Difference in Terms for Hair Loss

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

Hello Dr. Rassman, could you tell me what the difference between “thinning hair”, “Hair Loss”, “Miniaturization”, “Low and High Density”?

Also when people say poor nutrition, e.g. anorexia, zinc deficiency etc, causes thinned hair do they mean the shaft diameter of each hair decreases or hair falls out resulting in low density?

Thank You

Dictionary“Thinning hair” means a person is losing hair (usually hair that is miniaturized – i.e. thinning of the hair shaft) and does not have as much hair bulk as they once had. “Miniaturization” of hair means that a person’s hair shaft is not as thick in one area when compared to another area as it should be in its normal/healthy state. It is normal to have around 10% of miniaturized hairs for people who are not balding that may reflect what we call vellus hairs, present in every follicular unit.

“Density of hair” describes how many hairs are in a given area of scalp. For example an average Caucasian male can have a hair density of 2 hairs per square millimeter of scalp (which translated to about 100,000 hairs on a typical head size). If it is found that the density is 3 hairs per square millimeter, than the person is said to have a high hair density (born with about 150,000 hairs on the head). Hair density is variable and may depend on the ethnicity or race of a person as much as the inheritance patterns. Caucasians are born with an average of 100,000 hair on their heads, Asians about 80,000, and Africans about 60,000. These numbers are just averages and do not necessarily apply to what you may have on your head.

Tags: hair loss, hairloss, thinning, miniaturization, density

Terminal Hairs at Hairline

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

I read that all persons have peach fuzz and miniaturized hairs in the beginning of their hairlines, but my question is that if it is normal to see solitary terminal hairs 1 cm before the beginning of the hairline

Most hairlines are transition zones between the bare forehead and the thick hair of the scalp. Some people have a wider transition zone than others. Some people have solitary hairs in front of the transition zone, while others have a tight frontal hairline. We are all different. When I create a hairline, I always build a wide transition zone between the forehead and the scalp hair behind it so that the point where the hairline starts does not come on strong. Some patients want a strong hairline so I often find myself negotiating with these patients on this very point as we plan the hairline for the day of surgery.

Tags: hairline, hairs, terminal hair

Shampoo Eliminates Sebum, Allowing Follicles to Grow? (Video)

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

What do you make of the video below. It claims excess sebum on the scalp can cause hair loss and that the tincture of herbals and scrubbing (and brushing?) help to allow the hair follicles underneath to grow. Is there any chance that this could work? I am under the impression that shampoo eliminates sebum. Off topic regarding shampoo, should we be shampooing our scalp and our hair or just our hair?

 

There is hope everywhere (after all, it springs eternal). I would doubt that anything shown here will work for another person as it did for the lady demonstrating the technique in the beginning of the above video from Honolulu’s ABC affiliate. It’s obvious the news anchors have no idea about what they’re talking about when discussing hair loss, and this is quite a puff piece for this herbal maker.

As to your other question — you should shampoo your scalp and hair (the main reason for shampooing is to clean the scalp).

Tags: herbal, shampoo, video, hairloss, hair loss, hair growth

Blood Pressure Medication and Female Hair Loss?

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

(female) I have been taking Hyzaar 50/12.5, a high blood pressure medication, for several years and I am experiencing balding in the top of my head and thinning around the edges; before taking this medication I had a full head of hair. Is there a high blood pressure medication that would possible not cause hair loss or thinning?

Hyzaar is known to cause hair loss in some people (“alopecia” is listed as a side effect). The pill is a combination of hydrochlorothiazide (HCTZ) and losartan, and I’ve written about HCTZ before. That being said, blood pressure medication is not generally the first thing doctors look for when evaluating hair loss in women. There are many other medical conditions that contribute to hair loss in women and these should be evaluated by your primary care physician. Some (but not all) of the causes can be anemia, thyroid conditions, menopause, genetic, lupus, etc. (see here).

Tags: blood pressure, hbp, hairloss, hair loss, female hair loss, hctz, hyzaar

In the News – Pill to Stop Hair Pulling?

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

Snippet from the article:


Most everyone plays mindlessly with their hair from time to time. But for some people it becomes such an uncontrollable compulsion that they end up with bald patches or eyebrows plucked bare (called Trichotillomania).

If it’s any comfort, animals too suffer from “grooming compulsions.”

Though the behavior is documented in the Bible and ancient medical texts, treatment for hair-pulling has not been studied much. But now a University of Minnesota researcher might have found an answer in a common, over-the-counter nutritional supplement that costs about $15 for 100 pills.

Read the rest — Pill could end urge to pull your hair out

If this is true, it would be a great, inexpensive way to treat this obsessive behavior. I’ll wait for the larger study to be complete, but the small 50 person study is promising.

Tags: trichotillomania, trich, hairloss, hair loss, hair pulling

Female Hair Loss After Stopping Kariva

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

I was taking Kariva for a few years for perimenopause. I quit taking it in February and for the last month or more my hair has been shedding. It fell out while I was taking it so my doctor recommended Rogaine 2%. After 2 months my hair got so much better so I tried discontinuing the Kariva. Now my hair is shedding again and I was wondering if it will last for much longer. My doctor said to give it 6 months but I may be bald by then. Should I go to a stronger Rogaine while it’s shedding from stopping the birth control pills? Thank you

Kariva (ethinyl estradiol and desogestrel) is a birth control pill that is a powerful hormone. Listen to your doctor’s advice — he/she knows more than I do about this, as I do not treat many women for birth control. If you want, you can try the over the counter extra strength Rogaine, which is 5%.

Tags: kariva, bcp, birth control, hairloss, hair loss, female hair loss, rogaine, desogestrel

My Hair Transplant Made My Skin Cobblestoned!

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

Ive had a transplant 6 mnths ago.The hair that has been transplanted on the front top of my head has made the skin look bumpy cobble stoned appearance. I want to shave my hair short to blade 0 and not have the bumpy look. What procedures can be carried out to solve my problem. I do not wish to have another transplant so im looking on ways to make my linear scar fade away to. Is laser treatment good for the scar.

Cobble stoneOf course, I will start by saying I want to see what your hair looks like and if you can visit California (we have two offices here) it would be best to let us examine you directly. The second option (and probably most convenient if you’re not local) is to send me good photographs of what you are referring to with good lighting. Be sure to include photos of the scar where the hair was taken from.

Cobble-stoning is usually the result of the larger grafts which have a reasonably sized skin disk with it. The skin from the graft does not align with the scalp skin around it so that it appears bumpy. If that is what you have, your doctor used an obsolete technique and these just can not be fixed by shaving down the scalp skin with dermabrasion, which only makes the visibility worse with depigmentation of the scalp skin. The only solution is to put more hair around these bumps to hide it in the ‘forest’ of normal hair (more hair transplants, but this time by a well skilled doctor using modern techniques). Laser treatments do not work either and the linear scars from the donor area can be difficult to fix, but again, I would need to see it to understand the problem.

Tags: cobblestone, bump, hair transplant, hair restoration, hairloss, hair loss

How Many Grafts to Fill in an Area the Size of a Quarter?

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

Dr. Rassman,

I have two specific questions for you:

1) How many grafts/what would the cost be to fill in a moderately thin area about the size of a quarter?
2) Do you have any suggestions for good, reputable doctors in Rhode Island?

QuarterAnd I have two non-specific answers for you:

  1. A quarter sized area might take a variable amount of hair, depending upon where in the scalp it is located. It may possibly take between 100-200 grafts. Cost per graft varies per doctor, and many have a minimum fee for surgery. Without having your age, history, or really much information at all, it’s difficult to make recommendations — but assuming your thinning area is in the crown, you should talk to your doctor about Propecia or even getting some minoxidil (Rogaine). You might be able to avoid surgery altogether.
  2. I don’t have any physician recommendations in RI, but if you don’t mind a little drive, Dr. Robert Bernstein is in Manhattan and he’s the best doctor on the East Coast. I would recommend him if you can manage a trip to New York. He should be able to do a telephone consultation with you by looking at good digital photographs, and then you can do it in one trip all in the same day.
Tags: hairloss, hair loss, hair transplant

Why Are Vellus Hairs Normal at the Hairline?

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

Hi doctor, I just have two questions. Why in the beginning of normal hairlines the existence of miniaturized hairs and vellus hairs is normal?

And the second question is that how can you distinguish them in your hairline?

The very frontal leading edge of the hairline has more vellus hairs per square centimeter than other parts of the scalp. If you get a video microscope (see here), you can then study them and maybe understand what is growing out on your head better. It’s normal, because that is the way it is. It’s genetics. It’s a transition area from nothingness to a head of hair. Vellus hairs are usually short while miniaturized hairs can grow long, so they usually can be distinguished from each other that way.

Tags: miniaturization, vellus hair, hairloss, hair loss

Can I Take Propecia if I Have Puffy Nipples (and No Prescription)?

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

Hi doc,
I’m a 19 year old male and i’ve just started thinning. I say just because i still have a full head of hair and all my friends think i’m crazy but my dad was bald at 25 so… my mum is a pharmacist so she bought me a box of propecia even though i didn’t went to the doctor to get a prescription. i have two questions.

1) Can I take propecia if I take at the same time half a pill of 250mg of lamisil ( for my toes)? I have a liver in really good condition : I did all the tests.
2) I have very small puffy nipples. But very very small ones, my doctor told me it was nothing. can I still take propecia? I have an appointment with and endocrinologist in august for that but I want to start taking propecia as soon as possible.

Cheers from France!

Lamisil should not interact with Propecia.

It shouldn’t be a problem for you to take Propecia due to very small, puffy nipples. I’m not comfortable with you taking prescription medication without a prescription, though. If you saw a doctor about your puffy nipples, why did you not get a prescription for Propecia at that point? If you see any changes in your chest after starting the medication, discuss it with your physician.

Tags: propecia, finasteride, lamisil, hairloss, hair loss, nipples

Hair Growing in Different Directions After Accutane Use?

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

Hi,

I was wondering if it was normal for hair to grow out in different directions? I took a month course of Accutane 2 years and in conjunction with the hair loss, my hair feels a lot more brittle and different in texture. Specifically my scalp, I have this dime sized spot on my scalp that grows opposite to what the rest of my hair does. I know this sounds weird but it becomes even more noticeable when my hair isn’t shaved down.

Did Accutane do something to change how my hair grows?

Accutane (isotretinoin) does impact the quality of hair that grows, but it should not change direction. I would suspect that because of the changes in your hair character, the different direction of hair in one area was more easily noticed by you.

Tags: isotretinoin, accutane, hair direction, hairloss, hair loss

The Great Propecia Debate — Merck vs Message Boards

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

Reading some message boards, I see a lot of disgruntled people with regards to Propecia and saying the drug destroyed their hairline, hypandrogenicity, etc. It makes you think everyone suffers from severe hyperandrogenicity because they get a zit. I know you’ve mentioned in the past that people with negative things to say usually are the most outspoken. But it is easy to get an impression reading these boards Propecia is awful because the negativity outweighs the positivity when Merck proclaims the opposite.

My question is: in your practice, have you seen people suffer from in your own practice? And with those patients on Propecia, what percentage elect to stay on it and are generally content with the performance of the drug?

Thanks Doc!

The Propecia side effects statistics from Merck are in line with what I see in my practice. It really is very minimal. I agree that the message boards bring your attention to the agenda of the posters, which may not be pure and objective like mine. I really have nothing to gain by telling people about Propecia, a drug which can regrow hair and halt hair loss (I am, after all, a hair transplant surgeon).

Tags: merck, hairloss, hair loss, propecia, finasteride, side effets

Still Shedding Hair After a Year on Propecia

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

I’ve been on propecia for almost a year now and I noticed that I’ve started shedding hair after 2 months into the medication. Its almost a year now and I am still shedding hair, it looks like its becoming worse. The hair that is shedding has also become finer than usual. You mentioned that shedding usually occurs for a while and we should carry on for at least a year. Its a year now, so should I continue the medication?

It seems that your genetic predisposition may be winning the battle over Propecia. You should see your doctor who prescribed you the medication and discuss your options. You may consider adding Rogaine or even increasing the Propecia dose* (but again, discuss it with your doctor first). You may even consider having the HairDX Test for Finasteride Response done, which may explain a failure to respond to the drug. Have you had the status of your miniaturization compared with your pre-Propecia status? That would give you a great deal of information if you had that test done as miniaturization should have decreased on the drug.

* I have recently blogged of increasing the dose of Propecia on select few patients. This does not mean it works necessarily but for those few patients who have no side effects and are continuing to lose hair it may be worth a shot. Keep in mind there is no clinical study to suggest this approach is the solution.

Tags: hairdx, hair dx, genetic, test, propecia, finasteride, hairloss, hair loss

Young Daughter Lost Hair After Radiation to Brain Tumor

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

I’m hoping you can help us. When my daughter was 20 months old, she was diagnosed with a brain tumor. After numerous brain surgeries and chemo, we decided to have a bone marrow transplant just before her fourth birthday. Thankfully, this saved her life. She also had focal radiation to the tumor site – on the right side of her head – and unfortunately most of the hair on that quarter of her head did not grow back.

She has worn hair pieces since she has been five years old. We’ve talked to people about hair transplants in the past, but were told there was too much area to cover and also, that hair transplants do not work on the side of the head.

I’m wondering if this still holds true for this procedure. I could send you some photos so you could see the extent of the hair loss if you think that would help. Please let me know your thoughts.

Thank you

Most people with large defects are treated with balloon expanders, which stretch the normal scalp to cover the defective areas. There are a few doctors who are very skilled in this specialized technique and although I have assisted in this type of surgery, I would not consider myself at the lever of expertise needed. I have seen these expanders done in children, but every person and every situation is different. I would suggest that you send me photographs and I will forward them on to such a specialist. I have seen some miraculous results from this type of reconstructive surgery.

Usually, at the end of the expansion surgery, hair transplants are done to refine the work and cover remaining scars.

Tags: brain tumor, child, hair loss, hairloss, radiation, hair transplant, reconstructive surgery

Do Men Tend to Overanalyze Their Hair After Starting Propecia?

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

Hey doc, In your experience, do you feel that lots of guys tend to over analyze their hair after starting a treatment like propecia? For instance im 5 1/2 months in, for the last week i was convinced it was starting to see some hair come back, then today i look and it looks awful. I go through these mood swings all the time, since i started propecia. I should have listened to you and got a minuturization test done but my derm just gave me the meds, so now all I have to go off of is my memory of what it looked like when i started. Secondly between what months do most your patients see improvement in their hair, or become convinced that propecia is working in some form or another?

What was the phrase — a watched pot never boils? If you’re taking a pill to treat hair loss, of course you’re likely to watch your hair with an intense focus. It’s not unusual, but you shouldn’t stress yourself out about it. It generally takes 8 to 24 months to see the benefits of Propecia (finasteride). Full benefits may take the full 24 months.

The reason I suggest mapping the scalp for miniaturization is well defined by your comment. Our memory is not objective, but scalp miniaturization mapping is objective… so you do not have to rely on your memory.

Tags: propecia, finasteride, hairloss, hair loss