I Have Painful Scalp Bumps Across My Entire Crown!

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

Hi there, i just found your website and it is great.

I am a 26 year old white male. In 2006-07 i did a tour in Iraq. About a month before i headed back to the U.S. i developed a bump on my scalp, almost like a cyst or a boil. It came to a head and popped, but i noticed a bald spot in that place.

A few weeks later two bumps appeared and now 5 years later it has basically spread across the entire crown of my head sometimes one or two will appear close to my neckline also up top near my forehead.

I have mentioned this to my VA doctor and told him i want referred to a dermatologist or someone specializing in scalp conditions. He takes pictures and then i never hear anything again.

These bumps are extremely painful, sometimes causing me sleepless nights. I have researched and researched and dissecting cellulitus seems to resemble it the most.

Are there any shampoos that you recommend? Any advice will be taken very seriously, i am tired of, not only the pain, but the embarrassment of my scarred scalp and puss filled bumps.

Thank you for your time.

Based on what you’ve described, this sounds like carbunculosis, which is a contagious folliculitis (infections of the hair follicles) that moves from one hair follicle to another. The causes of this are bacteria or fungi, so a culture of one of these boils should be done by one of your doctors and the treatment will be determined once the cultures are reported back.

I am surprised that you are struggling to find a doctor who can make this diagnosis.

Tags: carbunculosis, carbuncle, folliculitis, infection, hairloss, hair loss

Can Hair Grown from Minoxidil Be Maintained By Propecia?

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

Hi Dr, thanks for maintaining such an informative and unbiased blog.

I have had good results with propecia for a couple of years. Having recently started minoxidil (4 months) i am starting to see some good results.

However, do you know if hair regrown by the minoxidil would be maintained with propecia if i where to stop using minoxidil?

Thanks!

Unfortunately, hair grown from minoxidil won’t be maintained by Propecia (finasteride)… and vice versa. Their methods of action are different, so one won’t keep the results from the other one.

Tags: propecia, finasteride, hairloss, hair loss, rogaine, minoxidil

My Hair Loss Hasn’t Stopped Since Giving Birth 2 Years Ago

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

I noticed hair loss after my son was born 2.5 yrs ago. I know that’s normal so tried not to worry. It hasn’t stopped. I’m 38 years old.

Life has been stressful as my 10 yr old daughter died in March this year. My thyroid level was 11.9 my doctor with no raised TSH so my doctor has prescribed thyroxine which has helped with tiredness. The hair loss is worse than ever at the moment and my scalp burns and itches. If this is down to stress how long is it likely to be before it improves. Some hair is regrowing in places but it falls out quicker than it can grow.

Thanks

Hormonal changes following childbirth can cause hair loss, though I wouldn’t expect it to last years. I’m very sorry to hear about your daughter. Stress is known to cause hair loss, and the amount of stress you must be going through from losing a child could undoubtedly lead to more thinning. Additionally, it’s possible that thyroxine might be a contributing factor.

With that being said, hair loss in women is a frustrating issue with little or no definitive treatment. There are a variety of blood tests that can be conducted to possibly help explain female hair loss (listed here), but I really cannot diagnose or give you personalized medical advice via this site.

It seems you are already being followed by a doctor. If you want a second opinion near your area (UK), I can suggest that you visit Dr. Farjo with offices in Manchester and London.

Tags: hair loss, hairloss, female hair loss

Can I Have Hair Transplanted Into a Scalp Scar I Got From a Machinery Accident?

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

My question is, can a hair transplant be successful on an scar that has no hair follicles? I got a 2 inch area on my head that was literally ripped from the top of my skull in a machinery accident. The top of my skull was literally exposed. Skin and tissue has grown back, but the problem is the hair follicles did not. So I now have about a 2 inch radius area on my head that is bald, and on me it looks really strange and dumb since I ain’t balding in any way. I have a full head of hair and it’s long hair even, except that one area that is just a bare bald spot now.

So can a hair transplant work on an area with no hair follicles?

There are many types of solutions for this type of problem, but I would need to know more about your specific issue before suggesting a transplant as the solution. As a start, send me good quality pictures and I will try to assess what the problem is (please reference this post when sending). The photos alone may not be enough though, and possibly an examination would be critical.

Transplanted hairs can grow into scars, but I don’t know enough about your case — when the injury occurred, your age, if you have any genetic hair loss (or family history), etc. Until I make an assessment, I couldn’t say whether a hair transplant would be the best path for you to take.

Tags: scarring, accident, hair transplant

Did Propecia Make Me Shrink in Height?

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

Hello Mr Rassmann,

I wonder if propecia causes to lose bone density.Maybe it seems unreasonable to you but after I have started using propecia at 17 years old, I believe that my height decreased.I am 20 right now. My height was 6ft 1 and now it is 6 ft.Is that possible? My last question is does propecia affect muscle size and muscle growth.I also think my muscles become weaker since I have been using that medication.

Thank you for your help

Propecia (finasteride 1mg) should not impact bone growth or muscle mass. It sounds like you need to see your doctor to get to the bottom of your problem. The solution is not with me over the internet.

Tags: propecia, finasteride, hairloss, hair loss, bone density

FUE Failures Are Far More Common Than Most People Recognize

/by William Rassman, M.D./8 /

This is going to be a long post, but this week I saw two patients (on the same day) that had transplant growth failure nearly a year after they had follicular unit extraction (FUE) surgery… and I needed to vent / post a reminder / warn about researching certain doctors and looking beyond the hype. I’ve written before about what doctors don’t want you to know about FUE and I’ve probably written enough posts like this one before, too. But it doesn’t hurt to try again.

—

We performed a strip surgery this week on a patient who was disappointed with the FUE procedure he had done by a well known surgeon that promotes himself all over the hair loss forums (we’ll call him Dr. X — I can’t name him as I do not need the possible legal hassle). This patient reported that he received 1500 FUE grafts from Dr. X, and it was very long and very tiring, even though the doctor routinely brags that he can do up to 4000 FUE grafts in under 8 hours.

Many months later, by the time the grafts should have grown out, there was very little actual growth. The patient said that not only was the FUE surgery disappointing, but additionally he now had thousands of very visible white dot scars at the back of his head that were highlighted after he had a buzz cut. He is in the military and these white scars bothered him more than the graft failure! He had learned to live with his balding, but could not deal with the dots. He previously had a strip procedure with a barely detectable scar, and these dot scars were more visible and bothersome to him… which is why he came to visit our office, where he knew that the surgery would work.

Coincidentally, later the same day I had a consultation with another patient who had a complete failure of FUE from the same doctor. That is what has prompted me to write this post. We have seen quite a few similar cases that originated from that doctor’s FUE practice. In other words, these aren’t isolated cases.
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Azelaic Acid / Minoxidil Combo Made My Eyes Puffy and Dark

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

I have been using rogaine 5% for over 20 years. recently I changer to a new formulation containing Azelaic Acid. After 2 weeks I started to get eye puffiness which I believed is due to minoxidil absorption which causes water retention. I stopped the minox\azelaic acid combo but after 4- days my eyes are less but still puffy with dark circles. will this go away or do I need to take a diuretic to make it go away ? If a diuretic is needed should hydrochlorothiazide be used or Lasix ?

Thanks

If you have water retention or even believe your puffy eyes are related to minoxidil’s use, get a doctor to tell you what is going on. You could have an allergy or who knows what else. Maybe you have a completely unrelated serious medical issue that may be coincidental. If the azelaic acid is causing too much minoxidil absorption, you run greater risks than just a puffy face. Have you noticed any irregularity with your heartbeat?

I would think this would go away after a few days, but I suggest you see a doctor for an examination to be on the safe side.

Tags: azelaic acid, minoxidil, puffy face, dark eyes, hairloss, hair loss

Can I Catch a Flight Right After a Hair Transplant?

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

Quick question Doc,

Can you fly straight after a hair transplant?

Thank you.

We do have quite a few patients that fly in from all over the country (and world), so this is a question we get a lot.

Many of our out-of-town patients will fly home the same day they have their hair transplant. I do suggest that they spend the first night locally after the procedure so they can come in early the next day and we allow us to wash your hair to minimize scabbing… and then fly home.

Tags: hair transplant, flight, fly, airplane, travel

In the News – Bald Men Look More Dominant?

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

Snippet from the article:

Forget hair transplants, pills and hair regrowth serums. A University of Pennsylvania researcher has a better alternative for balding men: shave it all off.

In three experiments, researcher Albert Mannes, a lecturer at the Wharton School at U. Penn — and a balding man himself — found that guys with shaved heads are not only perceived by others as more manly and dominant than other men, but also taller, stronger and having greater potential as leaders.

Read the rest — Shave It Off! How Bald Guys Can Look More Manly and Dominant

We have been performing Scalp MicroPigmentation to give a balding shaved head the appearance of a full-looking, non-balding shaved head, and it is quite popular. Of course, we also provide hair transplants for men that don’t necessarily agree with this researcher’s experiments. Different strokes for different folks.

Tags: bald, dominant

After 6 Years on Propecia, I’m Seeing Shedding — Should I Add Minoxidil?

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

Hi Doc

I am 32 and have been using propecia for 6 years. I have recently noticed a lot of shedding and my hair feels thinner. Is this normal after 6 years? Should I now introduce minoxidil to my hair prevention? Does minoxidil affect non balding hair (back and side) and make them dependent on the drug as well. I am slightly concerned about making non balding hair weaker by making them dependent on a chemical. is there any reason to worry about that?

Also what ever happened to the potential of a natural apple based solution that helped prevent baldness? I saw a few years ago that a japanese company was running trials and said they had good results. Did this ever go anywhere or are they still running trials?

If your doctor measured your hair bulk throughout your scalp before you started the medication (something that probably wasn’t available then) or performed miniaturization analysis (which was available), you would now know when/if the drug stops working optimally.

Some men have said they’ve seen their hair loss resume after years of taking Propecia, but each case is unique. I’ve had patients on the medication for well over a decade with continued great results. I don’t know that it is “normal” but you’re likely not alone in what you’re experiencing. You should get a doctor involved so that you can start getting measurements now, which will be beneficial if you do decide to add minoxidil.

Topical minoxidil is an off the shelf medication that you do not need a doctor’s prescription to use in most countries. Many men start using it, then get lazy and stop after about a month or two when they don’t see immediate or significant results. It takes about 6 to 12 months of twice daily use to see some effect. Before starting or stopping any mediation it is always good to speak with your doctor. As to your question about dependency, see here.

With respect to natural apple based solutions, I have not heard or read much about it.

Tags: minoxidil, rogaine, finasteride, propecia, hairloss, hair loss

In the News – FDA is Raising Awareness About Dangers of Buying Pharmaceuticals Online

/by William Rassman, M.D./6 /

Snippet from the article:

The name of the Food and Drug Adminsitration’s new public awareness campaign, “BeSafeRx,” has the same ring to it as the websites you aren’t supposed to be trusting: “expressrx4les,” “healthydrugsonline,” “ineedmypill.com” and 10,000 others that the National Association of Boards of Pharmacy identified and recommends against.

It also comes off, at first glance, as a bit of a no-brainer. Don’t buy pills from the people spamming your inbox — it’s like not accepting unwrapped Halloween candy from your creepy neighbor, except riskier. But the FDA’s survey of over 6,000 people revealed that only 13 percent of those who had purchased drugs online checked to see if the site was licensed. Almost one in five admitted to purchasing medications from websites that weren’t affiliated with their local pharmacy or health insurance plan, and 47 percent of those same people relied on comments and reviews to verify the drugs’ safety.

Read the rest — How Legit Are Pillz-4-Cheap Websites?

On one hand, I get why people might be tempted to buy prescription drugs online — price and embarrassment being key issues. On the other hand, there are reasons why prescription drugs require a prescription, and you’re taking a huge risk when buying from these unlicensed and illegal websites.

How can you be sure you’re actually getting the right medication? How can you be sure you’re not actually doing yourself more harm than good? How do you know if you even NEED the medication that you’re buying? If it seems to good to be true, it probably is.

Tags: fda, prescription drugs

I Have a Bald Spot At the Back of My Head That Keeps Growing (with Photo)

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

Hello,

I am 25 years of age. I am having a situation where I have bald spot on my lower right back side of my head. It started out as the size of a dime when I noticed it 3 to 4 months ago. Now, the bald spot it spreading, and it is bigger than a half dollar coin size and is balder. I have no family history of anyone balding besides my father, who was the only one balding way back when. Is there any treatment that I can take for my bald spot? I hate wearing hats now, since I found out about my bald spot.

 

There’s no way I can diagnose you without an examination, but sometimes bald patches like this can be a sign of a condition called Alopecia Areata. You can learn more about this at the National Alopecia Areata Foundation site.

You need to see a doctor for a definitive diagnosis and this, almost certainly, will require a biopsy.

Tags: bald spot, hairloss, hair loss, alopecia areata

Press Release – Dr. Bernstein Improves Procedures Done with the FUE Robot

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

Snippet from the press release:


Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., a world-renowned hair transplant surgeon, presented a series of improvements to hair transplant procedures which use the ARTAS Robotic System for Follicular Unit Extraction (FUE). These updates include revisions to the FUE surgical protocol and technical adjustments to the robotic extraction system. He presented his refinements at the first user meeting held by the developers of the system; Restoration Robotics, Inc.; on September 14 – 16 in Denver, Colorado.

Dr. Bernstein described his series of improvements in a lecture to an elite group of physicians who are among the first adopters in the industry of the image-guided, robotic-assisted system.

Read the rest — Hair Restoration Pioneer Improves Robotic-assisted FUE Hair Transplant Procedures

For those doctors that use the FUE robot (ARTAS), these procedures that Dr. Bernstein presented should help to minimize problems with graft growth.

Tags: artas®, fue, hair transplant, bernstein

5 Months After My Transplant, Nothing Has Grown In and Now I’m Losing Hair All Over!

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

Hi Dr. Rassman,

I find your blog to be incredibly informative and helpful to those with concerns after their hair transplants. I decided to undergo a transplant exactly 5 months ago as preventative maintenance. 1,700 grafts to fill-in the thinning top portion of my head. I still have hair on my head, but under direct light you could visibly see through to my scalp. I followed my doctor’s instructions and had no major issues after the surgery.

At 5 months, the incision scar is still pink and I have occasional pimples on the top of my head (with what seems to be a noticeable increase in grease on my head). Also, after the surgery I had shock fallout. But it seems that ever since my surgery for the last five months my shedding has been consistently increased. Not just from the top of my head, but all over (sides and back). I have yet to see any growth from the grafts. But I have noticed white streaks in my hair. I have pitch black hair, and there are now random strips of white developing throughout my hair (I had never had white hair before the surgery). Is it possible that the shock of surgery would cause some of my hairs to begin to turn white?

And I’m also concerned at this point that my grafts will not grow in and that I will continue to get thinner and thinner since my fallout has increased. Thank you for your input and advice.

In my practice, we never recommend a hair transplant surgery for “preventive maintenance”, mainly because most patients would not likely see much of a result as they continue to bald and run the risk of being worse off. There is also a good possibility that the surgically induced hair loss might make it look worse, something we call “shock loss”.

If you are really losing hair on the sides, maybe something else is going on like diffuse unpatterned alopecia (DUPA). Shock loss doesn’t usually cause hair to fall out from the back and sides of the head. White hair does appear with stress on some people, but I really do not understand the cause. It sounds like you need a good doctor to talk with and be examined by. Perhaps the surgeon that did your transplant would be a place to start.

In general it takes about 6 to 8 months before you can see results and I tell my patients that most people can see 80% of the impact from a hair transplant in 8 months. You should notice growth beginning about now and see improvement in the next 3 months. If you are young and had the transplant without taking the drug finasteride, and assuming that your preventive hair transplants were not really needed, then you will most likely not have as much hair as you did before the transplant (based upon what you are saying here). Hopefully though, over the next 3 months you’ll see some gains.

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

My Doctor Said Propecia Could Stop My Bone Growth at 17 Years Old

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

Hey, Dr

I first noticed my hairline receiding and the top of my head was thinning when I was 15, doctor told me to use rogaine but 2 years later I stopped because of no results and was tired of putting it on everyday. Now that I’m 17 my doctor said propecia will still be too risky for me because he is worried that propecia could eventually stop my development (bone growth). What are your thought on what effects propecia could have on a 17 year old?

Thanks

I’ve never heard of Propecia stopping or impeding “bone growth” on an adolescent, however it has been theorized and I’ve written about that before here.

If your doctor is worried then that is his/her opinion and medical recommendation. If you would like a second opinion you need to see another doctor. If you do not want a second opinion, you should ask your doctor about the reasoning behind his/her statements and even ask to see (or pointed) to the literature he/she is basing the statement from. After all, that is your doctor and you have a right to ask these questions.

Tags: development, bone growth, propecia, finasteride