, you take photos of various areas of your scalp and compare those photographs a year later at the same location. Then it will be easy to see what has happened to your hair. You do not have to be a rocket scientist to do this, just a motivated victim of hair loss.

That being said — yes, I can tell much more because of the years of experience I have. I was one of the first ever to do this and it reflected my invention (U.S. Patent 5,331,472), which defined the process for measuring hair density and observing the appearance and thickness of the hair. I then published the same process in various articles written since 1993 (see my CV for a list).

Tags: miniaturization, mapping, hairloss, hair loss, patent

I Had 5 Hair Transplants and 5 Scalp Reductions…

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

Hi, (classification: Norwood 6)

I need some advice on scalp reductions please!!!

I started to lose my hair at the age of 17-18 and it had a profound impact on me. I went to a dermatologist who recommended a very good hair transplant doctor and at the age of 19, I had my first hair transplant which really helped my confidence. As the years progressed, I started to lose hair in the crown area and it was suggested to have a scalp reduction.

Well, i’m 33 years old and i’ve had 5 transplants and 5 scalp reductions. Along with some cover up, my hair looks pretty good! But i’m still losing hair in the crown area! My question is: Do scalp reductions really work? What about stretch back? I still wonder back to the days when I was 17, and wonder if I had just shaved my head bald!!

Your thoughts and opinions are appreciated, thanks.

Scalp reductions do not work well and have caused misery for many patients, including myself (having had three of them and ended up more bald in the crown then before I started). I went on a campaign to discredit that surgery and I believe that my opinion is now shared by most competent doctors. That is why scalp reductions are not the standard of care for balding men today.

You probably should not have had a hair transplant in your late teen years — and as you can see now, you’re probably out of donor hair and options. As you wonder back to your days, I agree with you. Sometimes bald is beautiful!

Tags: scalp reduction, hairloss, hair loss, hair transplant

Very Asymmetrical Hairline Is a Shared Trait In My Family

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

Hi Doctor,

I have a very asymmetrical hairline (mature on the left corner, juvenile on the right) which I first noticed at 16 and concluded that I must be going bald. Happily, 11 years on, my hairline hasn’t moved at all. I’ve since noted that my father has the exact same hairline complete with the same degree of recession on the left corner. I was just wondering the significance of this shared trait – do you think it’s reasonable to expect my future hairline to bear some resemblance to his?

Thank you.

There is no significance. It is just the way you are. A few months back a patient of mine had a similar problem… at least, it was a problem to him. So he had a hair transplant procedure to make his hairline more symmetrical.

I do not know if this is a genetic trait per se, but I suppose it does run in your family. And with respect to your future hairline, I do not know. I can only assume after 11 years of having the same hairline, your hairline seems stable.

Tags: hairline, hairloss, hair loss, genetic, asymmetrical

Does Dutasteride Produce More Estrogen?

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

Hi Doc,

I have been on propecia for 15 months with no results and less hair. I really want to try my luck with Advodart or Dutasteride. I just want to know if this produces more estrogen? If so is there risk for blood clots or stroke with dutasteride? I really would appreciate your opinion on the switch and lethal concerns . Thanks so much for your time.

It appears that there is a competitive effect of DHT and estrogen, so if you block DHT with any DHT blocker such as dutasteride or finasteride, the estrogen levels will rise. As far as I am aware, the increased risk of clots or stroke is negligible, but I’m not well versed in everything dutasteride as I do not regularly prescribe it at this point.

Tags: dutasteride, finasteride, blood clots, estrogen, hairloss, hair loss, stroke

Viviscal Before and After Photos

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

This is an old post that slipped through the cracks and never got posted, so my apologies to the author of the email for taking so long to reply…

Dear Dr Rassman,

I am writing to you abaout my experiences with Viviscal (a.k.a Nourkrin). I have first noticed thinning at the temples at the age of 24, and looked for an expert’s advice. After the evaulation I was told that I am also thinning on the crown a little and I may lose my hair within two years. I was advised using Viviscal to prevent balding. However, what I have already lost at the temples could not grown back anymore. It only could have been prevented, if I had started the treatment at my late teens.

I have linked an interesting page about Viviscal with before and after photos. Haarmittel.com (German). The photos underpin that the hair loss at the front only can be prevented, but great results can be achieved on the crown, since follicles are not dead just inactive.

I am skeptical of the photographs and the changes shown make me doubt what the Viviscal marketing department wants me to see. Viviscal reportedly contains “special marine extracts and a silica compound” — and yet I’m to believe this will regrow hair? If these photos were real, the product would have taken over the market years ago.

I ran the page through Google Translate, so this link may be more interesting to my English readers — Viviscal photos.

Tags: viviscal, hairloss, hair loss, marine, silica, photos, nourkrin