Has Rogaine Caused DUPA?

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

After using rogaine and the quitting i discovered a mix between thick and thin hairs. Have I created DUPA because my hair is worse now then before. Also the colour of those hairs are gone..same thing happening to my pubic area and facial hair. Do you think rogaine has created DUPA on me. I used it for a month and haven’t used it for two months now

Having thick and thin hair does not mean you have diffuse unpatterned alopecia (DUPA). You need to be evaluated by a good dermatologist or a hair transplant surgeon to find out if your diagnosis is DUPA. The changes in hair color in different parts of your body indicate that you are undergoing some preprogrammed change, probably not related to Rogaine (minoxidil).

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

What is Chronic Telogen Effluvium?

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

hi there! What does chronic telogen effluvium mean? I have ulcerative colitis, and it seems like every time I get sick, about two months later my hair falls out. then after about six months it stops. Then when i get sick again, it will start to fall out again. is this chronic effluvium and will it last forever, or does chronic mean that the hair will always be falling out?

The exact mechanism of this is unclear, but what you are describing does seem to be chronic telogen effluvium. The hair is pushed into a resting phase (telogen) by the activation of your autoimmune system with the ulcerative colitis. You may try 2% Rogaine (minoxidil) for 8 months and see if you can push the hair out of the resting cycle. The good news is that the hair is sill there and probably alive (resting), but the bad news is that treatment results are generally unpredictable.

For more information on TE, see Telogen Effluvium by Elizabeth CW Hughes, MD.

Tags: telogen, effluvium, chronic, hairloss, hair loss, ulcerative, colitis, rogaine, minoxidil, telogen effluvium

I Was Diagnosed with Mild Alopecia Areata After I Was Prescribed Propecia, Follow-Up

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

This is a follow up to “I Was Diagnosed with Mild Alopecia Areata After I Was Prescribed Propecia” The dr never did the biopsy because he said there was strong evidence that I had alopecia areata due to small patches on my face and amount of grey hair present. He wanted to try the simple stuff and since my hair has yet to start falling out again didn\’t feel the need to do one. However I have yet to see regrowth in two months of being told to stop using the topical. It was Fluocinonide .05%

The hair loss from alopecia areata may take months or years to reverse — or it may not reverse at all. You need to have good communication with your doctor on this issue. The diagnosis does not require a biopsy, as a good doctor knows what to look for in most situations. Patience is a virtue in waiting out the course of this disease. Topical steroids have value when used by a knowledgeable doctor and some may use fluocinonide (a prescription item) as one of these steroids. See Wikipedia for more on fluocinonide.

Tags: alopecia, areata, hairloss, hair loss, fluocinonide, fluonex, lidex, lidex-e, lonide, lyderm, biopsy

Using Minoxidil on Bald Spot from Trichotillomania

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

Dear Dr. Rassman,

My question is: might minoxidil work for a bald spot caused be trichotillomania? Is this worth a go? If so, have you heard of the product ‘Kirkland Signature’ who are a cheaper alternative
to Regaine?

Many thanks.

Trichotillomania produces hair loss from traction, which can kill the hair follicles that are under constant attack. Once they die, I would think that the follicles can not be brought back to life, and as such, I would not expect that minoxidil will have a benefit in the areas where balding is produced from trichotillomania. I have heard of the Kirkland brand, which I believe is just a generic minoxidil.

Tags: trichotillomania, trich, hairloss, hair loss, minoxidil, kirkland

Hypothyroidism and Hair Loss

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

Good day doctor, I was reading a short article about hypothyroidism, and I was left with a few lingering thoughts. Perhaps you might be able to answer my questions:

a) Would you say that hair loss due to hypothyroidism is a common or a rare incidence among those who suffer from hair loss?
b) Or, among the various symptoms of hypothyroidism, is hair loss a common or rare occurrence?

I understand that there may not be good statistics to answer these questions, but perhaps you might be able to shed some light, based on your experience.

Hair loss is one of many symptoms of hypothyroidism, but the frequency of it is not reported. Patients suffering from hypothyroidism usually have other symptoms along with hair loss, including weight gain, cold intolerance, fatigue, weakness, constipation, and depression. The diagnosis of hypothyroidism is made through blood testing for the level of T4 (the main thyroid hormone) and TSH (thyroid stimulating hormone).

Most of the patients in our practice suffer from male pattern baldness (MPB). Patients concerned about hair loss should have a miniaturization study to determine if the pattern is consistent with MPB or if there is an underlying medical condition causing the hair loss.

Tags: hypothyroidism, hypothyroid, thyroid, hairloss, hair loss, mpb

Dissecting Cellulitis of the Scalp

/by William Rassman, M.D./302 /,

I am a family medicine resident finishing up my last year. I unfortunately have a condition which I discovered doing my own research called Dissecting Cellulitis of the Scalp. It is horrible!!! This is a rare condition that usually affects black men in their 20’s. It is a very painful, cosmetically disfiguring disease that I have dealt with for about 4 years now. I have tried all of the antibiotics and medical treatment that you can think of and have seen many dermatologists that in my opinion, are not really aware of how tough this is to treat. I have read some studies that state that Laser therapy has been used with some success and others that state that complete scalp excision is successful. Of course, I don’t want my whole scalp taken off, but I am willing to try Laser therapy if it really has good results. At this point, I am really ready to try anything. If you are familiar with this or can even refer me to someone who is, I would really appreciate it.

This is a rare condition and as you said it is very difficult to treat. Before going as far as having surgical excision of your scalp, I found a case study in which they had success in treating recalcitrant dissecting cellulitis with Nd:YAG laser. The study was published in Dermatologic Surgery in August 2004, Volume 30 Issue 8, and was written by Eric C. Parlette MD, Nathan Kroeger, EVictor Ross MD — Laser Treatment of Recalcitrant Folliculitis Decalvans.

Unfortunately, I can’t post the text here and the publisher charges a fee to view the text, but it may be worth looking into. Good luck.

Tags: folliculitis decalvans, laser, dissecting cellulitis, dcs, hairloss, hair loss

I Was Diagnosed with Mild Alopecia Areata After I Was Prescribed Propecia

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

Im 24 and I noticed my hair thinning approximately two years ago. However it was hardly noticable. My dermatologist said it was due to hereditary and put me on Propecia. About three months later my hair began to fall out rapidly (about 200 plus hairs in the shower alone) from all over my head. It later slowed down to around 80 plus in the shower and has been consistently falling out at this rate for around a year. It seems to be affecting the top of my head more that the sides but it is hard to tell since it is diffuse loss. I saw a hair specialist who diagnosed me with mild diffuse Alopecia Areata. He prescribed a topical to apply once at night which in a few weeks stopped my hair loss completely. My question is will the hair I’ve lost ever grow back?

The diagnosis of diffuse alopecia areata is best made with a skin biopsy. Have you had that done? You have two diagnosis of genetic balding and alopecia areata…. both are not good from a hair loss perspective, but both can be treated. You need a confirmed diagnosis first and foremost. The treatment of alopecia areata is highly specialized. Some doctors use steroids to suppress the reaction in hope that the autoimmune process can be reversed. I wrote about a special treatment for this disease before — see Alopecia Areata in a Patient with a Miracle Cure (with Photos).

Tags: alopecia areata, alopecia, hairloss, hair loss, propecia, treatment, finasteride, biopsy

If I’m Diagnosed with MPB, Can It Later Turn Into DUPA?

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

Dear Dr. Rassman
I was curious if one is diagnose with MPB on the hamilton scale. Is it possible for that person to later develop DUPA in the future randomly. Or once you have MPB that the route you will go according to the hamilton scale. Hope that makes sense. thank you (great blog site by the way)

That is a great question. To give you a specific response, I’d need to know if you had miniaturization study done (and the results of this). For a more general answer, although male pattern baldness (MPB) and diffuse unpatterned alopecia (DUPA) are both classified as androgenic alopecia, it is unlikely that you would go from MPB to DUPA — although I suppose anything is possible. DUPA is more common in women.

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

Is Alopecia Areata Like Cancer?

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

my son has alopecia. i was woundering if that has a risk on life and is it dangerous. he is barely 9 years old and has extreme bald spots and lots of hair loss. i want to know if its like cancer and what the difference

Without seeing photos of your son or knowing anything about his medical history, it is difficult to tell, but from the brief description you gave, it does sound like he has alopecia areata. This is a condition that affects about 1-2% of the population with initial presentation in the teenage years. It is not contagious and is thought to be an autoimmune disorder, and not cancer. It is an inherited process. Since the exact mechanism of hair loss is not known completely known, there is no known cure to date, but in the hands of some specialists who focus on this disease, there are some effective treatments. In 90% of cases the hair will ultimately regrow. It would be wise to have your son seen by his primary care doctor to determine if there are any potential underlying causes of his hair loss and a dermatologist for possible biopsy.

Tags: alopecia, areata, alopecia areata, child, son, hairloss, hair loss, disease

Small Bald Spot Appeared Behind Left Ear

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

I am a 27 yr old asian male. About a month ago, I noticed a small bald spot at the back of my left ear, the size of a corn. I thought it was from my hair cut but now its getting bigger; about 2 inches in diameter. I can see there are some new hair growing in but very scatter. To the touch, the spot with no hair feels a bit rubbery. My concern is if this will continue until there is no more hair?

This could be alopecia areata, but this is a diagnosis that requires a doctor to make in person. Certainly make an appointment to see you dermatologist to try to figure out what this is.

Tags: alopecia areata, alopecia, hairloss, hair loss

I Have Diffuse Thinning, But It’s Different From the Genetic Balding Patterns in My Family

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

Dr Rassman,
I am a 24-year old male, I have always had extremely fine hair from the time I was a small child. In the past six months or so, however, I’m not sure if I just noticed it more, or if I am actually going bald. I could always see my scalp when wet, in certain lighting, etc., but now I’m not sure if this is just the way I am, or if it is worse now. I have very little balding in my family. My dad has a full head of hair at 51, as do my uncles on his side (whom are all older). My maternal grandfather is a Norwood 4 or 5, but did not really start losing his hair till around the age of 50 my mom said. One of three uncles on mom’s side is balding however. He is a Norwood 3 or 4 at the age of 40 (The other uncles on mom’s side, full heads of hair.) My hair still has the normal hairline, and no balding at the crown, but instead its thinning throughout the whole top. This is not the same pattern that these two men’s hair has taken (which worries me more). My questions are, what is the likelihood of going bald without it really being in your genes? I have also been a vegetarian for 6 years, and am wondering if this could be a factor? Also if I am going bald, would’nt it most likely take the same pattern (and start at around the same age) as the uncle and grandfather who are experiencing this as well? Very sorry for the long question, and thank you so much for the time and reply.

You really can not predict with any degree of certainly what the pattern of hair loss would be or even when it might start. If your hair loss is really diffuse, then you might have Diffuse Unpatterned Alopecia (DUPA) and should be evaluated with mapping out your scalp for miniaturization. This will point directly to the diagnosis if it is DUPA or genetic hair loss. DUPA will show miniaturization in the donor area, while genetic hair loss will show a normal donor area without miniaturization.

Tags: dupa, miniaturization, predict, genetic, hairloss, hair loss, genes

My Hair Loss from Accutane is Different

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

Hey, I am currently going through Accutane hair loss for 9 months. I was diagnose with ‘Diffuse Alopecia Areata’ by my derm. and currently on steroids. The question is, what can I expect in the future? My hair loss is unusual compared to other Accutane hair loss sufferers. I shed mainly short and medium hair, only occasionally would I notice long hairs being lost. Some of the hair strands that I loose are finer compared to the rest which are thick in comparison. I only receded only at my right temple while the left is perfectly fine. Also both the hairs above my ears have receded at least an inches above, and its skin bald. What can I expect in the future? Thank you

I don’t know what to expect for your future. If you have diffuse alopecia areata, the hair loss may not be predictable. What did your dermatologist tell you? You need to seek the advice of your doctors who know you, not me who only sees a brief outline of your situation via email.

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

Bald Spot Started As Small Spot Months Ago, Now It is Growing

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

I have a spot on the left side of my head. It appeared in the summer as small as a pea and know is about 2 inches. The hair that falls out looks like an exclamation point it is thick and then really thin near the scalp it also is discolored. My hair is dark black so the ends near the scalp are light brown. The bald spot is very smooth no hair or subble. What might this be and what kind of doctor should I visit my doctor has no clue.

I think that this is a test of my knowledge. ‘Exclamation point hair’ is a telltale sign found in certain diseases like alopecia areata (see Exclamation point hair). If the spot is expanding, then that may be your diagnosis. You need to see a dermatologist for your condition. Different diseases can cause this type of patchy hair loss, but the most common in western countries is ringworm (a fungal infection problem).

Alopecia areata is an autoimmune disorder in which hair is destroyed by the body’s defense mechanism. For those that have it, there is a genetic component which can be identified in the DNA. Hair loss could be seen anywhere in the body and is more obvious on the head and face, because of the density of hair in those areas. Recovery is spontaneous, but may take several months to years and it may not reverse. Some medications may facilitate recovery from this condition, but the best treatments are in the hands of a few doctors who have a particular interest in this disease.

Tags: alopecia, exclamation point, hairloss, hair loss, alopecia areata

I Stopped Washing My Hair Because I’m Worried About Losing It!

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

Hello, I started receding about a year ago and recently its getting worse, everytime i go in the shower and wash my hair there is about fifty or so hairs on my hands which didnt happen about three months ago, my scalp also itches but i dont want to wash it too hard because more and more hair will fall out, i need help bad, im avoiding washing it at the moment, there is also some white stuff on my scalp in some places which i can scrap off with my nail and doesnt smell too good. can you give me some advice please. thanks

You need to see a dermatologist soon. Several conditions could be causing your hair loss. Having extensive dandruff and scalp itching is a sign of inflammation of the scalp and seborrheic dermatitis. Seborrheic dermatitis is an inflammatory disease that can involve scalp skin and other areas. Although seborrheic dermatitis does not generally cause hair loss, if you are genetically predisposed to baldness, inflammation can accelerate your patterned hair loss. Some other inflammatory conditions, such as infectious disorders of the scalp, can do the same to the follicles. Find a good physician who can diagnose and treat the condition so that you can limit your hair loss or even regrow your hair. For an accurate diagnosis of genetic hair loss, if that is what you have, you need to get your scalp mapped out for miniaturization.

Tags: washing, clean, wash, dermatitis, hairloss, hair loss, inflammation

My Son Has Alopecia Totalis

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

My son has had alopecia areta past 5 years, we tried all kinds of medications ( from ayurveda, homeopathy, allopathic mecinines) but all in vain.. he is now diagnosed for opheosis…(alopecia totalis). We all are going through stress and depression.. and even our social life is getting affected becaause of all this.. is there any solution.. in laser therapy….
Please help…

Alopecia totalis is one of more advanced types of alopecia, in which hair loss spreads to involve the entire head. The mechanism of this disorder is similar to other more limited types of alopecia, like alopecia areata. Autoimmune reaction against hair follicles is suggested to be the cause of this condition. Although recovery could be spontaneous in a few cases, it may take months to years to appear.

Medications, such as minoxidil, have very limited success and topical immunotherapy is considered the most effective current treatment, but the response is not universal among all patients. You should have your son see a dermatologist who has special experience in treatment of this condition. If you are in the Los Angeles area, I can refer you to someone local.

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