Female Hair Loss and Chest Pain

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

I am a 33 year old female who visited a dermatologist that specializes in hair loss because of a receding hair line, (frontal hairline thinning). Very much the same why men start receding in the front. I was diagnosed with female patterned baldness and told to take Rogaine. In the past I was told the 2% was not very effective to use the 5% but the nurse has informed me to use the 2% and it will take up to 12 months to see any results. I have used the 5% in the past and have not had any side affects though I am not completely happy with the results. Is there any other medications or options I can take other then the Rogaine? I am feeling a tightness in my chest and shortness of breath which I think is from using Rogaine, but I am not 100% sure. I have had blood work done and everything has come up normal. I take no medications other then the Rogaine. It is just so frustrating to be told to use Rogaine when there has been so many medical advancements for men.

Bells go off for me when I hear about tightness in the chest. Women with heart disease is far more common than most people realize. You must remember that Rogaine is a hypotensive medication and could induce (under certain conditions) a drop in blood pressure and chest pain from Angina. Please, see a good doctor. If you want an opinion on what to do about hair loss, please take a read through the many Female Hair Loss posts on this blog. If you are on the west coast, please come and see us.

Thinning on the Sides

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

i have noticed that on the side of my head my hair is very thin and i notice bald spots on the side. can you please tell me why? please tell me why?

I would want to see pictures of your sides to differentiate between various forms of balding and skin/hair diseases. Please send me digital pictures to the address on the Contact page and I will give you feedback on what I see. Best if you could come to see me either in Northern or Southern California, where I have offices.

Hair Loss in Autistic Female

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

I have an autistic 17 year old female whose normally thick and healthy hair is now thinning. I know her diet is not the best secondary to autism but she gets ample amounts of protein and loves all vegetables. There are no medidcations involved and no diet changes or home stress issues that I can pinpoint. She is not verbal so questioning her is not an option. Could you lead me to a resource for information or suggestions. Thank you for your time.

I have not read any research that indicates a higher instance of hair loss in autistic teens or adults. However, I would think that autistic people have a higher level of emotional stress, which is one of the ‘big four’ causes of hair loss. You should have a good doctor examine her and look for one of the many medical causes of hair loss. The following problems are among those that should be considered: anemia, thyroid disease, connective tissue disease, and various gynecological conditions. These laboratory tests may be useful if underlying medical problems are suspected: CBC, Chem Screen, ANA, T4, TSH, STS, Androstenedione, DHEA-Sulfate, Total and Free Testosterone. Many medications, including vitamins and over the counter drugs, can also contribute to hair loss.

Genetic causes of hair loss in a 17 year old female, is unusual. Look to the family and see if anyone had such a problem at that age or if there is female genetic hair loss in any of the women in your family. It is more likely that a medical condition, rather than genes, may be the cause of the hair loss.

Trichotillomania

/by William Rassman, M.D./9 /,

I have been picking my hair for years. I would like to think that I stopped, but I know that I keep picking at it. I now have a series of bald areas where the picking has taken out some hair. Is this permanent? Will it come back if I stop picking at it? Can it be transplanted if it does not grow back?

The medical condition is called trichotillomania. Children or adults sometimes twist or pull their hair, brows, or lashes until they come out. This hair pulling is sometimes a coping response to unpleasant stress and occasionally is a sign of a serious problem of an obsessive disorder. If the picking stops early enough, then the traction alopecia that results will reverse. However, this is not what usually happens as most of the people with this disorder continue to pick on the hair until it eventually becomes lost permanently. The best way to determine permanence is to look at the area with a high-powered microscope. Active areas of trichotillomania show blunted, short hairs which are signs of recent regrowth of plucked hair. When these short hairs do not show up under microscopic examination, the traction alopecia is probably permanent.

Yes, hair transplants can put the hair back in the area of alopecia produced by trichotillomania, but the problem with doing it is that the person will just pluck out the same hair again and again and produce the bald spot. What is the point of transplanting the area of alopecia only to have it returned? The key is to address the trichotillomania from a medical/psychiatric medication or therapy approach and solve the underlying problem. Once the patient knows that the cause of the trichotillomania has been fully addressed, then the reward can be a hair transplant to put their hair back.

Scalp Psoriasis and Transplants

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

Does a history of scalp psoriasis (assuming it is under control with treatment) rule out using minoxidil or transplants to offset hair loss?

Psoriasis is an autoimmune disease that has a genetic preference in its victim selection. It comes in all degrees of activity. Simple dandruff may be a very low active state of psoriasis and as it becomes more severe, it takes on more of the characteristics of the disease state, where scaling of the skin and red areas in the affected area can become painful. Flaking of the skin can be easily seen when psoriasis affects the scalp. Baldness is also a genetic process but it is unrelated to psoriasis. Both processes can co-exist in the same person and both can be treated independently at the same time.

People with psoriasis often ask about transplanting the disease from one area of the scalp to another. Can, for example, skin taken from the area where psoriasis is active, move the disease to areas in the recipient area that are not showing signs of the disease? The answer here is no, as the disease seems to be localized in the area where the scaling exist and moving the hair from the scaling area does not impact the normal recipient area, assuming the recipient area is normal. Psoriasis can be aggravated in the area where the disease is active by any trauma and surgery is a trauma. Some people who tend to pick at their skin and hair can develop traction alopecia (hair loss) if they persist on picking over a prolonged period of time.

I generally tell my patients to use a topical treatment (steroids) on any active area of psoriasis prior to a hair transplant so that the scaling that occurs will be less bothersome during the transplant process. I try to get good control of any scalp psoriasis prior to a hair transplant.

With regard to minoxidil, if this medication does not produce skin side-effects, then one can use it with psoriasis. If side effects should appear or the psoriasis should become worse with minoxidil, then the medication may not be a good choice.