I Have So Many DUPA Questions…

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

Hello,
I am a 23 year old male and am fairly certain I have DUPA. The hair on the sides and back is still pretty thick I think. However the hair on the top is thin from the normal hairline to the crown. It still isn’t that bad, I don’t think anyone would ever think I was going bald when it is dry, however whenever I exercise or go swimming it gets wet and almost looks as if I am malnourished or something; seriously. And God forbid it rain (I get extremely concerned when it rains and I’ve forgotten an umbrella) cause when it hits my head you can see straight to the scalp. My hair has always been very thin/fine ever since I was a child, but now I feel that it is getting worse. What I would like to know is if DUPA is not always caused by DHT, then what is it caused by? And it seems as though there aren’t many solutions to this type of baldness, except possibly Propecia, is there anything else? Also I have begun using Rogaine, is it worthless for DUPA? I know that’s quite a few questions, but to be honest that’s just the tip of the iceberg for me, I’m sure I’ll ask for more, Thank You so much.

You should see a physician to get a firm diagnosis of DUPA (diffuse unpatterned alopecia). You may not have DUPA if you have thick hair as you describe in the back of your scalp. Propecia (finasteride 1mg) in particular works by blocking the DHT hormone which causes AGA (androgenic alopecia) or MPB (male pattern balding). Since DHT may not cause DUPA, Propecia may not be of any benefit. BUT… I generally recommend male patients try a course of it, as some patients with DUPA do get a response from the drug. Keep in mind, nobody really knows what causes DUPA and drugs such as Propecia and Rogaine have not been studied for the treatment of DUPA.

Thank you for all the questions, but please keep in mind this site is NOT meant for the diagnosis or treatment of any medical conditions.

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

Spina Bifida

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

Hi. Im 15. I was born with spinabifida. About a year ago I started noticing my hair falling out. It wasnt much. Just a little but here and there when I combed it out. Then as time progressed, the amount of hair I was losing increased alot. Now every time I take a shower, I usaully comb my hair in the shower after I put conditioner on it. Massive amounts of hair come out. Its really scaring me. Is this normal or is there somthing wrong with me? Or does this go along with the spinabifida?
Thanks!

Hair loss in men and women usually has genetic causes that could be accelerated by other factors. There is no report to show that spina bifida is causing hair loss or that hair loss is one of the coexisting factors in patients with spina bifida as of yet. You can also see another posting on this topic here: Spina Bifida and Hair Loss.

Tags: spinabifida, spina bifida, hairloss, hair loss

I Can’t Take Propecia Because I Have Hepatitis B?

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

Hi Doc,
I am very concerned about my hair loss, and so far my frontal area is balding apparently. I thought about having hair transplant, but one doctor told me that I need to take propecia to stop losing the existing hair after the surgery.

However, I have Hepatitis B so my personal doctor suggested me not to take propecia since propecia can increase the chance of me getting liver cancer.

This is truly a delimma to me, do you have any suggestion or solution to that? Thanks

I do not understand why your doctor suggested that you can not use finasteride (Propecia). Finasteride get metabolized in the liver like many other medications. If you are in liver failure, then that may be a different story. Its use needs to be controlled and it probably needs dose adjustments in the patients who have liver disease or cirrhosis (not just hepatitis). I am not aware of any evidence that indicates an increased risk of liver cancer with finasteride if you have hepatitis.

Tags: hepatitis, propecia, finasteride, cancer, liver, hairloss, hair loss

Tuberculosis Medication and Hair Loss

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

i have been taking TB medicine AKT-4 for 2 months and now i am on AKT-2 for six months. my hair is falling rapidly. is this because of my medicine? please advice

First and foremost, you should not start or stop taking any medication on your own without consulting your doctor that prescribed the medication to you. Tuberculosis is a serious matter and you should not do anything to jeopardize your treatment regimen. With respect to hair loss, it is virtually impossible to tell if it is the medication that is causing it. You may have a component of genetic hair loss and may be noticing a coincidental correlation or the existence of TB as a debilitating disease — this alone can cause hair loss. You may consider seeing a physician for further medical work-ups to rule out any other potential causes for hair loss and particularly determine if your overall ‘nitrogen balance’ is positive (nutritional balance). For genetic balding, finasteride should not be contraindicated.

Tags: tuberculosis, tb, akt-4, akt-2, hairloss, hair loss, finasteride

Central Centrifugal Cicatricial Alopecia

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

I am a 54 year old Africia American Female that has Central Centrifugal Cicatrical Alopecia, is there hope? and if so what can I do.

Also called “hot comb alopecia” in the past, central centrifugal cicatricial alopecia (CCCA) is a rare condition that presents with cicatricial alopecia in the central scalp. This lesion grows larger around its center and tends to destroy the hair follicles and causes permanent balding.

It was thought that this condition has to do with combing or use of oil for hair styling in African-American women. The cause of this type of hair loss is still not known and its treatment is difficult, as seen with this and other similar scarring alopecias. This condition that is usually seen in African women presents as an unusual sensation (pins and needles) on the top of the scalp followed by tenderness in those areas. There is no visible sign of inflammation in the area. Skin color may change to become fleshy and eventually hyper-pigmented (darker). Hair loss in this condition is usually permanent.

Tags: central centrifugal cicatricial alopecia, ccca, alopecia, african, women, woman, female, hot comb, hairloss, hair loss

DUPA Questions

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

Hi Doc-
Could you please do me a favor and talk for atleast a paragraph about DUPA. I cant begin to tell you how frustrating it is to suffer this kind of balding. Even though I have a good hairline, there are times when I wish I was going bald in the MPB fashion rather than this general thinning ALL throughout my scalp. Please DOC!! For example:

  1. What is chemically different in my hair folicles than someone with MPB
  2. Is it really impossible for me to get a hair transplant? The hair in the traditional donor areas is really thin.

Thanks DOC, even if you dont have good answers, atleast just talk about DUPA cause I feel like my situation gets swept under the rug.

You can find a lot the information on DUPA (diffuse unpatterned alopecia) and possible treatment methods in one of our previous posts: How Fast Can DUPA Take Effect?.

In regards to the chemical basis for DUPA, we don’t really know much, because the mechanism of this condition is not clear yet. Genetic factors are big players in most patients with DUPA. There are some medical conditions that cause general miniaturization and hair loss. If clinically indicated, you should get tested for medical conditions that cause diffuse hair loss such as iron deficiency, thyroid problems, and some immunologic conditions. Hair transplantation is contraindicated for treatment of DUPA, because so much of the donor hair that is normally protected in male patterned hair loss, is miniaturized in DUPA and has no transplant value. Some patients respond well to medical treatments such as minoxidil and finasteride. You need to check this with your hair specialist.

Tags: dupa, alopecia, hairloss, hair loss, hairtransplant, hair transplant, finasteride, minoxidil

DUPA and Propecia

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

hello i have Diffuse Unpatterned Alopecia (DUPA) and was wondering if propecia worked for me would it thinken the existing hair or would it have to shed and grow again as a new hair? and if possible could you tell me how long i’d have to wait to see if the propecia was working for me?

Propecia works by blocking DHT effects on scalp hair that is affected by male pattern hair loss (androgenic hair loss). Hair loss from DUPA (diffuse unpatterned alopecia) is not related to male pattern hair loss and it may not be affected by DHT. Thus, Propecia may not work, but it is the only drug that can be used. That being said, some doctors (include me in this group) will prescribe Propecia to patients with DUPA in case there is an underlying androgenic component to hair loss. In some patients with DUPA, I have seen improvement with Propecia.

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

Head Fungus for Over a Decade

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

my best friend has a head fungus. she is 32 and as had it since she was about 13. she went to the doctor a couple of times back then but quit because she didn’t want her classmates to see medicine in her hair. i am trying to get her to go back to see a doctor but she thinks it is to late. so my question is if you have a head fungus for 14 years with no treatment can you get rid of it? please help!

Clearly this requires a medical doctor to make a diagnosis and then start a treatment program. If your friend does not want to do this and follow the advice given to her, I can not help her over the internet. Even if I could, I would need to examine her, test hair scalp for fungus and make a diagnosis first.

Tags: fungus, scalp

Tuberculosis and Hair Loss

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

sir,
I have swelling in neck region lymph node from last three months. Positive for TB after FNAC test. Not yet taken medication. Doctors suspects extra pulmonary TB. Lungs are clear in xray. I have hair loss. Is it just cuz of TB and will it be continue if i take medication regularly? Is it temporary or permanent hair loss? Or i regain hairs after treatment, cuz i have no hereditary for hair loss in my family. i have very low density of hairs now. no bald spots but hairs density getting lower.

please help respond me soon

Before worrying about hair loss, you need to see a doctor (or continue seeing a doctor) to have your medical problems treated. Tuberculosis can manifest in many ways, which can include hair loss due to weight loss and chronic illness issues. If your hair loss is not genetic, it may be due to the stress on your body from the disease process, but if you add genetic hair loss on the disease problem, it will probably not come back. Generally you hair should return, but there is no guarantees and you do not have genetic hair loss compounding your problem.

From a historical perspective, hair loss was very common in the cities when TB ran wild. That was why a woman looked for a hairy man to qualify a man as a prospective husband. If a man lost his hair, the presumption was that they had TB and would probably die from it, not living long enough to provide family support for the long term.

Tags: tb, tuberculosis, hairloss, hair loss

Hairless Spots in Facial Hair

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

I am a 28 year old male living in the east bay area california, and I have a question in regards to facial hair loss. There are two different areas of my face that are being affected, one on the right side of my face 1″ from my chin, surrounding a mole and the other to the left of my face that starts just under my chin and ends about an inch and a half to the left. Both spots are circular in nature.. and seem to be growing. In the past i had hair in both spots, but now the skin is smooth and the hair (if any) is blonde-ish in color an extremely sparse (almost like the peach fuzz you get when you are in your early teen-age years before hair growth really starts. What could be causing these bald spots on my face, and is this something that I should be concerned about?

thanks

Sometimes hair loss that occurs in patches on different parts of the body may be caused by a condition known as alopecia areata. There is no definitive treatment, but usually hair will grow back in many of these patients. You should see a dermatologist for this condition. For more information please see National Alopecia Areata Foundation.

Tags: naaf, alopecia, alopecia areata, spots, facial hair, hairloss, hair loss

Hair Loss and Autoimmune Diseases

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

I am 42 years old and have had progressive thinning of my hair for about 12 years. Thinning is mostly on the top of my head. I have been to Rheumatology who has referred me to Dermatology. I am a University of Michigan patient. I have had every lab possible (I think) drawn. Only thing that is positive is my ANA. My nuclear antibody titer is >=1:2560 NAB pattern is HOMO. ADNA is negative. Do you think I should ask to have my androgen levels tested? Should I be asking to be referred to Endocrine? I’m at a loss. I’m ready to visit a hair loss center but before that I want everything else ruled out. I NEED YOUR HELP!

If you have an elevated ANA titer, one might worry about autoimmune diseases that can cause hair loss. Please see Lupus.org – My ANA Is Positive… What Does That Mean?

First, I would get your hair mapped out for miniaturization and see if your pattern shows one that is typical for male patterned loss (I am assuming that you are male, if not then there are many other things that can play in the causes of hair loss). Working with a good rheumatologist should shed light on any autoimmune component. Keep with the good doctors you seem to have and pump them for information, adding to it what you might learn from a miniaturization analysis of your hair shafts.

Tags: autoimmune. disease, hairloss, hair loss, ana

Diagnosed With DUPA, But Another Doctor Sees No Balding

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

Hi Dr. Rassman,

I am a 26 y/o male who has been diagnosed with DUPA by one doctor. I went to get a second opinion from another doctor who said I have no balding at all. I have been on propecia for a year and went as far to say that I should stop treatment. I am so confused, frustrated and depressed b/c I don’t know what is going on. I shed so much hair….some is miniturized, some is not. If I gently tug on my hair, I say that 5 times out of 10 a hair will fall out. Do patients with DUPA always end up looking like a Norwood VII? Is there a certain age where DUPA will show its full effects if you destined to be a Norwood VII? Please help Dr. Rassman, I dont know what else to do. Thanks.

You are getting terrible advice from someone. If any of these doctors did not measure your miniaturization, then I would not trust them. If you have DUPA the diagnosis is not rocket science. With DUPA (diffuse unpatterned alopecia), you will have significantly more than 20% miniaturization in the donor area. If you tug on your hair and more than 10% of the hair comes out, then you have a more complex problem. If you are in California, consider visiting me; if you are on the east coast, I’d recommend Dr. Bernstein in New York.

The progressive course of DUPA is not clearly defined by age, but it is often permanent unless it can be positively influenced by Propecia (finasteride). A small percentage of men with DUPA may have benefit from Propecia.

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

I Have Alopecia Areata — What Can I Do About My Eyebrows?

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

Hello baldingblog staff!

My question for you, I’m a guy , 35 years old, im suffering alopecia areata (patches). I really can do nothing, Im very affected by this disease and decide to completely shave my head and i deal with it. My real problem here to resolve is the eyebrows… I’m wondering what i should do for this particular case. Im not sure about tattooing my face. I’m sure the same way you just wrote it in your article, that it will look fake on a man… Anyway, I’m asking you what’s the best avenue for my needs here?

For men tattooing the eyebrow may look “fake”, but a stippled effect with some pencil on it may be helpful. There is no real great answer. Unfortunately for patients suffering with alopecia areata there is not much hope in terms of a hair transplant procedure as long as the disease stays active for then a hair transplant will not work. When the disease burns out (become inactive) then hair transplants can work and you can get your eyebrows back. There is always a risk that the disease may return.

Tags: eyebrow, tattoo, alopecia, hairloss, hair loss, hairtransplant, hair transplant

Congenital Adrenal Hyperplasia and Hair Loss

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

I’m 32 years old/female. I have recently been diagnosed with CAH and wanted to find out if there is any chance my hair will grow back if my condition is being treated and the hormone levels (DHEA-S and 17a-OH Progesterone) return to normal levels. Does hair loss in the pubic region, eyebrows, and eyelashes also occur in patients with adrenal disorders?

The scope of hair loss varies with individuals that have CAH. If you happen to have the genes for hair loss in women, then CAH could activate the process. If you get your hormones under control, chances are that your hair loss may grow back. You might have to wait one or two hair cycles (5-12 months) to know one way of the other. Hair loss could occur anywhere on the body, including the pubic region, eyebrows, and eyelashes. See eMedicine for more information.

Tags: congenital adrenal hyperplasia, cah, hairloss, hair loss, female, women, woman

Leukemia and Hair Loss

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

i have been diagnosed with c m l leukemia. for 7 months i have been taking gleevec 400mg by mouth each day. i have been successful with the blood work but my hair is getting thinner each month. first my curly hair went straight, then it began falling out one hair at a time. now it is very thin. do you know if it is permanent? i need some info. can you help?

Generally, hair loss from chemotherapy reverses as the hair cycles out of telogen and into anagen (about 6 months from the end of the chemotherapy). That assumes that you are not a male who is undergoing genetic hair loss as well. In men on chemotherapy who have genetic hair loss as well, some of the genetic process may be accelerated. Much of it should reverse for women and in men over 40 (general rule).

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