I Obsessively Rub and Pick at My Scalp

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

I am 28 years old and I have been obsessively rubbing and picking my head for around 15 years. I have noticed that my hair line has moved back and that my hair overall has become thinner. No bald “spots” but an overall thinning. My question is if I stop now will my hairline return to normal and will my head become fuller again?

What you describe sounds a lot like trichotillomania, a psychological disorder of picking at the hair/scalp that often produces significant balding. In general, hair lost from this picking does not grow back due to years of trauma, as the impacted hair has been killed off.

Tags: trichotillomania, trich, ttm, hairloss, hair loss

Association Between Early MPB and Prostate Cancer?

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

Snippet from the abstract:

Results: Our study revealed that patients with prostate cancer were twice as likely to have androgenic alopecia at age 20 [odds ratio (OR) 2.01, P = 0.0285]. The pattern of hair loss was not a predictive factor for the development of cancer. There was no association between early-onset alopecia and an earlier diagnosis of prostate cancer or with the development of more aggressive tumors.

Conclusions: This study shows an association between early-onset androgenic alopecia and the development of prostate cancer. Whether this population can benefit from routine prostate cancer screening or systematic use of 5-alpha reductase inhibitors as primary prevention remains to be determined.

Read the rest — Male pattern baldness and the risk of prostate cancer

I was recently asked by a reader of this site about a link between developing early genetic balding and having prostate cancer somewhere down the road, so I researched it a little and found the above article. I don’t think we wrote about it before, but this study was published in the Annals of Oncology a little over a year ago.

The MPB / prostate cancer connection seems to be present, but what to do about it, if anything, remains to be seen. The suggestion that the 5 alpha reductase inhibitors like finasteride, may have a role in reducing the risk for prostate cancer, but that process is not well understood and the long term risks of such drugs are presently under a cloud of controversy.

There were 669 patient studied, of which 388 had a history of prostate cancer. There was no association on the degree of balding, just the presence of genetic balding patterns earlier in life. Men under the age of 30 and those who have developed vertex (crown) balding seem to have a higher prostate cancer risk. The study was taken in many countries and each patient answered questionnaires, from which the data was extracted.

Tags: prostate cancer, hairloss, hair loss, balding

Hair Cooling Can Prevent Chemotherapy Induced Hair Loss

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

I’m worried about losing my hair from chemotherapy. Obviously treating the cancer is the most important thing but can I avoid going bald? I read some stuff about cooling the scalp. What can you tell me about that? Thanks

Hair loss from chemotherapy is a common problem with certain drugs used to treat a variety of cancers. Recent reports show that systems like the Paxman Hair Loss Prevention System can prevent chemotherapy induced alopecia. It doesn’t work for everyone going through chemo, but cold cap systems like this have shown some success. You can learn more about it here.

Tags: chemo, chemotherapy, cold cap, hairloss, hair loss

Bump Appeared On the Scalp After Chemo Treatments

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

My patient had adenocarcinoma of the colon and now has adenocarcinoma in the right colon. She has completed 6 of her 8 chemotherapy treatments. She had a bump that appeared on the top of her head in the last month. It does not itch, hurt or produce any symptoms.She picks it but nothing comes out. Suddenly appeared. Differentials for this diagnosis?

Thank you

You sound like a doctor asking this question. There could be some inflammation following the hair loss from chemo, but I would want to know what the bump looks and feels like, its size, and the presence of any lymph nodes in the neck, etc.

Tags: bump, scalp, chemotherapy, chemo

My Psoriasis Transferred with My Transplanted Hair

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

I just underwent a transplant 2 weeks ago. Regarding your post on Psoriasis i would have to respectfully disagree. I get have really bad psoriasis in the back of my head (donor area) and it definitely transferred to the recipient area, even so much as to go a little bit on my upper forehead just below where the grafts were placed. On day 7 post op i took a normal shower and with my fingertips rubs all the scabs off. Should i be worried that I could have harmed my potential new grafts? Also please let me know how you would treat this?

If you transferred psoriasis, you would be the first patient I heard of that had experienced this. Rubbing scabs off always worries me, but it will not damage the grafts if it was not done roughly. Your psoriasis should be treated by your doctor, not me over the internet.

Tags: psoriasis, hair transplant, dermatology

Syphilitic Alopecia

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

How do you distinguish between Syphillytic Alopecia and DUPA Androgenic alopecia? I’m probably experiencing Andro Alopecia diffusely around my entire head but I just want to make sure. Is Syphillytic alopecia treatable? How do you test for it?

Thanks

In a very basic sense, physicians diagnose patients by taking a history and examining the patient face to face. In more recent years with the advent of the Internet, many self diagnose and run into conflicting information and/or scare themselves with wild diagnoses.

If you think you have syphilitic alopecia, diffuse unpatterned alopecia (DUPA), androgenic alopecia (AGA), or any other form of alopecia, a good start is a visit to your doctor. And if you do believe you have syphilitic alopecia, I’d think hair loss would be the last among your list of concerns, since other symptoms of syphilis would be hard to ignore. Tests are available to diagnose syphilis.

Tags: syphilis, syphilitic alopecia, hairloss, hair loss

Hepatitis B Vaccine and Hair Loss?

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

I just started the Hep B vaccine and am experiencing hair loss at 54. Will it grow back?? I’m very concerned because of my age.

All health care workers receive hepatitis B vaccine, yet health care workers are not at any increased risk for hair loss. What you may be experiencing may be coincidental or very rare.

I did find this quote from the National Foundation for Infectious Diseases: “There have been rare reports of hair loss after hepatitis B vaccination, with the majority of individuals regrowing their hair (Wise, 1997). Studies are in progress to better quantify the possible slight risk of hair loss.”

Tags: hepatitis b, hep b, vaccine, hairloss, hair loss

In the News – Former Hair Model Now Has Alopecia Areata

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

Snippet from the article:

We are a culture obsessed with hair: From the big and small screens to the pages of fashion magazines, it seems no woman’s look is complete without a perfectly-coifed ‘do – and that poses a serious hurdle for aspiring actress Georgia Van Cuylenburg. Van Cuylenburg is bald.

Like 5 million others in the U.S., Van Cuylenburg suffers from alopecia areata. The disease results in sudden and often unpredictable hair loss on the scalp and often across the rest of the body. It is cyclical in nature and has no known cause or cure.

For the effervescent Van Cuylenburg, it is particularly ironic because she used to be hair model.

Read the rest — Hair Model’s Worst Nightmare: Going Bald

This is the story of a young woman’s journey after she suddenly found herself losing most of her hair from alopecia areata.

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

Pudendal Neuropathy and Propecia

/by William Rassman, M.D./8 /, ,

I read on one post that Propecia caused someone to have pudendal neuropathy which caused both sensory and motor dysfunction in the genital tissues. Is this a Post-Finasteride-Syndrome? Is pudendal neuropathy a side effect?

The term “neuropathy” means damage to a nerve… so “pudendal neuropathy” is damage to the pudendal nerve. I cannot imagine how Propecia can cause damage to this specific nerve. Damage to the nerve is usually from mechanical injury (bike riding, falling on your buttocks, etc) or inflammatory issues (infection) or chronic medical conditions that damage your nerve, such as diabetes or multiple sclerosis. Propecia is a drug that that partially blocks the conversion of testosterone to DHT. If someone is going to claim that there is some special DHT relationship to a pudendal nerve, we might as well be blaming Propecia for our economy or the color of the sky.

Stating that a drug (Propecia) caused a neuropathy to the pudendal nerve is questionable, because there is no difference in the pudendal nerve to a nerve that innervates your thumb. The pudendal nerve is one of many nerves in your pelvic area (for both men and women) and one segment of it innervates your penis or clitoris. I believe many readers may have heard of sciatica when doctors refer to certain back pain caused by the sciatic nerve. The pudendal nerve is a distal branch of a sciatic nerve. Patients with back problems or pelvic area problems/trauma/tumor/etc can have pudendal nerve issues. Pudendal nerve damage can cause erection problems, but it will also cause perineal numbness or pain (see here).

If there is an erection issue, the most simple test is a nocturnal penile tumescence (NPT) test. Imagine a roll of stamps wrapped around a flaccid penis and taped. If you get an erection, the stamps will stretch and break at the perforations. I assume there are better devices out there and better tests, but this test can sometimes be a good starting point to help delineate if erectile issues are psychological or physical. Normally, men will have involuntary erections during sleep (aka “morning wood”). It would be interesting to see if the 70 or so men that reported permanent erection problems can achieve nocturnal (involuntary) erections and if they ever underwent these tests, But from my reading I believe the erection issues were self-reported and no subjective testing was performed.

In matters of medical health, the Internet is not a place to self diagnose medical conditions or become armchair physicians. But alas, it is what many readers will continue to do and the urban legends will propagate.

Tags: propecia, finasteride, dht, nerve damage, pudendal neuropathy

Prostatitis and Hair Loss?

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

Hello Dr Rassman,

I am a 29 year old male who recently noticed that my crown was thinning. My hairdresser confirmed that she only noticed the thinning very recently. Over the last year I have also been battling a severe and stubborn case of what the urologist told me was prostatitis.

Are these two problems linked. I have read that a swollen prostate will produce more DHT then a regular size one. Is that accurate?

I would doubt that prostatitis will increase DHT, as the prostate itself has nothing to do with DHT production. DHT is a metabolic derivative of testosterone which is made in the testicles, not the prostate. The prostate is a target organ that is impacted by DHT and that is why blocking this DHT with finasteride or dutasteride will reduce the enlarged size.

Tags: prostatitis, prostate, hairloss, hair loss, dht

Hashimoto’s Disease and Female Hair Loss

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

my daughter was diagnosed with Hashimotos in 1998. she has been suffering hair loss since then and it is now quite serious. She went to a dermatologist who told her that her hair loss was genetic and unrelated to the Hashimotos. That is hard for me to believe. She is very resistant to getting further help so I don’t know what to do to do and where to send her. She is at Stanford and there is a Dermatology Clinic with a specialty in hair loss but I keep thinking the problem is the autoimmune disease. Can you give me some advise about what to do.

While having a diagnosis certainly helps with finding a treatment, for women’s hair loss there is no definitive treatment. If you treat the thyroid disease the thinning may slow down, but it is unlikely that after treatment the loss will reverse. I have never seen it revert back to the original fullness. Even for genetic women’s hair loss (just like men’s genetic hair loss) there is no cure. If the hair loss issue is from an autoimmune disease, there is really no cure either and many doctors are suggesting that genetic hair loss may actually be an autoimmune process, not uniquely genetic alone.

At best, you can treat the Hashimoto’s disease and the hair loss may slow down. I am sorry for the bluntness, but at this time there is no medical cure for genetic hair loss in men or women… and unfortunately, we seem to know far less about treating female hair loss than we do with male hair loss.

Tags: hashimotos disease, female hair loss, hair loss, hairloss

I Have DUPA and Need a Specialist in Toronto

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

Dear Dr Rassman,

I just wanted to thank you for all the inspirational information you have provided for men and women that suffer from hair loss. I currently suffer from DUPA and I’m very concerned that I will not have the necessary donor hair in order to do a hair transplant.

I was wondering if you could let me know which doctors in the Toronto, Ontario Canada area provide miniaturization testing.

I have seen several dermatoloigists and transplant surgeons. However, my diagnosis from all of them have been a mixed bag: some say I suffer from telogen effluvium others say I have MPB. My blood work is normal. My hair loss is not just limited to the crown area but I am thinning from the sides and back of my hair severly at a tremendous pace!

Any help and/or suggestions would be greatly appreciated! I just need a straight answer in order to make an informative decision in regards to the necessary treatment options for hair loss.

Thank you again for your exceptional work and in keeping members advised of hair loss treatment options.

The straight answer is that there is no cure for diffuse unpatterned alopecia (DUPA), assuming that this is your correct diagnosis. I would recommend that you obtain a solid diagnosis of DUPA first (as it seems you may be self diagnosing this).

For a list of doctors in your area, you can try the physician search at ISHRS.org. I don’t have any personal recommendations in that area. Ask these doctors if they perform bulk analysis with the HairCheck instrument and miniaturization testing before you go and visit them.

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

I Lose Spots of Hair That Regrow White Before Changing to My Normal Color

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

Hi doc

Im 51 and for many yrs now, i some times lose my hair. its always in a circle, in different spots on my head. Now it always grows back in white at 1st then it changes back to my normal color..why does it do this ????

You may have a condition called alopecia areata, as the stigmata of this type of hair loss is (as you describe) in circular patches that eventually regrow over time. I haven’t heard of the changing of hair color, though. Follow up with a doctor for a diagnosis, as I am taking a wild guess here.

In any case, the diagnosis of this disease is by biopsy of the area around the lesion. If it does happen to be alopecia areata, you can find more info here — National Alopecia Areata Foundation.

Tags: hairloss, hair loss, bald spots, alopecia areata

In the News – Alopecia Areata Treatment in Testing

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

Snippet from the article:

New findings that show T-cell activation plays a critical role in the development of alopecia areata has opened new doors to treatment.

A report last year from a genome-wide association study involving 1,054 patients with alopecia areata (AA) and more than 3,000 controls, identified eight genes strongly linked to the disease (Nature 2010;466:113-7). One of the gene’s codes for a ligand, ULBP3, appears in the dermal sheath of hair follicles in patients with AA. The ULBP3 ligand appears responsible for attracting the cluster of T cells that produce the characteristic histopathology of affected hair follicles, Angela M. Christiano, Ph.D., said at the meeting.

Read the rest — Genetic Basis of Alopecia Areata Leads to Abatacept Trial

Abatacept is a rheumatoid arthritis medication marketed as Orencia. The study will include 56 patients receiving either an abatacept or placebo injection over the course of 6 months.

Dr. Christiano is a top physician that has made treating alopecia areata her mission, and I hope this study shows some promise for those suffering with this disease.

Tags: alopecia areata, hairloss, hairloss, orencia, abatacept, arthritis

Wolff-Parkinson White Syndrome and Hair Transplants

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

Hi, thank you for providing your blog as a source of information. I’m a 40 y.o. male and recently had an appointment for a transplant to correct some mild thinning in the frontal and temple area… approximately 800 grafts. I was literally minutes from the procedure when the doctor learned that I was diagnosed with Wolf Parkinson White syndrome as a teen and informed me that he would not continue with the transplant. From a providers perspective, is this the consensus of the industry as a whole or are there still transplant options available to me? Thanks in advance

There is no contraindication to an outpatient surgery (such as a hair transplant procedure) for patients with WPW. Moreover, if you were diagnosed with WPW in your teenage years, I would assume you have had it treated with ablation. If you were not treated with ablation, I would think you should be followed by a cardiologist.

Tags: wpw, wolff parkinson white, heart, cardiac, hair transplant, surgery