Severe Histamine Reaction to Hair Transplant

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

Dear Dr. Rassman,

I was reading through your blog with regards to histamine positive scalp. (Which I have). My question has to do with autoimmune response and hair transplants. I have a very over-active auto-immune response to some things, especially poison ivy/oak.

Several years ago (2006, age 50 at the time) I had a transplant done. Top-flight hair transplant surgeon! My hair was relatively dense, with receding hairline. The histamine reaction to the transplant was severe, with a tender and red scalp for over 8 months. Today, I have lost over 50% of my 2006 density, my hair has turned nearly white (was salt and pepper), and miniturization is everywhere (when there was none prior to transplant in 2006). A prolonged histamine response can cause antibodies to attack the body (or follicles). I am convinced this is what happened. Any thoughts from the information I have given you?

Well, if you are convinced that is what has happened, what more can I say?

I do not know of histamine response connected with hair loss. Maybe you need an allergist or a good diagnosis of what is going on with your hair. Maybe you have diffuse unpatterned alopecia (DUPA), which is causing more thinning everywhere. I really do not know without examining you.

I realize you are trying to establish a cause and effect relationship between histamine and hair loss, but I do not know how it is relating. When I talk about histamine reaction of the on the scalp it is the redness that a person sees when you scratch the skin/scalp. Your body releases histamine and makes the skin turn red temporarily. This is not an autoimmune response you are referring to. This is not the histamine reaction from poison ivy/oak. Moreover, histamine is used by your body in many other ways (other than auto-immune related). So you see, biochemistry and our human body is very complicated.

Tags: hair transplant, hairloss, hair loss, histamine

My Crown is Thinning at Only 14 Years Old!

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

well i seem to be having a thinning problem at the crown of my head. The real problem is that i am only 14. It appears that this runs in my family because my uncle is in his twenties and he has the same problem. I am an African American male.

I have also heard that African hair is fragile. i brush my hair with a boar brush that is quite hard. So i am wondering if the hardness of my brush could possibly make my hair look even more thin at the crown. currently i am also obtaining that popular waves hairstyle that is quite popular among african american males is this also a factor?

Boar brushAfrican hair is fragile, but if your brush is indeed too ‘hard’ on the hair I’d suspect you would notice thinning everywhere you brush.

It’s not too common for male pattern baldness to start in 14 year olds, but it is not outside the realm of possibility and it could start with puberty. Considering you have an uncle with early loss, it certainly points to your genetics. You might even find others in your family line had similar issues in their youth. See a doctor, get a diagnosis, and have a miniaturization study done to see what is really going on.

Tags: crown hair loss, hair loss, hairloss, black, african hair

Female Hair Loss from Depo Shot, Stress, or Breastfeeding?

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

I took the depo shot twice. The first one in oct. and the last in jan. in march I noticed a bald spot on the top of my head and it is now that bald spot is as big as my fist compeletly bald, I also have over 12 bald spot all over my head and they just seem to be getting worse.

Is this the cause of birthcontrol or is it due to stress and breastfeeding? Will my hair ever grow back. Please help i’m going bald, i can’t hide it anymore. I going to have to buy a wig, please,please help me!

thank you

If I had to guess, it sure sounds like alopecia areata, due to the many bald spots you’re describing. It might just be stress or hormone related, but it can be a serious problem and you should see a doctor to get the proper diagnosis.

While breastfeeding does not cause hair loss, thinning hair can occur months after giving birth, but it is usually a diffuse loss across the scalp (not strictly in spots).

Hair loss from the Depo-Provera contraceptive shots is another possibility, and I’ve written about that here.

Tags: alopecia areata, hairloss, hair loss, hormone, stress, female hair loss, breastfeeding, depo

In the News – Baldness and Enlarged Prostate Linked?

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

Snippet from the article:


Male-pattern baldness and an enlarged prostate go hand in hand, Spanish researchers reported Monday at a San Francisco meeting of the American Urological Assn. The findings hint that early hair loss could be sign that men are going to develop prostate disease and that preventive treatment should be begun, they said.

Read the full article at the Los Angeles Times — Baldness and an enlarged prostate go together, Spanish researchers say

Interesting reading. The study of 30 men is small and may not be statistically significant. It would be nice to see a larger study. Remember, that in the large Proscar study done with 15,000 men completing the double blind study, prostate cancer was 25% less. Could this have to do with the enzyme that makes for more DHT?

Tags: hairloss, hair loss, mpb, prostate, bph, news

The Finasteride FDA Probe Has Triggered Intense Anxiety!

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

Dr. Rassman,

The latest news regarding the FDA and Propecia has triggered some intense anxiety in me. I have been using Propecia for 5 years, and have always had a little concern in the back of my mind. The fact is, its still a relatively new chemical.

In response to a question regarding the FDA looking into potential dangers of Propecia, you replied “In my opinion, Avodart and Propecia are both safe medications when used as directed…under the supervision of a physician.” You also quoted from the Merck spokesperson who referenced that there was already mention of male breat cancer in the propecia literature.

1. Shouldn’t we take this news as a warning flag that perhaps there is more to long-term use of Propecia than we might have originally thought?
2. You probably have had a number of patients taking Propecia for close to 10 years, or longer. In fact, you probably have a pretty decent sample size of patients using this drug. What have you seen in patients with regards to side-effects over the years?
3. You frequently answer questions about the hair-loss catch-up phase if someone stops taking Propecia. I am curious as to why someone would stop taking Propecia if they have been on it for several years or more?

I am sorry you have so much anxiety with the news, but at this point it is just an investigation. There is no link that Propecia causes breast cancer so don’t jump on the hysteria bandwagon. I would strongly recommend that you speak with your prescribing doctor about your concerns. Make educated and well informed choices, weighing out risks and benefits.

In my private practice of 10+ years of treating patients with Propecia, I have not seen a patient who presented with breast cancer. We have treated thousands of patients with Propecia/finasteride.

Most of my patients do not stop taking Propecia after several years, and many of them have been taking it for 5-10+ years with no issues. People might stop taking any medication for a variety of reasons, and the questions I post here are usually not from my patients so I’d have no way to know if there were medical reasons, financial reasons, etc. We should wait for any word from the FDA that points to real risks that we are unaware of at this time.

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

Betamethasone Dipropionate Prescribed for Treating Hair Loss?

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

Hello Doc, I am an underweight person (25 years,55kg ,height 176cm)of South Asian origin and i don’t have a family history of hairloss. All my siblings have great hair but I have been loosing hair since last two years.I tried Fin but it gave me the side effect even with the lower doses(o.5mg).I started using minoxidil(5%) a month ago but the loss hasn’t reduced a bit. My dermatologist has advised me to use betamethasone dipropionate (0.05%) on effected area. What’s your take on it? Should i use betamethasone dipropionate lotion or not coz after few applications it appears that the loss rate has gone up instead of decreasing.

DiprosoneI can’t give you specific advice about what medication is right for you for multiple reasons, but the main one being that I do not even know what you have. What is your diagnosis for the hair loss? Do you have male pattern baldness (MPB), or do you have an autoimmune problem?

Propecia (finasteride) and Rogaine (minoxidil) are the only proven drug treatments for MPB. They are not perfect and by no means a complete cure, but they do work if given time. I don’t know how long you were taking finasteride, but you’ve only used minoxidil for a month and that’s simply not enough time to see any benefit.

Corticosteroids like betamethasone (marketed as Diprolene or Diprosone) are used to treat psoriasis and other skin irritations, but have never been proven to help with MPB. In fact, it might make your hair loss worse. I’ve written about betamethasone before here.

If you need a second opinion, I would make an appointment with a doctor who can explain these things to you in detail.

Tags: betamethasone, hairloss, hair loss, propecia, finasteride, minoxidil, diprolene, diprosone

Why Is My Hair Changing from Blond to Black?

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

Drs –
I have been on finasteride for about 3 months for mostly frontal thinning and receding. One thing I’ve noticed on close inspection of my fine, darkish blond hair (and this could pre-date my finasteride treatment, of course) is the presence of a few coarse, jet black strands coming in and even the color of existing strands darkening remarkably towards the root. Is there an explanation for hair color anomalies? Could this be related to finasteride treatment? Is this a sign of something sinister going on hormonally or otherwise? And lastly, could this be viewed as a positive development in my treatment?

There is an excellent review of the genetics of hair color here. There is mention in this writing that some people will go dark after having light colored hair in younger days. Maybe the pigment for black hair gets turned on genetically in rare older people. Or perhaps these random hairs have occurred from time to time, but you’re only noticing them now because you’re more focused on your hair looking for finasteride benefits. I’ve not heard of finasteride causing black hairs to grow or turning blond hair into darker hairs.

It seems you’re not alone with these random coarse, black hairs, as I found others asking about the same thing (see here). Unfortunately, I don’t have an answer.

Tags: finasteride, propecia, hairloss, hair loss, black hairs, blond, blonde

Hair Loss After Running a High Fever

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

I came down with high fever last November 2009. For several days, my temp was 105 degrees. After a week, my hair started falling out. the worst affected areas were the crown and the top. My dermatologist said I had a bout with TE. Today, May 2010, six months later, the shedding has significantly lessened and i guess has returned to normal BUT the hairs lost to TE still hasn’t grown back. How long does it take for those hairs to regrow?

I am 45, male and had very thick hair before this nightmare. My two older brothers have genetic balding but one older brother was ‘spared’ and still has thick hair even though he is over 50. My hair is still thick except for the part of the crown where I lost a lot during TE. Will they ever grow back?

Thanks for your attention!

FeverIt can take up to one full year to see hair regrowth start. Remember though, when it grows, it grows at a rate of 1/2 inch per month.

If you have genetic balding and the fever precipitated the hair loss it may never come back completely, but if it was just a telogen effluvium like your dermatologist says, that will be known to you by the end of this year.

Tags: hairloss, hair loss, telogen effluvium, fever, sick, illness

Dad Lost Hair in His Late 30s, I’m Losing Mine at 20

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

Hi Doc. Really nice blog! Been so helpful!

Just want to know. Is it normal to see hairloss several years before your dad did? I’m balding in the age of 20. My dad began losing hair in his late thirties.

All the best!

It seem you are an early bloomer. Hair loss can start as early as teenage years and doesn’t necessarily follow the exact timeframe as other family members. I suspect what you are going through is normal… for you. You need a good diagnosis with a doctor who will map out your hair for miniaturization to help make the diagnosis. Drugs like Propecia can slow or stop the balding process and change the course of hair loss over time.

Tags: hairloss, hair loss, age, propecia, genetics

I’m a Woman and Was Prescribed 5mg Finasteride Daily

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

I am a female, aged 68 years. My doctor just put me on finasteride 5mg daily. Is it now safe for women? And is the dosage too high? If I cut the pill into fourths, would that still be too much?

I would ask this question and your concerns with your doctor. If you need a second opinion, you need then see another doctor.

Please understand this from a medical perspective and I’m not just trying to brush you off. You provided your gender and your age, but I cannot advise you with just that information. For example, is there a breast, ovarian, or cervical cancer history in your family or have you had one of these cancers in the past? There are many variables, so that is the role your doctor plays in these decisions.

Finasteride is not FDA approved for treating female hair loss (I assume that is why you were prescribed it), which means that your doctor prescribed it to you off-label and you need to ask him/her about this. For men, 1mg is recommended for treating hair loss and 5mg is for treating the prostate… so it is unusual for a doctor to prescribe 5mg finasteride for treating female hair loss.

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

When I Move to Another Country, Will the Water Make Me Lose Hair?

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

Hi. I am from Europe in Slovenia. In 5 months i’m gonna move to Canada for studying. So I wanna know, is “different” water gonna hurt my hair and started to make me bald? I am 18 years-old. And if water is bad there (in Canada) or if there’s “hard water” there or filled with chlorine… so if I don’t wash my hair with that water and I wash it with bottled water from stores, will that be OK, will the water be good for my hair, prevent baldness because of the “bad water”?

Thank you in advance for your answer.

CanadaWhen you go to Canada, look around to see if the people there are all bald. If the people’s hair in Canada look like they do in Slovenia, I wouldn’t worry too much.

Hard water (with a high mineral content) won’t make you go bald, though you might notice your hair lacking body or shine. If you are still worried and don’t want to even chance it, I suppose you will be spending lots of money on bottle water… or you could invest in a water filter.

Tags: hard water, hairloss, hair loss

Reader Stops Telogen Effluvium with Fish Oil

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

Dr, I wanted to share a success story with you that I recently had with telogen effluvium of the eyebrows.

After some stress, I got seborrheic dermatitis which triggered telogen effluvium. After about 5 months with no end in sight to the shedding, a skin care specialist told me about her success she had taking 6000mg fish oils (I cant remember what her skin condition exactly was). But long story short, I began taking them & I actually take about 7000mg. My seb derm. & tel. eff. both stopped. I’m very happy about that, & I read your blog & your new posts weekly so I thought I would share this & maybe it will benefit some of your readers.

BTW, fish oils are like $10 for 400 capsules of 1000mg capsules.

Fish oilThank you for your story and experience. I’m not suggesting fish oil supplements will work for everyone that is seeing eyebrow hair loss, but your advice may help others and the risks are very low in trying it.

Tags: stress, telogen effluvium, fish oil, supplements, hairloss, hair loss, eyebrows

Could a Steroid Shot to Treat Strep Throat Lead to Hair Loss?

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

I had strep throat and the doctor gave me a steroid shot to bring down the inflammation. Now, I am assuming one little shot should not have any effect on my hair, correct?

I would agree with your assumption if you are looking for some assurance, but hypothetically, if you knew the single steroid shot caused even minor hair loss, would you have refused treatment for your strep throat?

Tags: strep throat, steroid, hairloss, hair loss, treatment

My Surgeon is Reluctant to Do a 2nd Hair Transplant!

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

Dear Dr Rassman,

Great blog with an incredible depth of information. I had a hair transplant 12 month ago with a reputable European surgeon. I am very pleased with the result; I had 1500 grafts placed at the front, restoring my hairline as i have quite thick hair. However, I was considering having further surgery to further thicken the frontal areas and also increase the density around the temples.

My question is two fold:

  1. Would you recommend such as course of action? My surgeon is reluctant to do so in case there is future recession behind the grafted hairline, thus causing a splitting effect. I am currently on propecia and have not noticed any further recession but am aware this may happen.
  2. How many hair transplants can you reasonably have and what is the optimum amount of hair you can transplant? I ask this because I am slightly conscious that if i do have further surgery to thicken up the front then i might not have enough supply if i do further recede.

  1. I have no recommendation. How can I? I have never seen you, examined you, or even have any idea of what your balding pattern and level of thinning or your donor hair density, etc. Before any surgery, you must have specific goals and a Master Plan, which is a plan for your future balanced with your donor hair reserve (this is very important).
  2. The number of surgeries or the optimum number of hairs you can transplant is highly variable on each individual. It depends on your hair density, scalp laxity, the number of grafts you attempt for each surgery etc etc. These are very basic questions that your surgeon can easily answer. I want to help you but you need to first start by talking to your doctor and asking these same questions to him. Maybe you can write your questions down on a piece of paper and ask those questions one by one to your surgeon. I am not trying to be facetious but I do realize that maybe when confronted face to face with a doctor your mind may go blank.

For your general knowledge, the donor area is between 25-35% of your total scalp area. That means that the average person with 100,000 hairs on their head have around 30,000 donor hairs. Keeping half and transplanting half means that this person with average sustained laxity can move up to 15,000 hairs or 7,500 grafts in his lifetime. Those with higher densities can move more, those with lower densities can move less.

The Asian man with 80,000 hairs or the African man with 60,000 scalp hairs still must maintain 15,000 hairs (approximately) in the donor area. That means that the number of transplantable hairs in the lifetime of a person with low density will be less (you can do the math). With these numbers, your having 1500 grafts means that you probably had 3000 hairs transplanted (assuming that you have an average hair density) leaving you with lots of reserve hair for future hair loss. This is a general rule, and your doctor will modify it based upon his examination and your vital statistics. If your scalp became tight after one strip harvest procedure, then you may not be a good candidate for another surgery, but possibly follicular unit extraction (FUE) would be a good alternative.

Further reading on this topic:

Tags: hair transplant, hairloss, hair loss, donor density

Should I Be Worried if Minoxidil Is Making Me Cough Up Blood?

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

I just started using kirkland minox two days ago and after my second application last night I woke up with dried blood on my nose and I had blood in my phlegm. Should I be worried about this?

Regards

BloodPlease make an educated guess. What do you think? If something is causing you to wake up with blood in your phlegm, I’d say that is cause for some concern. Minoxidil isn’t known to make people cough up blood, but if it continues it is something you need to take seriously.

Who knows… maybe you had a bloody nose, the blood dripped down your throat, and you coughed up the blood in the morning. Dry air can cause a bloody nose. Or you could have had bronchitis and broken a small blood vessel in the lung. Or you might have cancer of the lung. These are obviously just complete guesses, so please go see your doctor.

Tags: minoxidil, rogaine, blood, hairloss, hair loss