Do Doctors Know to Even Look for Body Dysmorphic Disorder?

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

Hi Dr. Rassman
I truly believe that HT surgeons like yourself offering good and honest advice to the general public, are few and far between. As we both know hairloss can be a devastating condition for any man. My severe worry is, that given this invaluable tool we call the internet, alot of misplaced paranoia is given to very young people (17-25) who should be enjoying their youth and the best years of their lives. It is of major concern to me, given the easily accessed nature of the internet, how (a minority) of young men (and women) may be posting pictures of their hair when there really is nothing wrong with their appearance.

I only mention this as i myself am a long term sufferer of a mental disorder know as “Body Dismorphic Disorder” and although there is nothing wrong with my hair, i have severe BDD. I know BBD sufferers are a minority but i believe especially when it comes to cosmetic procedures, sadly for alot of sufferers (especially the young) it is often overlooked.

My main question is, do professionals as yourself check for such (sometimes severe) disorders when assessing a patient and given the devastation they can cause among sufferers, how do surgeons like yourself deal with, what can be life or death situations for sufferers of this chronic condition?

Thank you for your time

I obviously can’t speak for all doctors, but we do occasionally see men and women with body dysmorphic disorder in our clinic, and for some of those patients much of the consult time is spent on counseling them.

Most of the time these patients are already under care for BDD when we see them, but otherwise we refer them to psychiatrists.

Tags: bdd, body dysmorphic disorder, hairloss, hair loss, dysmorphia, mental illness

Vitamin K and Hair Transplant

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

I have a question about Vitamin K. Since it helps with blood coagulation, would it be OK to take it before and during a hair transplant procedure? My platelets have always tended to run a bit low, which has made previous surgeries last a bit longer than they should. Thanks, and you are still doing a wonderful job with the blog!

I do not think taking vitamin K supplements would help with a hair transplant surgery. Blood coagulation is not as simple as adding a vitamin. Please ask your doctor to address your blood coagulation and platelet issues. Do you have von Willebrand disease (vWD)?

Tags: vitamin k, hair transplant, hairloss, hair loss, blood coagulation

In the News – Alopecia Areata and Stress

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

Snippet from the article written by Dr. Maria Hordinsky, a dermatologist from the University of Minnesota:

Stress has been cited frequently as a factor in autoimmune diseases, including alopecia areata. Yet experimental evidence to decisively link stress and alopecia has been lacking.

It is easy to link alopecia with stress, as many but not all patients associate stressful events with the development of hair loss. Moreover, there are a lot of nerves in and around hair follicles. The actions of these nerves, as well as various nervous system products called neuropeptides, could affect the hair growth cycle.

Read the full text at NY Times — Can Stress Cause Hair Loss?

I have seen a few cases of surgical stress induced alopecia areata. One patient that comes to mind had a hair transplant surgery just before the alopecia areata appeared and it was active for about 6 months.

Tags: alopecia areata, stress, hair loss, hairloss, hair transplant

I Thought DUPA Was Diffuse All Over the Scalp?

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

In response to My Hair on Top is Thick, But My Sides Are Thinning Quickly!

You said, “If you are thinning only on the sides, something that I have rarely seen, it’s often associated with diffuse unpatterned alopecia (DUPA).”

Doctor….How the heck can he have DUPA if only his sides are thinning and not the top? Makes no sense.

You’re right. In the above referenced post, I was a little quick in my reply. Perhaps what I should’ve said in addition to the above quote is, “There may be additional miniaturization in the front, top, and crown that you’re not noticing, but if the hair is longer it could be more difficult to detect.”

Generally if the sides of the head have significant miniaturization, the rest of the hair on the scalp will also show the same. The degree of miniaturization may not be the same in different parts of the scalp, though. As I can’t see the hair loss through text sent in an email, I have to make guesses (educated or otherwise) when trying to answer a question like this. The individual needs to be seen by a doctor to examine their scalp, since who knows what is actually happening with their hair loss.

So just to clarify once more… in the case of someone losing hair on the sides of their head, chances are good that there will be hair loss elsewhere on the scalp. I apologize I wasn’t more clear about that in my earlier reply.

Tags: dupa, diffuse unpatterned alopecia, hairloss, hair loss

My Hair on Top is Thick, But My Sides Are Thinning Quickly!

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

First of all i would like to take this time to say that this is the most helpful internet site about regarding hairloss.

My question is that i have began receding and thinning badly on the sides of my hair. From the side burn to just above my ear. My hair on top is thick and i am slightly receding at the corners, but at the side of my hair it is getting extremely worse quickly. why is this? what options do i have?

This is a good situation for mapping out your miniaturization. This will put numbers to what you are observing. A good doctor will know how to do this for you.

If you are thinning only on the sides, something that I have rarely seen, it’s often associated with diffuse unpatterned alopecia (DUPA).

Tags: dupa, hairloss, hair loss, thinning

Your Hunch Was Right — I Have Alopecia Areata

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

Dr. Rassman,
Some time back I made the following posting and your hunch turns out to be right! I went to see a hair loss specialist (on my own as my physician tends to be dismissive). She did a biopsy and the results came back indicating alopecia areata. She recommended that I see a dermatologist. When I had the results in hand, only then did I tell my physician. My physician said he would refer me to dermatologist but the problem is there so few in our city that it takes months to get an appointment. Even then, preference is given to patients with more severe conditions.

I am wondering what I can do in the meantime. It seems my hairloss area is growing. The funny thing is that it looks somewhat like mpb. Initially the hairloss was visible only on the front right side just behind the hairline and then progressed towards the hairline and further back. The left sides is also catching up.

I’m really stressed out about this as my head does look good with short hair.

Treatment options are limited for alopecia areata, but a great starting point is the National Alopecia Areata Foundation. I wish I could offer more, but at this time you should see the dermatologist… and if it takes too long for an appointment, ask your doctor for another referral to someone that can get you in sooner.

Good luck to you!

Tags: alopecia, alopecia areata, hairloss, hair loss

My Daughter Is Missing Half Her Hair After Radiation Treatment Years Ago

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

Hello Dr,

I have a 12 year old daughter who suffers from partial alopecia due to radiation cancer treatment to her brain at the age of 4. On the lower half of her head she has absolutely no hair, her hair follicles were burnt out by the treatment and on the upper half, her hair is very thin. Is there anything to re-activate the hair follicles? We are desperate for something mostly now that she is approaching her teens. Please let me know. your help is greatly appreciated

There really is no perfect solution in a case like this. If the hair follicles that were damaged from the radiation treatment haven’t regrown by this point, they likely never will. Wigs are one option, hair transplantation may be an option as well, or even various surgical options that move sections of the scalp after stretching it (balloon expanders). I couldn’t say at this point though, as each and every individual is different.

You can come in and let us take a look at your daughter’s hair loss. As you indicated you are in Los Angeles, such a visit may have value. The consultation is free, so please call my office at 310-553-9113 if you’d like to set up an appointment.

Tags: hair loss, radiation, cancer, treatment, hairloss, hair loss, child

In the News – Bald Women Are a Fashion Statement?

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

Snippet from the article:


Women who want to go bald as a fashion statement may find the process smoother than ever.

Some fashion experts believe female baldness is getting its most positive fashion exposure since singer Sinead O’Connor hit it big in 1990. Although Britney Spears went bald a few years back, it was viewed as a cry for help, not a fashion statement.

Part of the reason why baldness is in is because of the positive press given to Miss America finalist Kayla Martell, who suffers from “alopecia areata” — an autoimmune disease that led to complete hair loss when she was a child.

Read the full story at AOL News — More Women Taking a Shine to Going Bald

I agree that Miss Delaware Kayla Martell is a good role model for young women dealing with alopecia (we wrote briefly about her here), but I also found a rebuttal to the idea of hair loss as a fashion statement at Salon.com.

Tags: bald, hairloss, hair loss, female hair loss, miss delaware, kayla martell, alopecia

Staph Infection on My Crown

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

i had a staph infection on the crown of my head. my question is that it has left bald patches in my scalp and in other areas around my head but mainly on the crown. I do not have male pattern balding but will Rogaine help regrow the hair?

Rogaine (minoxidil) may help regrow some hair, but it usually takes about one full year for you to notice some difference. I’d just be patient and wait out for the hair to regrow on its own if you’re certain you don’t have genetic male pattern hair loss.

Tags: staph infection, hairloss, hair loss, minoxidil, rogaine

In the News – Getting the Word Out About Trichotillomania

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

Snippet from the article:

Laura Forbes has a ten-a-day habit that she is desperate to break. She tries to keep her hands and her mind occupied, but when she does succumb to temptation she feels guilty and frustrated to have derailed another attempt to give it up for good.

Laura is not addicted to cigarettes or to any other well-known vice. She is a trichotillomaniac – one of more than a million women in Britain who are tormented by the constant urge to tear out their own hair.

That Laura is plucking only ten hairs from her head a day is a great triumph of willpower for a girl whose obsession, at its peak, left her bald from the crown to the front of her head.

Trich
Photo source

Read the full story at DailyMail UK — The secret compulsion that’s as disturbing as any eating disorder

Trichotillomania is an obsessive compulsive disorder, and the article delves into looks at what triggers the desire to pull out your hair and how to possibly treat it. There’s no single solution that has worked across the board for everyone, but research has pointed towards new treatment paths.

Just a little over a year ago, we wrote about an over-the-counter pill that might help control the compulsion, but I haven’t found any newer info about it. If I find out more, I’ll post it on this site.

Tags: trichotillomania, trich, ttm, hairloss, hair loss, female hair loss, hair pulling, ocd

In the News – Like a Forest Fire of Hair Loss

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

Snippet from the article:

Matt KelleyMatt Kelley was 38 when he first noticed a round, hairless spot in his beard. Within six weeks, every inch of his body that once had hair — including his eyebrows, eyelashes, arms and head — was completely bald.

“It was like a forest fire of hair loss,” Mr. Kelley said.

Mr. Kelley, now 43, has alopecia areata, an autoimmune disease that causes the body to attack its own hair follicles. Alopecia, which does not include normal male-pattern baldness, affects nearly 2 percent of the global population and has no universally effective treatment. Its progression is unpredictable and can range from a few bald patches to a completely hairless scalp to the loss of every hair on a person’s body — known as alopecia universalis. Sometimes the hair regrows, sometimes it does not, and sometimes it grows in only to fall out again years later.

Read the full story at the NY Times — A ‘Forest Fire of Hair Loss,’ and Its Scars

The article discusses how quickly this disease wiped out all of this man’s hair, the impact it had on his life, and the treatments he’s tried. The recent alopecia areata gene discoveries that were announced earlier this month has brought about renewed hope for a cure or at least a reliable treatment for those with this disease.

Tags: hairloss, hair loss, alopecia areata, alopecia universalis

Pityriasis Lichenoides Chronica and Hair Loss?

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

I have been diagnosed with Pityriasis lichenoides chronica which I have had since I was 15. About the same time my hair started thinning. I am now in my mid 30s and I have general thinning (no hairline recession) from the crown to the front. Both sides and the back of my head is fully thick. I have started propecia and minoxidil.

Is there any connection between the PLC and my hair loss?

I have no personal experience with pityriasis lichenoides chronica (PLC), but as I understand it, there’s not much known about the condition. How it relates to hair loss is unclear. For those readers that are curious, PLC “is characterised by the gradual development of symptomless, small, scaling papules that spontaneously flatten and regress over a period of weeks” (source: DermNet NZ).

What I do know is that the most common cause of hair loss in men is genetic male pattern baldness (MPB). It occurs in a pattern from crown to front as you describe, leaving the hair on the sides and back “fully thick”, as you also describe. It could be possible that you have PLC along with MPB and the two are unrelated.

It seems you need a good diagnosis and you cannot get that here on the Internet. You need to find a physician who can examine you and give you his assessment. A miniaturization study may be helpful as well and may point to the association of genetic male patterned hair loss if that is also present.

Tags: mpb, hairloss, hair loss, plc, pityriasis lichenoides chronica, rash

I Have Characteristics of DUPA and MPB

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

I have been losing hair since I was about 17 (I am now 23), and I’m confused as my hair loss seems to have characteristics of both DUPA and typical MPB.

For example, I have a receding hairline and a small bald spot at the vertex – typical of MPB. However, I also have general thinning on the crown, forelock and down the sides and back of my head. Is it possible to have a receding hairline with DUPA? I was under the impression men with this kind of hair loss retained their hairlines.

NW 7If you have the gene for male pattern baldness (MPB), the expression of the gene will dictate when the hair loss starts and which balding pattern that you will evolve into. In most people, the frontal loss starts at the leading edge of the frontal hairline, but a few people will keep their frontal hairline while they lose the hair behind it. When it comes to those with diffuse unpatterned alopecia (DUPA), the loss of the hairline as you describe is possible.

Here’s an excerpt from a paper published in 1997 referring to DUPA that may clarify: Diffuse Unpatterned Alopecia patients have a similar progression of balding as the DPA [diffuse patterned alopecia] patient except that the progression is often more rapid and will more likely eventuate in a “horseshoe pattern” resembling the Norwood class VII, except that in contrast to the Norwood VII, the DUPA “horseshoe” can look almost “transparent” due to the low density.

The hair on the sides and in the back of the head (a 3 inch high part of the scalp that starts at the body prominence of the skull aka the “horseshoe pattern” mentioned above) is looked at as permanent hair in most men. In the diagnosis of DUPA, this permanent zone has miniaturized hair in excess of 20%. The higher the miniaturized hair count in the permanent zone, the more difficult it will be to get enough good healthy donor hair for a hair transplant.

Women have what looks like DUPA in that same area and also often throughout the head. This makes most affected balding women poor candidates for hair transplantation.

Tags: dupa, hairloss, hair loss, mpb, diffuse unpatterned alopecia

Will a Hair Transplant Make Psoriasis Worse?

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

Dear Sir,

I have psoriasis and may be it has caused some hair loss. I would like to know if I conduct hair transplant on the affected area can the hair grow there or the skin become worse?

I too have psoriasis and had a hair transplant twice. The psoriasis did not impact the hair transplant or vice versa. I wrote about this very topic in one of my earliest blog posts way back 5 years ago — Scalp Psoriasis and Transplants.

It’s worth noting that I doubt the psoriasis caused your hair loss unless you picked at your scalp and developed traction alopecia.

Tags: psoriasis, hair transplant, hairloss, hair loss

In the News – Alopecia Areata Genes Discovered

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

Snippet from the article:

Researchers have implicated eight genes in the development of alopecia areata, a disorder that causes hair to thin and fall out.

The genes are already associated with other autoimmune diseases, including rheumatoid arthritis and type 1 diabetes, meaning that drugs may already be in the pipeline that could benefit people with hair loss, the researchers said.

“This greatly accelerated our ability to think about new drugs for patients with alopecia areata because so much work has already been done in these other diseases,” said senior study author Angela Christiano, professor of dermatology and genetics & development at Columbia University Medical Center in New York City. “It is a huge advantage.”

Read the full story — Genes Tied to Hair Loss Disorder

This is a fantastic breakthrough and will hopefully lead to treatments for this disease. For more about alopecia areata, see the National Alopecia Areata Foundation.

More info about this new discovery might be in the articles at LA Times and CNN.

Tags: alopecia areata, hairloss, hair loss, christiano, ULBP3