Lichen Planopilaris Scarring

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

I am 52 years old and have been diagnosed with Lichen Planopilaris.

I have been shaving my head since 1997 so the baldness caused by this condition is not an issue…what is an issue is the scarring left behind by the disease. Is there any way to remove the redish purple scarring?

Generally, scarring on the skin is relatively permanent. I don’t recall seeing patients with lichen planopilaris in my practice, so I really couldn’t comment based on experience. I would consult with a dermatologist for possible treatments. Sorry.

Tags: lichen planopilaris, scarring

In the News – Thinking Positive Means Drugs Work Better

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

Snippet from the article:

When it comes to taking medicine, you may get what you expect.

A new study has found that your expectations can affect how well pain medications work. Being optimistic may boost their effectiveness in blocking pain, while being pessimistic may lower their effectiveness.

Unlike earlier research, the new study used brain imaging techniques to examine brain regions that are known to be associated with pain. Scientists say that until now, little research has been done to clarify the brain mechanisms that control how different expectations affect drugs.

Read the full story — Positive Thinking May Make Drugs Work Better

This is a very interesting article. Pessimism may lower effectiveness, wishful thinking may make the drug work. We’ve talked about this before on the blog, and this is something many of my colleagues have expressed. When physicians prescribe a medication to patients who are obsessed or too worried about side effects, they usually seem to get the side effects. It’s almost a self-fulfilling prophecy.

Tags: medication, drugs, expectations

I’m Pleased with Propecia Results and Have Taken it for a Decade

/by William Rassman, M.D./10 /

I’ve been taking Propecia/finasteride for going on 10 years now (started when 23). I am very pleased with my results, including hair REgrowth on dome and even in front.

My question is, how long can I anticipate this will continue to work and should I have any concerns about taking this drug for so many years now and into the future? I have not experienced any known side effects.

I am glad you’ve had good results with Propecia with no side effects in the last ten years you have been taking it. Unfortunately, I cannot predict the future. I have no basis of your own personal progress. I do not have a set of measurement points so that I can even take an educated guess. This is one of the reasons why we remind folks to follow up with their doctor. Hopefully if one doctor has been following your progress, there should be some sort of documentation or some objective measurements that they can refer to give you a better answer. Generally speaking, some patients report their visual benefits decrease after around 5 or 6 years, but I’ve got some patients taking it for over a dozen years with excellent results. Each person is different.

We suggest that all men taking finasteride get a bulk measurement baseline to help quantify when the drug may be starting to show less benefits. Bulk measurement will tell you much and if you do it every year, then you can clearly see a trend if it is starting.

As for safety… well, Propecia is a safe medication and I don’t think you should be concerned about the long term use. It’s worth noting that finasteride (in a larger 5mg dose) has been on the market for nearly 20 years now.

Tags: propecia, finasteride, side effect, hairloss, hair loss

Is Retinoic Acid Important with Minoxidil Use?

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

Hello,
I have used Minoxidil 5% with good results for 2 years. In the first year I used a solution with ethanol and retinoic acid but switched to ethanol retinoic-free minoxidil 5% after a year.

1. Are these agents vitally important to the work of minoxidil?
2. My hair seems to go in cycles from quite thick to quite thin and back again over 6 months or so.
3. is this normal with minoxidil use?

Many thanks

  1. Retinoic acid produces a mild burn to the skin which increases blood supply and the absorption of minoxidil. That is why, I believe, some doctors use retinoic acid, though it isn’t necessary for minoxidil to show benefits. Ethanol (alcohol) is an ingredient in Rogaine and I’d assume most topical minoxidil products.
  2. Some patients have reported hair cycling by time of year. It seems to be rarely talked about, so I really do not know the answer to question #2.
  3. Cycling occurs with or without minoxidil use, but this is the normal hair cycle — anagen, catagen, and telogen. I’ve previously written about hair cycles.
Tags: rogaine, minoxidil, hair loss, hairloss, retinoic acid

Hair Loss and Hashimoto’s Disease

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

(female)
in 2007 my thyroid gland was removed due to Hashimoto. ever since i suffer severe hairloss. take Euthyrox 150 and Tertroxin 30. TSH/T4/T3 normal. normal estrogin, low Progesterone. Iron normal. take lots of vitamins and amino’s. lost eyelashes below as well.

It has not been unusual to see women who have had hair loss associated with a variety of thyroid diseases, not return to their normal state, even after treatment and cure of the thyroid problem. These diseases may have induced genetic female balding as the cause of the hair loss. I just can’t be sure.

Have you followed up with your physician, who has a better knowledge of your case and treatment history?

Tags: hashimoto’s disease, thyroid, hairloss, hair loss, female hair loss

Upside Down Grafts?

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

What would happen if a graft was placed in the recipient site upside down??

A graft placed upside down would:

  1. Grow a hair ball below the skin
  2. Die and get attacked by the body’s immune defenses, forming an abscess or cyst.
Tags: hair transplant, hairloss, hair loss, grafts

Who Invented the Strip Method?

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

Did you invent/discover the strip method for hair transplants??

InventionNo, I did not invent the strip method in hair transplantation. I do not believe there was an official inventor of it. The surgical crowd moved somewhat together in the evolution of the strip, which was a neat solution to harvesting that became obvious.

When I was learning about the state-of-the-art donor harvesting, I saw some doctors use a large drill and attached from end to end the holes that were used to harvest the plugs. This caused an irregular wound of connected holes that were sewn together. Any reasonably good surgeon could have figured out that an irregular, sloppy wound would be better created by a controlled strip, and that is what the surgeons were evolving towards. So you see, there isn’t always an inventor.

I remember that there were few doing strips when I started doing hair transplants in 1991. Dr. Paul Straub demonstrated the method to me back then. I immediately went to the strip for harvesting, having never used a large drill as others were doing. A few doctors were already using this method, but the art at that time was still about establishing large grafts, not small ones. When I started doing the surgery, I began with small grafts… and made them smaller and smaller, which required more and more of them to get the amount of hair that would make a difference. This refined the look of the hair transplant as we know it today.

Tags: hair transplant, surgery, surgical, technique, hairloss, hair loss

Cipla’s HairMax Gel Contains Minoxidil

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

Dr. Rassman, Thank you so much for your valuble insight. You are helping thousands of people without expecting a benefit. I am 27 years old I blieve I am norwood 3, My doctor prescribed propecia which I will be taking shortly. I just ran into Cipla’s Hair Max Gel, which has minoxidil 5%. Have you heard anything about this? I would greatly appreciate your insight.

Hairmax GelThere are many lotions, potions, and similar products that are sold containing minoxidil. I have no real experience with most of them.

I haven’t heard of this HairMax Gel (unrelated to the hair laser sold by Lexington)… and the Cipla website does not offer any insights into the product that I can hang my hat on. I assume this is some kind of styling gel, but why would you need styling gel applied to a bald area? Unfortunately, all I can find in the Cipla product catalog is a photo of the packaging.

I’ll open it up to the blog readers to give their 2 cents. Anyone try this minoxidil gel?

Tags: hairmax gel, cipla, minoxidil, hairloss, hair loss, hair product

Can Inadequate Diet Trigger MPB Before It Would Otherwise Begin?

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

I am a 23 year old male, and I have been a vegetarian for over 10 months now. I am careful with my diet and take a multivitamin every day; I am not absolutely meticulous about what I eat and take in for nutrients, but I was positive that I have been getting an adequate nutrition. Lately, however, I’ve noticed some frontal hair loss, and I was told that my diet might have something to do with it.

Now, I am well aware that inadequate diet can lead to hair loss, but my hair seems okay other than what appears to be the onset of male pattern baldness (or a mature hairline). So, my question is this – can an inadequate diet somehow trigger male pattern baldness, or does genetic hairloss have a mind of its own?

If you love in a third world country and can’t eat a balanced diet due to starvation, it is possible that there is such a connection… however, in the United States or Western Europe, even a diet of only greasy fast food will not be a cause for hair loss.

I would want to understand what you mean by a poor diet. Being a vegetarian does not mean that you can not get all of the needed foods for a good, healthy diet.

Tags: diet, vegetarian, hairloss, hair loss

In the News – Early Hair Loss = Higher Prostate Cancer Risk?

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

Snippet from the article:

Men with prostate cancer may be twice as likely to have started showing signs of male pattern baldness at the age of 20 than those without prostate cancer, a new French study suggests.

Men who start losing their hair in their 30s or 40s do not appear to face a similar boost in prostate cancer risk. And those whose hair loss starts in their 20s do not face a higher risk of developing the cancer at an early age or of developing more aggressive tumors, the research team noted.

Whether or not men who experience youthful hair loss may benefit from prostate cancer screening is yet to be determined, the study authors added.

Read the full story — Could Hair Loss at 20 Signal Higher Prostate Cancer Risk?

Researchers say it is too early to conclude that hair loss and prostate cancer are definitively linked, but they do point out that of the 388 men with prostate cancer enrolled in the study, statistics showed any form of hair loss at age 20 was linked to a doubling of prostate cancer risk.

Tags: prostate cancer, cancer, hairloss, hair loss

What Percent of Patients Get Transplants and Skip Propecia?

/by William Rassman, M.D./9 /,

Hi Drs. Rassman, et al., and thanks for your great site. I was wondering what percentage of patients in your practice elect to have hair transplant surgery as the sole treatment option for male pattern baldness and forgo Propecia. And, of those who do not use finasteride, how do their results compare long range with those who do? Is the difference significant? I plan a hair transplant procedure this year but have decided against using Propecia due to the controversy surrounding its side effects.

Thanks again!

Controversy surrounding Propecia’s side effects are nothing more than circumstantial and hearsay. I realize most of you reading BaldingBlog are smart or savvy enough to use the Internet to conduct your research and form opinions. What some people seem to be missing though is that the Internet is not the source of medical information for self assessment, treatment, and management. I am not your doctor, but if you have concerns with medications (such a Propecia) talk with your doctor and get the real facts.

I will say again that in my 10+ years of prescribing and managing thousands of patients on Propecia (including my sons), I have yet to see the exaggerated side effects that I read on the Internet. I recommend it to almost all my male patients that have hair transplant surgery to preserve the existing hair as well as minimizing the shock loss that occurs in a limited number of patients. While I have not documented the exact numbers, I would say that in my practice well over 75% of my patients who have surgery take Propecia (finasteride). There are patients who do elect not to take Propecia and that is perfectly OK as well.

In general, I feel most patients who continue to take Propecia seem happier in the long run, because the hair loss has been arrested. It may be my perception, but those who do not take Propecia tend to come back for another hair transplant surgery as they lose more of their existing hair faster… and hey, that is fine by me. It is my practice to give my patients all the information they need (on surgery and medication) and come up with the Master Plan in managing their own hair loss. The ultimate decision is left to the patient themselves.

Young men (those under 30), in particular, are in a rapid mode for their hair loss. On the other hand, men over 50 are not prone to the acceleration of hair loss seen with the young man. Those men between 30-50 years old are somewhere in between the two groups. There are tests that we do routinely to advise men what to expect with their hair loss and when to expect it. It is so important to develop a Master Plan, bond with your doctor who you should visit and follow with yearly examinations, as the tests we now use (bulk assessment, miniaturization studies) clearly define just how progressive the hair loss will be and how effective we are at controlling it. Using Propecia (finasteride) does require, in my opinion, that these tests get done to allow you to follow the Master Plan and change it accordingly.

Tags: propecia, finasteride, shock loss, hair transplant, hairloss, hair loss

My Rheumatoid Arthritis Medication Caused Female Hair Loss

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

I used Leflunomide for R.A. for a few weeks, and developed hair fall for more than two months now. I have stopped the Leflunomide more than two months ago. Hair fall is still taking place.

Can I use Avodart capsules locally? How long does hair fall persist after stopping Leflunomide? Any further advice?

I am a 50 year old housewife by the way. Thank you in advance

AravaOne of the common side effects of leflunomide (marketed as Arava) is hair loss, and this is a side effect for a number of other arthritis medications as well. Although it seems that it could be likely, I can’t say for sure if the medication is the cause of your hair loss. Though even if it is, are you willing to suffer the pain of rheumatoid arthritis? You really need to express your concerns to your prescribing physician, also noting any changes in medication.

Avodart (dutasteride) is not a medication for women and would not help with your hair loss, particularly if the RA medication was the cause.

Tags: arava, leflunomide, rheumatoid arthritis, hairloss, hair loss, female hair loss

In the News – Stress Research in Mice Could Lead to New Hair Loss Treatment

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

Snippet from the article:

Mouse researchers conducting stress hormone experiments have stumbled onto a surprising new discovery — a potential treatment for hair loss.

Scientists at the University of California, Los Angeles, and the Veterans Administration were working with genetically altered mice that typically develop head-to-tail baldness as a result of overproducing a stress hormone.

The experiment wasn’t focused on hair loss. Instead, it was designed to study a chemical compound that blocks the effects of stress on the gut. The researchers treated the bald mice for five days with the compound and then returned them to the cages, where they scampered about with several furry mice from a control group.



Read the full article at NY Times — In Surprise Finding, Bald Mice Find Their Fur Again

Doctors interviewed in the article are cautioning that not only might this mouse study not be applicable to humans, but that even if it is, it would likely only lead to treating stress-related hair loss (not genetic hair loss). The article also notes that mouse hair growth cycles are different from that of you and I. This is early research, so I’m sure there will be more news on the horizon.

Tags: mouse, mice, stress, hairloss, hair loss

Is Minoxidil Still Effective If I Restart It After Giving Birth?

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

I started using Minoxidil about 4 months ago, and it has been working nicely. I plan to try for a third child in a couple of years. I know pregnancy hormones protect your hair from falling out (as much) during pregnancy, but I would expect to lose some hair after the birth. My question for you is this: Is Minoxidil as effective the second time around? If I restart it after taking a break for pregnancy, should I expect good results?

There is no rule on minoxidil where you cannot restart using it. If it has helped in the past, you can try again. I would not know what to expect, but it is worth a shot!

Any readers have first hand experience with stopping and restarting minoxidil after a pregnancy?

Tags: minoxidil, hairloss, hair loss

Female Hair Loss from Tramadol?

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

(female)
Oh My God! I have been taking tramadol every night at bedtime. Now I have noticed my hair is falling out by the handful everytime I wash and dry my hair!I am freaking out! I am 51 years old. I am very disapointed to find out that other people are having the same problem. If this keeps up I will be totally bald in a few weeks! If I stop taking it, will my hair grow back? I can’t lose any more hair!!! Please help!

Back painTramadol is a back pain medication that isn’t known to cause hair loss according to the literature I’ve found (see side effects), but it isn’t outside the realm of possibility. Chronic pain and stress may also be contributing to your thinning hair.

You need to calm down, write down a history with time lines to it, and then bring that information to a good dermatologist or your family doctor (or even better, your prescribing physician). You’re panicking, and that won’t help things. Clearly, this is not an overnight problem you have. Female hair loss is complex and requires considerable analysis.

There might be something else going on and your taking Tramadol is coincidental to the hair loss. I don’t know how long you’ve been taking the medication, how much of it you’re taking, etc… and there’s really no way to know if the hair will regrow until a cause can be determined. Talk to your prescribing doctor about these issues before making changes to your dosage or stopping it altogether.

Tags: tramadol, pain, hairloss, hair loss