Doctor Recommended Vitamin D to Cure My Son’s Alopecia Areata

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

My seven year old son is suffering from Alopecia areata since december 2010 (first appearance: 7 spots of different sizes, stopped in june 2011, regrowth till mid-end september 2011, then hair loss starts again on other places, stopped in november 2011 and normal growth till february, new hairloss with 7 spots, actually regrowth…). A lack of vitamin D(25-OH vitamine D2-D3 is 10,7 ng/ml) has been diagnosed by a physician (who has some experience with AA patients) and he prescribed a vitamin D cure (choleciferol 25000 UI twice a week for one month, than once a week for two more months). But the dermatologist that is treating the AA thinks that this treatment is useless and that it could be harmful (he said that he would not administer vitamine D to his own kids…).

So my question: is there a risk for my son? can it help to cure the AA (or at least have less hairloss, longer periods without hairloss…)

I am not your doctor, nor your son’s doctor, and I am not an expert in vitamin D deficiency, so I couldn’t give you a personalized answer. If you’re concerned about one doctor’s recommendation, consider getting a second opinion.

I do know that alopecia areata is a self limiting condition that will resolve without any treatment in some people. A good resource for alopecia areata information is the National Alopecia Areata Foundation. I don’t know that they would consider vitamin D as a “cure” though.

Tags: alopecia areata, vitamin d, hairloss, hair loss

I’ve Been Using Rogaine Foam for Months But It’s Just Made My Hair Sun Bleached

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

My hair loss is destroying my confidence. Over a year ago I got on propecia at the suggestion from a reputable hair doctor. I did not like it and stopped about 5 months in. I got the side effects and I could just sense something was off in regard to my body. Since that time, I have been on rogaine foam. It has been 4 -5 months since I started using it. The only thing I can tell is that my hair has been “sun bleached”. I know peach fuzz is typical, but how can I tell if something is actually coming back ?

You can tell if hair is coming back if you look at the mirror and see an improvement. I realize this sounds basic, but afterall, you are using a medication to see real life results (not just to say you grew some hair). I am not sure about Rogaine sun bleaching your hair. I have not personally heard that one before.

Tags: rogaine, minoxidil, sun bleach, hairloss, hair loss

Does Toppik Work On My African Hair?

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

I am a African American woman and i was chemical burn by relaxer about 7 yeas ago. I do not know how and if you can help me with me living in the Caribbean. I was thinking of getting toppik but will that work on my African hair? please help

Yes. I know many African American men who came into our office to get a consult with us and when they are using Toppik, it seems to work well. I don’t see why it wouldn’t work in the same way for women. Give it a try!

Tags: toppik, hair loss, hairloss

Can My First Hair Transplant Be a Megasession?

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

Hi, I’ve got a “virgin” scalp, ie. no previous hair transplants.

Although, I’m not there yet, my hairloss looks like it will eventually end up in a Norwood 5-6 pattern.

Taking that info for face value I have the following question. Assuming a patient will need at least two to three procedures, is it better for someone with a virgin scalp to have their initial transplant be a large “mega-session?”

In other words, is it harder to have a larger subsequent done down the road because of laxity issues caused by a previous smaller surgery?

Basically, is it better to knock-out a mega-session first while the scalp has its best scalp laxity?

Thanks

Generally, we do not preemptively transplant hair to non-balding areas and prefer to treat the impending balding area with medications like Propecia. How do you know you will end up as a Norwood 5 or 6?

We pioneered the “megasession”, but just because we can do it does not mean we recommend it to everyone. Every case is different, and both the long term and short term goals must be discussed with each patient. For example, one patient may choose to have several smaller sessions over their lifetime as they are balding. Or another patient may wait until they are bald and have one big megasession.

Having a good scalp laxity works at making a megasession on the first surgery easier to do. Scar laxity usually returns to preoperative status after a surgery. If you have an FUE procedure instead of a strip surgery, the surgeon will take out what you need… and take out more and more of what you need as your balding progresses. No recurrent scars with FUE is clearly an advantage, but without seeing you, I am not sure how what I said applies to you.

Tags: hair transplant, surgery, hairloss, hair loss

Strip Scar Length and Graft Numbers

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

If I don’t require to have a lot of grafts placed on my scalp, and I want a strip surgery, can the doctor cut a small strip of hair, lets say, 3-4 inches in length so the linear scar is not big and doesn’t go from ear to ear?

My other question, if a person doesn’t require to many grafts placed on the scalp, why do the surgeons still cut a long strip that is from ear to ear?

Thank you

This is one of the things the doctor should go over with you during a consultation. There are many patients who do this! Requiring a small number of grafts will give you a shorter scar. Some patients wait a year after their first small surgery for another small surgery, and they end up with a single short scar (replaced from the old). Many patients are not informed about this opportunity prior to coming to see me, but learn of the option during the first consultation. This is a part of the Master Plan we create with every patient.

On the flip side… if you want to have as many grafts as possible in one surgery, a larger scar is necessary to obtain the grafts needed.

Tags: hair transplant, hairloss, hair loss, scarring

Finasteride Causes an Upregulation of Androgen Receptors?

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

hello doctor rassman
there was a study done where finasteride upregulates adrogen receptors in the prostate. here is the link– PubMed

is it possible that a user who takes finasteride for hairloss can have an upregulation of androgen receptors at scalp level? therefore causing more hairloss while on propecia? or propecia not working at all?

I am not a biochemist to give you a clear answer on how this study relates to hair loss. Of note, this was a very limited study in 47 cases in a cell line study.

The big picture here is that people take Propecia for the treatment of hair loss, and the studies of this drug have shown effectiveness for this. The research does not show that it produces hair loss.

Tags: propecia, androgen receptors, finasteride, hairloss, hair loss

ReCell Spray-On Skin in Hair Transplant Surgery?

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

Dr.Rassman/Dr.Pak,
Thought you might be interested in the following – ReCell Spray-On Skin

This technology was recently used to great effect here in the UK on a young child suffering from second-degree burns – Second Degree Burns Are Healed With ReCell Skin Spray

Do you think ReCell could be adapted for use in hair transplant surgery?

Interesting find, but scarring from hair transplant surgery has more to do with the tension created by the cut on the scalp (not a burn on the tissue or tissue damage). So I don’t think the product would have a great effect on hair transplant scars.

Tags: recell, scarring, scar

Why Do Scalp Pimples Occur After a Hair Transplant?

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

I had a hair transplant 2 months ago and have now developed pimples where they put the grafts. The doctor prescribed an antibiotic, but never explained the cause of the problem.

If you look at the anatomy of the hair follicle, you will see that this is a complex structure that contains skin, a hair shaft with a bulb, dermal papillae, outer root sheath, dermal fat, arteries and veins, nerves, muscles that hook up to the hair that makes it erect when you are cold or stimulated… and with regard to your question, the sebaceous gland.

Above: Schematic drawing of a two hair graft with all elements of the anatomy labeled (on left). The photo on the right shows an actual mirror image of this schematic drawing. Note the similarity between the diagram and the photograph.

 

After a hair transplant, everything you see here disappears, and when the new hairs finally grow, these structures are rebuilt by the body to complete the newly growing hair organ. The sebaceous gland may not die and often survives after the hair transplant. When that happens, it is still a functioning gland — and what do glands do? They put out sebum. If the gland survives the initial transplant, it will still be functioning, pumping out the sebum that normally came out through the pore in the skin that the hair exited from.
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I’m Taking Iron Supplements, But After 3 Months My Hair Has Gotten Worse

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

(female)
I’m really hoping someone will be able to help me out. I am 24 years old. Over the past 8 months or so I have had a few medical problems ranging from headaches, joint pain and severe hair loss. I have seen my primary, who then referred me to a rheumatologist. She was concerned about my ANA but ruled out Lupus. She referred me to a dermatologist. He informed me that my iron absorption level was low, and put me on an iron supplement, which I have been taking for three months.

My hair has gotten worse. I use to have thick curly hair. I have such thin hair now that you can see my scalp no matter what I do. It is extremely depressing. I’m only 24 years old and I fear I am going to lose all my hair. I am married and have a 5 year old son and a full time job, so like any other person I have stress, but I am not so overcome with it that I feel that is the reason this is happening to me. I do not have a family history of hair loss. I don’t know what to do. I’m 24; I can’t believe I am going through this. Please help me.

The best help I can offer is to tell you to consider seeing a doctor for your issues, including your depression and stress.

With respect to your hair loss issues, I cannot diagnose you or even offer a treatment (since I have not examined you or know exactly what is going on). Iron deficiency is known to cause hair loss, but I couldn’t say if that’s the cause of your loss. Continue the iron supplements for a good year or so, as it does take time to reverse any deficiency.

Tags: iron deficiency, anemia, hairloss, hair loss, low iron

Will Finasteride Prevent Hair Loss from Accutane?

/by William Rassman, M.D./11 /,

Two years ago I took accutane to deal with bad acne. During such time I ended up receding a lot around the temples – to the point of NW1.5ish – which certainly wouldn’t have normally happened – considering I was only 17 then.

To deal with the hair loss I’ve recently gone on Finasteride. However, my acne has also returned in a moderate form that like before, doesn’t respond to any creams. I know this second round will fix my skin once and for all, but I don’t want to lose any more hair.

Do you know if my taking Finasteride will somehow prevent hair loss from Accutane? The hair loss I suffered whilst on Accutane appeared to be TE as I was losing a lot more eyebrow, eyelash, and normal hair than normal – all with a white bulb at the end. I just want clear skin, and to maintain my hair. But my skin is so sensitive to acne creams thanks to Accutane, that I’m unable to treat it. It’s a real catch-22 and I’m afraid to go on Accutane again in case I go bald or something.

Propecia (finasteride) is used for the treatment of genetic hair loss, not for loss caused by other medications. I doubt that it will protect against possible hair loss caused by Accutane (isotretinoin).

Tags: accutane, propecia, finasteride, hairloss, hair loss

FUE vs FUT — Which is Better?

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

ImageThere is a question arising out of the hair transplant community which is becoming polarized and lining up for a fight: Which is better, FUT (Follicular Unit Transplant with Strip) or FUE (Follicular Unit Extraction)? Some doctors have already specialized in performing FUE alone, so their opinion is already made up. Some doctors new to the business entered the FUE market having never done an FUT strip procedure. That means that the nuances of quality control have not been learned (tricks to prevent graft damage from manipulation and drying).

I have had the opportunity to speak with some of these new doctors and they reported a substantial failure rate in their initial patients, but with time, they learned how to prevent damage and minimize transection of the grafts, and their results progressively got better. Their decisions on becoming hair transplant surgeons were initially made from a business mindset, under the assumption that the market demand would be there as they learned the process. This assumption is what actually happened. They also made the assumptions that the FUE technique would eventually be as good as the FUT technique over time. Again, this was a business, not a medical decision, and only time will tell these doctors if the quality of their work has met the needs of the patients.

ImageThe long term results with FUE (particularly on donor area damage in extensive FUE grafting) is not yet in. When we introduced the FUE technique in 2002 at the international meeting and in the Journal of Dermatological Surgery, there was not too much of an initial reaction, because the doctors who tried it quickly failed to get good quality grafts out. I remember two doctors in particular (names withheld) — one called me the first day after I returned from the meeting and I spent an hour on the phone explaining the subtle nuances that made it work for us. He thanked me, then quickly announced his new “pioneering invention”, the FUE technique, both on his website and through various press releases. Clearly he did not have the time to do more than one procedure and I felt sorry for that patient, a victim of a doctor’s greed for fame and money.

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I’m Feeling Tingling in My Fingers After Using Generic Rogaine Foam

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

I’m a 44 year old male and have been using Rogaine foam for the past 3 months and at the begging of this month changed over to a Generic “Rite Aid” brand of the Foam Rogaine. After using it for a couple of weeks I noticed my finger tips started tingling and feeling numb. Maybe from working it into my head with my fingers? Has this ever happen to anyone and is this a possible side affect?

I don’t remember hearing this complaint before, but tingling hands are a rare known side effect of minoxidil. It could be a sign that too much medication is being absorbed in the body. Are you using the medication at the correct amount and only twice a day? The generic should be the same as the name brand (I wasn’t aware a generic foam was available yet).

Maybe you should also consider using disposable gloves to keep the Rogaine Foam (or generic) off of your fingers.

Tags: rogaine foam, rogaine, minoxidil, tingling

Levothyroxine and Finasteride?

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

Hello,

My endocrinologist diagnosed me hypothyroidism a couple of years ago and I’ve been taking levothyroxine every morning to treat it. Since last year my dermatologist prescribes me finasteride to treat MPB. I take both at the same time (first thing in the morning).

Is there any problem about taking them together (poor absortion, etc)?

Thanks.

There are no interactions I know of. Taking levothyroxine should not be an issue with finasteride, but ALWAYS let your doctor be aware of any medications that you are taking when being prescribed something new. You should be asking this to your prescribing doctor and the pharmacist who fills the prescription.

Tags: levothyroxine, finasteride, hairloss, hair loss, hypothyroidism

In the News – FDA Looks Into Fake Adderall Sold Online

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

Snippet from the article:

Beware of fake versions of ADHD medication Adderall that are being sold on the Internet, the U.S. Food and Drug Administration has warned.

The agency issued the warning Tuesday after receiving complaints from the manufacturer Teva Pharmaceutical Industries that the 30 mg tablets, which do not even resemble the authentic version, was being sold online under the company name, FDA spokesperson Shelly Burgess told ABC News.

Adderall is approved by the FDA to treat attention deficit hyperactivity disorders (ADHD) and narcolepsy.

Read the rest — Fake Adderall Sold Online Gets FDA’s Attention

While not hair loss related, this is something to remember if you decide to purchase prescription drugs from online pharmacies that don’t require a prescription.

Tags: fda, adderall, dextroamphetamine, amphetamine, teva

What Are My Options After 2 Failed Hair Transplants?

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

What are my options after 2 failed procedures?

I had hair transplant surgery around 2007 using strip form back of head method, by what I thought was a credible Dr. from reviews online, experience level etc…Paid alot of money for hundreds of graft and got very little result. In fact only a few strands grew in at the hairline and temples grew in. None of the grafts in the crown area, where he said he really “packed them in” grew. He kept saying “you had beautiful grafts” and seemed dumbfounded as to why they didn’t grow.

After the salesperson tried to convince me that there was something wrong with me, the Dr. finally admitted that it was a failed procedure and agreed to do another one at no cost, This time saying he was going to try less grafts in that area hoping for better blood circulation. Well that also yielded very little growth. Although after about a year and half, filled in a little,but very little. Which shows me that there was no scalp biopsy necessary as they initially tried to say there was something wrong with me. I did get some growth. If there was a problem with my scalp, wouldn’t I have gotten 0 growth??

Overall I consider my decision to be a poor one because now i cannot even shave my head or wear a low style because of this huge scar (even wider now from 2 procedures) on the back of my head.

So my question is a two part question. Is a future transplant out of the question for me or could it be that this Dr and staff blew it twice? It should be noted that I am of mixed race(black and white) 38 years old,(34 at time of procedures), with more of wave than a curl to my hair, not real kinky but thick and puffy and coarse when it grows long on back and sides. The Dr did say they had experience in afro american hair types and seemed very confident during consultation with my donor area and being able to handle my hair type

Any insight as to what might of went wrong? The balding area was pretty much completely bald so I am not seeing native area that has thinned out after surgery, but the area that never fully grew in after 2 procedures.

Also is it possible that 4-5 year later that some of those graft may still have ability to grow?? With the aid of a product like Nioxin??

Thanks in advance for your answers

That is one hell of a story! If that happened to one of my patients, I would want to get a biopsy of his scalp, looking for a disease like alopecia areata that would cause rejection of the hair grafts. Unfortunately, your story is far more common than our profession would care to admit. Doctors who lack competence often use salesmen to push hair transplants beyond their abilities to perform it well.

One of the reasons that I started BaldingBlog is to have a place to let people share their stories. Your situation is quite unfortunate. For those that are shopping around for a doctor, remember that it is critically important to have thorough research. I’ve written a “how to” guide of sorts for selecting your hair transplant doctor.

As for your options, I think you should see a doctor who specializes in fixing screw-ups. The grafts should be growing, and if there’s nothing there after 4 or 5 years, I wouldn’t expect them to suddenly appear. I would be happy to give you my opinion, but I would have to see you. I’m in Los Angeles… but as you are in the Northeastern United States, consider a visit to Dr. Robert Bernstein for an opinion. Best of luck to you.

Tags: hairloss, hair loss, hair transplant