Hair Loss and Radical Prostatectomy

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

I’m 63, and 18 mos ago had a radical prostatectomy. About 12 mos before that I began losing hair, and began using Minoxidil, which I stopped when my prostate cancer was diagnosed. I continue to lose hair, even though I am now cancer free and over the “shock” period. My hair is very fine. I am not taking any medications, and regularly take a multivitamin, selenium, vit.D and Glucosamine.

I only wash my hair with baby shampoo. What can I do to slow down/stop/reverse hair loss?

You might try finasteride 1mg dose daily (with your doctor’s approval of course) and restart the minoxidil. Withdrawal of minoxidil (when it has been working well) will cause hair loss (or to be more clear, the loss of all benefits you received). You are to be congratulated for beating the prostate cancer.

Tags: minoxidil, finasteride, propecia, hairloss, hair loss, prostatectomy, prostate

Pseudopelade and Hair Loss in Women

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

I am a 47 year old female with a very strong history of family baldness.Initially(for 1 1/2 years) i ignored the hair loss.Putting it down to the very stressful period in my life.However when the bald patches couldn’t be ignored anymore I went to see the doctor. Was first diagnosed as areata alopecia and then cicatricial alopecia.Another docter then diagnosed it as pseudopalade. What is the differerence between these alopecias and what is the treatment for pseudopalade? What can be done to cover the bald patches.

Many of these autoimmune diseases are related to each other. Pseudopelade is another type of scarring alopecia. This is the world in which the dermatologist is supreme. Look at what dermatologist and world-class hair transplant doc Robert Bernstein said about the various diseases that are related: BernsteinMedical – The Diagnosis of Hair Loss in Women.

Tags: pseudopelade, alopecia, hairloss, hair loss, female, woman, women

I Want DNCB Treatment for My Alopecia

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

Hi Dr Rassman, you mentioned a man with a miracle cure of alopecia areata through dr. richard strick & you also mentioned that DNCB which was the treatment, is very dangerous. can you comment on that, i have alopecia areata and would like to know what i may be getting into?

You’re referring to the previous posting I made titled Alopecia Areata in a Patient with a Miracle Cure. I am not an expert on this treatment, but I suggest that if you wish to learn more, you should look to:

Tags: alopecia, areata, dncp, medication, treatment

Mono and Female Hair Loss

/by William Rassman, M.D./5 /, ,

I am desperate for information. I have been to dermatologists and M.D.’s and am not sure what to believe any more. The dermatologist told me my hair loss was due to an autoimmune disease and gave me steroid shots in the head and did a biopsy and said the hair follicles where still alive. Went to M.D and had blood test told it was not audio immune. Been told many times it was thyroid then had blood test done and they came back fine. There is nobody else in family with this problem. Please help am desperate. Had mono 1 and a half years ago. Can this cause hair loss? what can I do? I am a female and this is very embarrassing.

I can not be your doctor over the internet, but the questions you asked are ones that you need to know the answers to. You were told you have auto-immune disease, then had none. Then it was thyroid disease, then not. You need to get a full examination to find out the cause of your hair loss. Any illness (even mono) can trigger hair loss in those people who have the hair loss genetics (women included). Are you one of those women?

You need to bond with a good doctor. Like a good marriage, the partnership between patient and doctor is a partnership where the doctor works for the patient on the presented problem in the patient’s time frame. If you do not have the right partner (doctor), get rid of him/her and find one who respects you as an individual with needs and gives you the service you are paying for.

Tags: hairloss, hair loss, thyroid, autoimmune, mono, female, women, woman

Is My Alopecia Areata Getting Worse?

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

I first noticed the symptoms of alopecia areata at age 13. I’m 23 years old now. I briefly saw a dermatologist when I was 16 and received steroid injections for about a year. These proved ineffective. My hair regularly grows back, only to be followed by other areas falling out. At any one time I’d guess that about 40% of my head is covered in hair. I’ve learned to deal with the condition, but recently it seems that it’s migrated to my beard and as well I’m experiencing increased pitting in my fingernails, which hasn’t happened for about 8 years.

Is my condition significantly worsening? If so, what can I expect? Also, given it’s been 7 years since I’ve seen a professional about this, what sort of treatments might be effective in a case such as mine?

Thanks for your time

You need to be managed by a doctor whose specialty and interests are focused on alopecia areata (usually this would be a dermatologist). The disease moves around and sounds like it is active in you. Biopsies of the active area at the border with the normal hair will show inflammatory cells suggestive of auto-immune disease. Look at the case I posted about the other day (Alopecia Areata in a Patient with a Miracle Cure). This type of expertise is what I would want if I had the problem. I am not an expert on alopecia areata, so I am unfortunately not the person to ask.

Tags: alopecia, areata, hairloss, hair loss, dermatology, dermatologist

Signs of DUPA?

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

Hi Dr Rassman,

Ive been reading your blog daily for a short while now, and im curious, if you were to look at someone how would you know if they had dupa, what are the symptoms that you would be able to diagnose that with?

Thank you.

Diffuse unpatterned alopecia (DUPA) is a condition where miniaturization is present all over the head, even in the areas that hair transplant surgeons think is sacred (the back and sides of the head). Thinning in the donor area where there was no thinning before, would make me suspicious of DUPA. You should get your hair mapped out for miniaturization and that would clearly give you the diagnosis.

Tags: alopecia, dupa, hairloss, hair loss

Son Pulls Out His Hair Without Realizing It

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

While my son is watching TV or playing games, he doesn’t realize it, but he is pulling his hair out.

What can we do to help him be conscious of it and stop?

Seems like your son has the condition called trichotillomania, which is a compulsive disorder characterized by the urge of pulling out hair from different areas. This is one of the common causes of hair loss in children and is usually self limiting. This condition that is often an obsessive-compulsive disorder and it could be aggravated in children by stress and environmental factors. You should see a psychiatrist or at the least his pediatrician for further evaluation of your child. If the problem persists, it will eventually produce permanent hair loss (traction alopecia) in the area that the picking is focused.

Look to:

Also, please read this previous posting, I Am Pulling My Hair Out and Need Advice.

Tags: ocd, hairloss, hair loss, trichotillomania, pulling, pull, alopecia

Propecia and DUPA

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

Dear Dr. Rassman:

Thanks for the informative website.

I am a 28 year old male who has been diagnosed with diffuse unpatterned alopecia (DUPA), and I have some questions about available treatments.

My doctor prescribed Propecia, which I have just started taking. I was wondering about its effectiveness with my condition. Your blog says in various places that finasteride works for about 50% of people with DUPA. Does that mean that 50% experience regrowth, or just a halting of the DUPA process? I feel that my DUPA hasn’t progressed particularly rapidly, and while I would love to have regrowth, I certainly would also be happy to have the process halted.

Also, I have been using Rogaine foam for about 10 weeks with no noticeable results thus far. I end up using a lot of it, as I use it on almost my entire head, and as you can imagine it’s an expensive pain. Is there any reason that minoxidil does/should work better or worse with DUPA, such that I might stop using it and use only finasteride?

Thanks

Benefits for diffuse unpatterned alopecia (DUPA) with Propecia (finasteride 1mg) is a subjective call on my part. You may see cessation of the process or reversal. Half of patients who I follow, have no impact from the medications.

The effects of minoxidil (foam or otherwise) will not be seen for 8-12 months. Wait it out.

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

Alopecia Areata in a Patient with a Miracle Cure (with Photos)

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

One of my patients came in yesterday to show me the results of my referral and his treatment for alopecia areata. I have included his before pictures and his after pictures below. One treatment reference is included here — Alopecia areata: successful half-side treatment with DNCB.

The treatment on this patient was managed by Clinical Professor of Medicine/Dermatology at UCLA School of Medicine, Dr. Richard Strick, a real expert on the treatment of this disease. Most doctors should not attempt this treatment, as it requires extensive experience with the drug and its dangerous side effects.

Please click the photos to enlarge.

Before:

 

After:

The after photos show only three small balding areas remaining — one on the back and one on the side of the scalp both about 1/2 inch or less in diameter, and one in the middle of his frontal hairline.

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

I Have Psoriasis, Hair Loss, and Low Self Esteem

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

hi,
i have psoriasis all in big regions of my body mainly my scalp and im balding on the top. my self esteem is already low. i want to keep my hair so bad to hide the disease . i need some answers. and i just started rogaine. no signs

I truly empathize with you. What you described is just what I went through. My psoriasis started in my scalp and moved through much of my body over the years. You need to get a good dermatologist to help you manage the psoriasis. Whatever you do, do not pick on the psoriasis flakes in the scalp, for you could get traction alopecia to compound your problem. There is no magic bullet for this condition. Some newer medications have allowed better control for the really bad psoriasis, but it still can’t be cured.

Tags: psoriasis, hairloss, hair loss, rogaine

Seborrheic Dermatitis and Hair Loss

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

Hi Dr.I wanted to follow up with you. I wanted to let you know what I’ve found out after three trips to my primary care doctor. I gave blood twice and had it checked for thyroid, full panel scan, cancer and HIV to name a few. Plus chest x-rays.I have all normal levels and no HIV. I’ve been diagnosed with seborrheic dermatitis on my face and scalp. When I started using the brow conditioner is about the time my eyebrow hair started falling out. The areas it was applied, started flaking bad. I am still having hair loss in my eyebrow and some on my temple areas with itching. I hear hair loss is normal with seborrheic dermatitis? I notice the eyebrow hairs falling often have a piece of dry skin attached to the base. How long can I expect to have hair loss now that I’m being treated with desonide cream? Will the hair grow back once the seborrheic dermatitis clears? If not when can I consider scalp and eyebrow transplants. Will they be successful? Thanks.

The role of seborrheic dermatitis in hair loss is debated. Patients with seborrheic dermatitis may lose hair indirectly due to the inflammation of the skin that can accelerate telogen effluvium, which is reversible in most cases. The other mechanism of hair loss in these patients is through traction alopecia by scratching and rubbing hair. Traction alopecia is reversible in many cases. A small group of patients with baldness due to chronic traction alopecia may never grow hair back and a hair transplant may become necessary and could be done successfully after the skin inflammation is over. Before embarking on a transplant for the eyebrows, be sure that you have controlled the seborrheic dermatitis. This should be easy for a good dermatologist.

Tags: seborrheic, dermatitis, hairloss, hair loss

Psoriasis in Donor Area

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

I have psoriasis (as know, non-curable) in a part of my potential donor area. Does this rule me out as a candidate for a transplant from that location? Is it possible to use other parts of the donor area since I have good overall density?

Psoriasis does not move, so it stays where ever it originally was (in the donor area in your example) and will not be transplanted to the recipient area. The psoriasis needs to be under good control if one is to use the skin from impacted areas for the donor site. One could be selective where the donor is taken from, but this will reflect supply and demand relationships for the donor supply and the size of the bald area.

Tags: psoriasis, donor, hairtransplant, hair transplant

Dermatologists Specializing in Alopecia?

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

In one of your comments you noted that there are certain dermatologists that specialize in the treatment of alopecia areata. Could you please provide the names of any that you are aware of (particularly those on the east coast as I live in the DC Metro area). Thanks.

You need to go to your family doctor and ask that question. Each doctor in each city has worked out the referral patterns for their patient’s best interests. I have a good doctor referral that has built a reputation — Dr. Richard Strick at UCLA in Los Angeles. You might check with the National Alopecia Areata Foundation for other sources.

Tags: naaf, alopecia, dermatologist, hairloss, hair loss, doctor

Ulerythema Ophryogenes and Hair Transplants

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

1.I have a condition called Ulerythema Ophryogenes, i was thinking of getting hair transplants but i was wondering would they just fall out.

2.Also how often do eyebrow hairs usually fall out and regrow

Thank you for your help

According to eMedicine: “Ulerythema ophryogenes, a rare cutaneous disorder, is characterized by inflammatory keratotic facial papules that may result in scars, atrophy, and alopecia. This disorder has been described in association with other congenital anomalies such as Noonan syndrome, Cornelia de Lange syndrome, or Rubinstein-Taybi syndrome.”

Unfortunately, this is a rare condition that not many doctors (especially hair transplant doctors) have significant experience with. That being said, if you have this condition and also have genetic androgenic alopecia (or male pattern balding) your donor hair (in the back of scalp) should be considered permanent hair. There is no reason for me to believe that a hair transplant may not be successful. There may be a slight increased risk of scarring or discoloration on the recipient area.

With respect to the eyebrows that may be lost with this condition, a hair transplant may also work, but with the same caveat as outlined above. The growth rate (or the cycle rate) of eyebrow hair is different than that of scalp hair and it follows a one to two month cycle.

Tags: hairtransplant, hair transplant, ulerythema, ophryogenes, hairloss, hair loss, eyebrow

Meds for Temple Hair Loss?

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

hi i’m 24 years old male and have noticed a slight loss of hair about an inch long in a triangular shape at both sides of my temple, is there any medication which helps this area, ive been taking procerin for nearly a year but am not sure if its working or not, thanks in advance

I would need to see what you are talking about. There is a genetic disorder called triangular alopecia that you may be describing. If you have this condition, medications probably will not help.

Tags: alopecia, hairloss, hair loss, temple, triangular