Levothyroxine, Hypothyroidism, and Female Hair Loss

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

(female) I’ve been diagnosed with hypothyroidism, and have been taking Levothyroxin 75 mcg for about two years now. I just recently had lab work done, which indicated that my thyroid levels are low again, which means I will have to increase the amount of Levothyroxin I take daily. I have about 30 ongoing medical conditions, and I do take many medications along with this one. I asked my pharmacist about hair loss (as mine has been thinning and coming out for over a year now, but it’s really bad now though), which of my meds could be causing it, and what vitamin(s) I could take to combat it. He told me that my hypothyroidism was most likely the cause of my hair loss, and suggested I take 200 mg of selenium everyday to stop the problem. Is he correct? What kind of doctor would I need to see for this problem? What more can I do? Help me, PLEASE!! There is no pattern baldness in my family. I used to have a nice long full head of hair and now it’s so thin. I cry everytime I wash my hair because so much comes out at once. This problem is making my depression worse as well. Where can I go and what can I do? I’m on disability so I do not have a lot of funds to combat this problem so yet another issue with which to deal. HELP!!!!!
Thank you so much for your help!

Hypothyroidism is a cause of hair loss and thinning. First you must get your thyroid problem regulated. Best to see a good medical doctor who feels that this problem falls without his/her expertise, possibly working with a dermatologist to follow your hair loss. An endocrinologist may be a good choice for a specialty. You also asked about taking selenium — it should not be harmful and actually may help.

Tags: hypothyroidism, thyroid, hairloss, hair loss, female, woman, women, levothyroxin

What Caused Sudden Female Hair Loss — Chemical Relaxer or Psoriasis?

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

A client I have serviced for almost one year accuses me of causing her hair to fall out after a relaxer I gave her. She called me two days after the relaxer saying her hair was shedding. I am very thorough with my rinsing of chemicals and the shampoos that follow. She said her hair was coming out in strands and that her scalp itched a little. I suggested she see a dermatologist. Her dermatologist told her that there was nothing showing in her bloodwork that would cause her hair to fall out. He prescribed her Luxiq which as you know is for psoriasis of the skin and scalp. Would’nt that not mean that she had a skin condition which caused her hair to fall out and not the relaxer?

It sounds like you may be looking for potential legal advice. I do not know your client or the entire circumstance involving her hair loss. This sounds like an acute episode of hair loss happened within a couple of days of the treatment you gave her. There seems to be a direct link between the use of chemicals and the hair loss, based on what you’re telling me. As I’ve written before, psoriasis will not cause hair loss unless you pick at it enough to develop traction alopecia. This does not seem to be a traction alopecia case, though.

There are many possible reasons for female hair loss, ranging from medical illness to genetics to hormonal to stress. Moreover, even with modern advancement in medical technology, the exact cause and/or cure for female hair loss is still elusive. Your client’s hair loss may have been related to the chemical stress or it may just also be coincidental. I really cannot say.

Tags: hair loss, hairloss, female, women, woman, chemical, psoriasis

Chemo After Breast Cancer 2 Years Ago — Hair Still Hasn’t Come Back!

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

I had breast cancer and my last chemo treatment was in July of 2006. I finished radiation in October 2006. It has been almost two years and my very thick curly hair has not come back. I have a few sparse hairs all over my head, but they are very sparse. I take tamoxifen daily. Will my hair come back and what can I do to help it. I have used Nioxin for two years and just recently started uses minoxidil. Are there vitamins to help? Just what can I do?

I do not know how to help you. My experience is not in the area of chemotherapeutic drugs. Your best information will probably come from the doctors who are managing your chemo. They see many people with hair loss and can probably give you the answers you are looking for. I wish I could offer more, but this is beyond my specialty.

Tags: chemotherapy, chemo, hairloss, hair loss, cancer

In the News – Onion Juice to Treat Alopecia Areata?

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

Snippet from the article:

Onion juice could help some people with patchy hair loss resulting from the disease alopecia areata, an Australian researcher says.

“Although there is no proven treatment, some people might choose to try a ‘safe’ treatment — such as a topical steroid — even in the absence of good evidence of the treatment’s benefit,” said Dr. Mike Sladden of the University of Tasmania.

One small, unpublished study found hair regrew in almost half of 60 subjects with mild cases who applied onion juice — an alternative medicine used for infections, Sladden said.

Full text at United Press International — Onion juice may help patchy hair loss

Interesting reading.

Tags: onion, onion juice, hairloss, hair loss, alopecia areata, alopecia

Alopecia Doctors — Dr. Vera Price or Dr. Richard Strick?

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

Hi,

I’m writing to you desperate for answers. About 6 months ago my hairline started to thin and recede rather rapidly after stopping ortho-tri cyclen birth control pills. My general doctor thought that stopping the pill was the cause. About 2 months after seeing the doctor I started to develop a round bald spot above my front hairline. It has slowing progressed over the last 6 months into a spot the size of a quarter with redness and tenderness along with some sporadic itching. I went to see Dr. Vera Price at UCSF in San Francisco. She had her derma pathologist review a biopsy that Dr. Kurgis of Templeton CA had taken and told me it was alopecia areata and not a scarring alopecia. However, this is where I get to my question, I wanted a second opinion because Dr. Kurgis thought it looked more like a scarring kind so I went down to UCLA to see Dr. Richard Strick who also reviewed the same biopsy slides. He said that neither he nor his derma pathologist could clearly read the slides to determine if it was either scarring alopecia or alopecia areata. Which doctor is more knowledgeable about these diseases? Who should I trust Dr. Strick or Price? Please help; I don’t know what to do at this point. Dr. Price said that having another biopsy again is unnecessary and might make it worse and she was certain it’s not scarring, but it keeps spreading every week, little by little and the redness spreads as well. I’m very worried I will have to wear a wig if this does not stop. Thanks for any advice you can offer.

I personally know Dr. Richard Strick, because he is in the Los Angeles area (where I am based), and can speak very highly of him and his work, but I only know of Dr. Vera Price based on her reputation. These are two terrific dermatologists, and I can’t make a decision for you on who to trust more in this situation. You should have asked Dr. Strick about Dr. Price’s recommendations, as he was the last doctor you saw. I wish I could offer you some advice, but these doctors are both highly skilled in dealing with conditions like these and are much more specialized with this than I am.

Tags: price, strick, dermatologist, dermatology, alopecia, hairloss, hair loss, female, women, woman

Diffuse Hair Loss

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

(female) Dear Drs,

I was told that I most likely am suffering from Diffuse Areata, the thing that directed my doctor to this diagnosis is diffuse all over hair loss, brow and lash shed and short tapered hairs shedding out. I can find nothing on the subject, nothing on the net and my doctor admitted he did not understand the disorder.

Could you provide me with information regarding the diffuse form leaving no bald spots but diffuse loss all over the head. What is the general prognosis etc?

Thanks for your help

First, I want to tell you that clinical medical science is a descriptive science in many situation. This is important because what we see is what we are reporting when we diagnose diffuse alopecia areata. What doctors are saying is that there is a diffuse form of the disease that mimics classic alopecia areata, except that it is found all over the head. Some doctors question if this is the same disease, but because it looks like the same entity when the skin is biopsied as localized alopecia areata, the conclusion is that the diffuse variant is different in ways that are not understood. Most people believe that it is an autoimmune disease and we see evidence in what we call chronic and diffuse alopecia areata of the microscopic changes seen in autoimmune diseases.

Second, I can point you to some sites of interest so that you can learn more (but hopefully not confuse you):

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

Do Men with Immune Deficiencies (Like HIV) Have Less Chance of MPB?

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

Hi!

Do those with severe immune deficiency, like people with HIV, have a smaller chance of developing an advanced MPB? This is a question that struck me, since the immune system is what eventually attacks/kills the hair follicles if sensitive to DHT?

To understand the immune system and how it affects one’s HIV status and balding, it would take a few pages to elaborate. So to put it simply, the answer to your question is no.

The immune system does not attack and “kill” the hair follicles sensitive to DHT. Your statement is not correct. Hair loss from immune system issues reflect many forms of the autoimmune disease groupings, such as alopecia areata, but the immune system issues regarding HIV and alopecia areata are not related since the target of the antibodies are different, as well as the cause of the disease.

If you have HIV and have the genes for hair loss, you will have HIV and have hair loss (which will almost certainly accelerate if your HIV gets out of control or your diet is not healthy).

Tags: immune system, hiv, immune, mpb, hairloss, hair loss, dht, virus

Taking Propecia for My DUPA

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

Hi Doctor,
I began noticing my DUPA a year ago. Since then i have been on propecia (almost 8 months now). I have made the decision to finish atleast a the full year of treatment. My DUPA has definitely been getting worse over time. My entire scalp is getting thinner. Do you suggest that i stop propecia if it continues to progress after a year? Does this mean that i am just one of the people that propecia does not help? I ask because it is a large financial investment… Please advise.

Thank you for the great site doctor.

Diffuse unpatterned alopecia (DUPA) has an unknown cause and as such, we are just using medications that may help. It may reflect a variety of diseases, including diffuse alopecia areata or chronic telogen effluvium, because it has similarities to both in the way DUPA looks when you see it with the naked eye. But microscopically, it is different. I would suggest that after a year without any benefit, you should speak with your doctor about the possibility of stopping the Propecia (finasteride 1mg). If it gets worse, then you could start it again. My heart goes out to you and I know what I said here may just add to the confusion, but frankly we really do not know enough about DUPA to be more scientific in its treatment.

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

Folliculitus Decalvans and Hair Transplantation

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

Doc,

I have something between reoccurring folliculitus or folliculitus decalvans, depending on which doctor (i’ve been to a few) you ask. I have had a biopsy. The problem is located on the crown of my head. Subsequently, there is bald spot on the vertex of my scalp (about the size of a dime). Assuming I can get the infection to go away, is this something that can be cosmetically repaired?

Thanks for your input

If you have folliculitis decalvans and you can get the infection under control, any type of repair work in this area (i.e. follicular unit transplantation) could set off the disease process again and you have the potential of losing the transplanted hair and having to deal with the disease process all over again. This is your worst case scenario. I have had 3 such cases over my years in practice. Two ended up with reasonable hair growth, the third one is presently being diagnosed and treated. Good luck.

Tags: folliculitis decalvans, folliculitis, hairloss, hair loss, hairtransplant, hair transplant

Seborrheic Dermatitis and Hair Loss

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

If seborrheic dermatitis is left untreated, can it possibly cause hair loss or small bald patches?

If you let it build hard plaques on the scalp and then you pick them off, it can cause hair loss. Just flaking scalp does not cause hair loss, though. An extreme example of seborrheic dermatitis is the disease called psoriasis, which does not cause hair loss unless the victim picks off the plaques on a chronic basis. My advice is to seek out a good dermatologist and get yourself looked at carefully.

Tags: seborrheic dermatitis, psoriasis, dermatitis, hairloss, hair loss

Celiac Disease and Hair Loss

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

doctor,
you answer most topics, however I cannot find any information about CELIAC DISEASE and HAIRLOSS. It is scattered all over the web, however the link, to me, is not clear. I am 20. and have diffuse hairloss, my doctor told me to take omega 369 and jarodophillus. and to not drink beer, or eat wheat. is this good advice, considering the link between cleliac disease and hairloss?

Hair loss associated with celiac disease can be related to its link to alopecia areata, and can also be a result of the nutritional deficiency caused by the disease itself. The treatment for celiac disease is to remove gluten from your diet and to address the malnutrition caused by the disease. It sounds like your primary care physician is right on track with his recommendation for treatment. Once this has been addressed the question will be whether your hair loss was caused by alopecia areata, a nutritional deficiency, or both. A good source of information on this disease is the Celiac Disease Foundation. Good luck.

Tags: celiac disease, gluten, hairloss, hair loss, celiac, nutrition

My Daughter Has Alopecia Universalis

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

I have a daughter that has had aolpecia universal for the last 10 yrs. Her hair completetly fall out and then regrew back with help of cortizone shots, lasted 2 yrs and than fall out again. Since then her hair has never returned. Now, at the age of 30 and the devasation of no hair and self esteem are at rock bottom. What would you suggest.

Thanks

There are dermatologists that specialize in this condition. There is a doctor here in Los Angeles that might be able to help her — Dr. Richard Strick is at UCLA and I’ve written about him before. He’s done remarkable work with alopecia areata patients (see Alopecia Areata in a Patient with a Miracle Cure), and although your daughter has a different form of alopecia, it is worth perhaps contacting Dr. Strick.

Tags: alopecia, unversalis, totalis, hairloss, hair loss, richard strick, strick, ucla

Psoriasis

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

Hi Dr. Rassman. When I was younger I had what I think was diagnosed as a form of psoriasis which was mostly on my scalp. I would have quarter size patches of dry flakey skin and if i tried removing the patches large clumps of hair would also come out. Although I’m sure I was experiencing MPB as well, I feel like this was something that increased the amount and rate of hair which was being lost. I had visited the dermotologist and Nizoral was prescribed at the time.

Just wondering if this is a condition you’re familiar with?

Thanks

I am more than just familiar with it, as I have a very aggressive form of psoriasis myself. When I was young, it impacted my scalp along the ears and frontal area and looked awful and felt painful as well. Psoriasis will not cause hair loss unless you pick at it enough to develop traction alopecia. If your dermatologist has his/her hand on it, then there is nothing to do unless you are not in control of it. If you have male pattern loss at this time then probably you should be on Propecia (finasteride 1mg).

Tags: psoriasis, hairloss, hair loss

In the News – Bexarotene 1% Gel to Treat Alopecia Areata

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

From the article:

Topical bexarotene 1% treatment produced a 30% hair growth response among patients with alopecia areata (AA), according to research presented here at the American Academy of Dermatology 66th Annual Meeting (AAD).

“Currently, there is no cure for alopecia, and it is often refractory to treatment. So new treatment possibilities are especially welcome,” said lead investigator Rakhshandra Talpur, MD, Instructor, Division of Internal Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas.

Full text — Bexarotene 1% Gel Shows Efficacy for Alopecia Areata: Presented at AAD

Tags: alopecia, areata, alopecia areata, bexarotene, gel, hairloss, hair loss, treatment, targretin

Cicatricial Alopecia

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

Would you please explain what Cicatricial (scarring) alopecia is? What can be done for it if lichen planus caused it? Thank you!

Cicatricial alopecia is one of the two major categories for hair loss (alopecia). It stems from an autoimmune process and is found in many types of non-genetic alopecias. The etiology for the way cicatricial alopecia works has not been well defined.

Included in this group are:

  • Lichen planopilaris: Lichen planopilaris is the name given to the skin condition lichen planus, when it occurs on the scalp. It often presents as purplish bumps or red to purple rims around hair follicles and can be associated with the skin conditions as well.
  • Frontal fibrosing alopecia: This condition is more common in postmenopausal women. It looks a little like androgenetic alopecia, but instead of lots of fine miniaturized hair there are large spaces between hair follicles of normal diameter. A scalp biopsy will reveal many immune cells around hair follicles that are in the process of destroying them.
  • Pseudopelade: This is a form of scarring alopecia that looks like alopecia areata in is general shape. It is not a specific disease but rather a pattern of any old or “burnt out” scarring alopecia, due to a variety of causes.
  • Dissecting cellulitis of the scalp: This condition is characterized by multiple pustules and large cystic nodules in the scalp and can be associated with severe facial acne. This most commonly occurs at the back of the scalp and on the vertex. It is much more common in people of African descent. After years of this condition a scarring hair loss often ensues.

A scalp biopsy can readily determine if hair loss is non-scarring or scarring and therefore permanent. However, determining exactly which scarring condition caused the hair loss can be difficult.

The bottom line is that if you are experiencing hair loss, it is important to see your doctor to determine exactly what type it is and whether it’s treatable. And if it is treatable, to start your treatment as soon as possible so that permanent hair loss may be prevented.

Tags: hairloss, hair loss, cicatricial, alopecia, scarring, lichen planus, cellulitis, pseudopelade, planopilaris