Could Hair Cloning or SMP Work for Someone with DUPA?

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

Hi Dr. Rassman:

Once again, thank you for contributing to a great blog.

I am a 32 yr old white male with dark hair. Approximately 2 years ago I first noticed thinning hair on the Crown (about the size of a ping pong ball). I went on propecia and have been on it ever since. There has not been any visible progression (at least to the naked eye). In terms of family history, all of my immediate family members have their hair except once uncle in his 50s has a bald spot around his crown. My one deceased grandfather buzzed his hair but according to my Dad, still hair hair (not completely bald).

I went for a consultation with a hair transplant doctor who advised me that I would need around 2000 grafts to cover that space but since I have an unstable permanent zone (i.e. miniaturization) he did not recommend it.

  1. The doctor did not use the acronym “DUPA” but is that what he was essentially saying?
  2. I have had fine hair since I was in my teens. Is DUPA progressive or stable? I have what appears to be a full head of hair – will it stabalize here or continue to progress?
  3. Dr. Bernstein states that those with DUPA can look “fine” if they keep their hair very short. Does he mean short as in the same look achieved through scalp micro pigmentation?
  4. Can scalp micro pigmentation be of use to someone with DUPA?
  5. There has been a lot of discussion about hair cloning/manipulation being available commercially within 10 years (according to Dr. Bernstein). In your professional opinion, do you think such an advancement be of any use to someone with DUPA?

1. Genetic male pattern baldness doesn’t include the permanent zone, so diffuse loss there could be DUPA.

2. DUPA is often progressive, but it can be stable for a number of years. These conditions tend to be unstable if it is associated with genetic balding.

3. No, not that short. I am sure Dr. Bernstein means clipping it to 1/4 or 1/3rd inch.

4. It can be, but I do not like to generalize on this without examining your scalp and hair loss.

5. That 10 year mark has been moving every year. There’s no use speculating on what cloning can or can’t do for treating various issues, as it won’t be commercially available in the near future. If hair cloning becomes closer to reality, I’m sure the answers will come.

Tags: diffuse unpatterned alopecia, dupa, hairloss, hair loss, cloning, smp, pigment

Can Pseudopelade Scars Be Cut Out?

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

Hi, I’m curious to find out if it is possible to cut out small scared areas when doing a transplant. I’m a 21 year old male and have many burnt out scars from the last six years of living with Pseudo-pelade.

It seems to have been inactive for a number of years and I’d like to get transplantation to get the density of my hair back with transplants into the small effected areas (about the size of a pen tip), however, is it also possible to make larger scars (about the size of the tip of the little finger in size and shape) made smaller by excision since I understand it is hard to transplant hair into large scars?

Thanks

Brocq Pseudopelade is a scarring alopecia and is difficult to treat. If the disease has taken its course and not changed much in the past few years, the objectives for a local small surgery are clearly defined, and if the area being addressed is located in a place that tends to heal well, then surgery may have value – provided that your expectations are not great.

For the general audience, take a look at this condition to appreciate the area needing treatment (photo link).

I just performed Scalp MicroPigmentation (SMP) on a very extensive case of this and although he would not grant me permission to post his before and after photos for this post, I have to say that the results were spectacular. Of course, this man had been shaving his head and was used to making everything seen uniform.

Tags: scarring alopecia, pseudopelade, hairloss, hair loss

Cubs Manager Mike Quade’s Hair Loss

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

I’m watching the Cubs game on ESPN tonight and I noticed their manager Mike Quade appears to have no hair on his head at all, including a lack of eyebrows and maybe even eyelashes. Thats gotta be alopecia right? I didn’t realize it could cause complete hair loss like that. I thought it was more spotty.

Mike QuadeAfter looking at some photos, I immediately assumed that this was some form of alopecia areata (probably totalis or universalis), so I looked into it a little to see if he’s spoken about it in the press. Sure enough, an article about Mike Quade in the NY Times from last year says, “Quade was 3 when he was found to have alopecia areata, a condition that caused him to lose his hair. Playing sports, he said, was a path to acceptance, a means of softening the taunts from other children.”

So there you go. Different forms of alopecia areata can cause different types of loss, and you can learn more about them at the National Alopecia Areata Foundation (NAAF) site. It appears that Mike Quade has alopecia universalis.

Another professional sports figure with alopecia areata that comes to mind is NBA player Charlie Villanueva, and he is as a spokesperson for the NAAF.

Tags: mike quade, alopecia areata, cubs, baseball, mlb, hairloss, hair loss

Ulcerative Colitis and Hair Loss?

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

I have been on finisteride since 2004 which is working great. I was diagnosed with ulcerative colitis in 2009. Been UC free for two years but got it back in 2010. I still have it a year later, although only in MILD form. My hair did change in texture while a tad thinner. Now, although my vitamin levels have been fine, could the hair thinning be from the UC alone or the medication?

I took Asacol the first time I had it with no side effects. This time, I took it as well as the masalamine enemas. Since it has lasted a year this time around, could it be the meds or the UC alone? Also, any chance of my hair re-thickening? I was wondering how long I should wait until I visit Dr. Bernstein again. It will be greatly appreciated if all questions are answered!!

Asacol does list hair loss as an uncommon, but known, side effect. Maybe it’s the medication or a combination with MPB… or even the UC itself. I do not treat many patients with ulcerative colitis in my practice so perhaps your GI doctor can address your concerns as well.

Hair loss or hair thinning can certainly happen from major stress or illness on your body. This type of hair loss generally should reverse itself in about a year’s time. But often, I find that patients never quite regain their hair. Maybe you should call Dr. Bernstein for another consultation (I’m not sure when your last visit was).

Tags: ulcerative colitis, ulcer, hairloss, hair loss, asacol

Garlic Gel for Treating Alopecia Areata?

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

For those of us with Alopecia Areata, – this study may be beneficial to you guys. The study is quite positive. Please read the link below:

Link: Local Study on Garlic for Alopecia Areata

GarlicNice find and thanks for sending. I don’t recall seeing too much about using garlic as an alopecia areata treatment.

This was a small study of 34 people presented last year at a conference in Australia. It does sound interesting, and I found another small alopecia areata study discussing the use of topical garlic gel in combination with betamethasone valerate, but I don’t know that the study mentioned in the link you sent was ever published in a peer reviewed journal. While the article is from the Philippine Dermatological Society site, it just mentions that the presentation was by one of their members…not that it was published in a medical journal.

I am glad there are new alopecia areata treatments being explored, regardless of how stinky they may be. And it’s worth noting that a few years ago the NY Times wrote about unlocking the secrets of garlic for use in medicine.

Tags: garlic gel, alopecia areata, hairloss, hair loss

What Happened to Steve Jobs’ Hair?

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

Dear Dr. Rassman,

This question is a little bit different, but I’m curious what your opinion is.

What happened to Steve Jobs’ hair? If you look here, he had a good head of hair until he was about 40, and then it all disappeared. Now I know Steve Jobs is a sick man, and has probably had several chemo treatments, but I always thought hair grew back after chemo. I also thought that if you didn’t have some hair loss in your younger years (20-30), that you would probably never progress to the level of balding Mr. Jobs has. Do you think his hair loss is genetic, or cancer-related?

Thanks!Steve Jobs

While it is possible to lose hair later in life due to genetics, we can’t discount what Steve Jobs has gone through with all of his medical issues over the past decade or so. It looks like he was losing hair in his late 30s and 40s, and then he got ill, possibly exacerbating the hair loss issue and leading to weight loss.

Simply put — When chronic illness hits, you lose hair. His multiple medical problems (liver transplant, pancreatic cancer) clearly impacted his hair.

Tags: steve jobs, apple, hairloss, hair loss

Scarring Alopecia Related to a Tumor?

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

I just had a tumor removed during what was anticipated to be a basic appendectomy. Fortunately, my doctor has assured me that the prognosis is excellent and that I don’t have any reason to anticipate any further complications. About 5 yrs ago I was diagnosed with a form of scarring alopecia. What are the chances that I unknowingly have been suffering from a “secondary” form of the alopecia that is directly related to this tumor?

You’re probably referring to this quote from the Cicatricial Alopecia Research Foundation: “In secondary cicatricial alopecias, destruction of the hair follicle is incidental to a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors.”

That being said, I do not believe your scalp hair loss has any relationship to the tumor you had in your abdomen.

Tags: tumor, cicatricial alopecia, scarring alopecia

How Do You Diagnose DUPA?

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

Hi Dr. Rassman,

I am an 18 year old male. I have experienced diffused thinning on the top and sides of my head for the past 10 months. I’ve probably lost 50% of my density. My sides are slightly thinner than the top. I was wondering if this would be diagnosed as DUPA?

The reason I’m asking is that my back is as thick as ever (of course there might be miniaturization that cannot be observed by the naked eye). Also, is it possible for a person to get DUPA this young?

In case it helps, no one in my family has MPB or DUPA. All 4 of my grandparents have quite thick hair on their sides, back and top

DUPA (diffuse unpatterned alopecia) is a condition found in men where the hair on the fringe area (back and sides) have significant miniaturization (greater than 20% of hairs). And yes, teens can have it.

No one knows what causes DUPA, but it looks like the pattern we see in women with significant female genetic hair loss, although their miniaturization may extend to other areas of the scalp.

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

SMP and Scarring Alopecia

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

I have lost alot of the hair on the sides of my head due to a form of scarring alopecia. Would it be possible to have micropigmentation done just on the sides as haircuts that are buzzed on the sides and a bit lengthy on top are very common and in style?

Generally, scarring alopecia with balding from it does well with Scalp MicroPigmentation (SMP). We have done a few severe cases which I could show you if you visited my office. One particular patient who had very extensive scarring and balding would rather not have his photos online.

Tags: scarring alopecia, smp, pigment, scalp micro-pigmentation, hairloss, hair loss

My Young Daughter Had Ringworm That Left a Bald Spot

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

My 8 yr old daughter got a bad case of ringworm a year and a half ago. The lesions became a superinfection and eventually cleared. She was left with a quarter size bald area on the top of her head and now has some small amount of hair growth. Is there anything out there could be doing for her to promote hair growth? Are there any specific doctors i should see? She is 9 and I believe it is bothering her a bit socially. Thanks

Hair loss from infection and scarring may be permanent if it has not regrown in over a year. One possible treatment worth using may be Rogaine (with approval from her doctor) topically applied, but you need to apply the medication twice a day everyday for about one year before may see any improvement.

Another option may be a limited hair transplant to the area which we have done on occasion. This may be a better solution, as it is a one-time event for most people. I realize she’s only 8 or 9 years old, but depending on how bothersome the bald spot is, it might be a consideration.

Tags: ringworm, hairloss, hair loss, child, bald spot

Hair Transplant for Woman with Polycystic Ovarian Disease?

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

Hi Dr. Rassman,
I was wondering about hair transplant in a female with active PCOD. I would really appreciate if you can share your experience in treating hair loss in PCOD both surgical and medical.

thank you

I do not have much experience treating women with Polycystic Ovarian Disease (PCOD or PCOS). Women with this disease tend to have hair loss that resembles male pattern balding, so I might treat them like men, addressing the pattern and the complaints that are given to me.

I’ve written about this before here.

Tags: polycystic ovary disease, pcod, pcos, hairloss, hair loss

I Had a Hair Transplant and Now My New Doctor Says I Have Alopecia Areata

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

I am a 58 year old female who had hair restoration done 18 months ago on my receeding hairline (1500 grafts). I have just learned from a derm. who specializes in hair loss and restoration that I now have alopecia areata. (This new derm. was not the doctor who peformed the original hair transplant. I went to this new Derm. b/c I wanted to know why my hair was still thinning. He took 3 scalp biopsies which confirmed areata.

Now in the temple area where I had the transplant every once in a while I get numbness and a burning sensation. Would this be possible nerve damage from the hair transplant. Just want a second option and thoughts. This new derm seems to think it is something to do with the transplant. By the way it took 3 derms to figure out what I had. The last derm. is great and is treating me right now. Your thoughts.

Second opinions are impossible to do over the internet through this blog. In general, I would want to know the following:

  1. Could you have had alopecia areata when you had your transplant?
  2. Did you lose transplanted hair in the areas of alopecia areata?

Any time a person has recipient sites in the scalp, small cutaneous nerves are injured. I would have to know more about your nerve problem. Good luck!

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

In the News – Young Boy with Trichotillomania

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

Snippet from the article:

TrichotillomaniaHair loss is a common problem that can be caused by a variety of conditions.

Imagine, though, it happening to a young boy because he pulled out his hair.

That’s what Max Sherwood of Riverdale, Iowa, had to endure. Max, 11, has trichotillomania, a psychological disorder that causes people to pull out hair from their head and other parts of the body to the extent that it causes patches of baldness.

“He started to pull out his eyebrows when he was in second grade, then he quit,” mother Candace Sherwood said. “Then, when he started fourth grade, he started to pull out his hair.”

Read the rest — Iowa Boy Pulls Out His Hair and Goes Bald

The video that plays at the start of the article is about OCD in general, and isn’t specific to this young boy’s story. But for those curious about the disorder and the steps used to treat it, I’d recommend giving the article a read.

Tags: behavior, ocd, obsessive compulsive disorder, tricotillomania, hair pulling, hairloss, hair loss, child

Can I Get a Beard Transplant If I Have Alopecia Areata?

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

Hi, I am a 22 year old male studying in New York. Since August last year, i have been facing hair loss from my facial beard. Doctors claimed it is alopecia areata. I was under meds for about 4 to 5 months and it got better momentarily but i guess it came back since i am loosing my beard around my chin and neck area! I read a couple of your stuff on this website and i was eager to know if i would be able to do a beard transplant on the affected area considering i might be suffering from alopecia areata. Your help would be much appreciated. Thank you.

Alopecia areata is an autoimmune disease, potentially affecting all of your hair follicles. It could attack any transplanted hair that is placed into the balding area and those hairs will die. So unfortunately, transplantation isn’t a wise option for you. For more on alopecia areata, see the National Alopecia Areata Foundation.

Tags: alopecia areata, beard, hairloss, hair loss

I’ve Had DUPA Since My Teen Years

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

I have been experiencing DUPA-patterned thinning since puberty, if you can believe it. I had my thyroid checked at 15 (20 now) and apparently everything was in order. Classic MPB runs in both sides of my family but I haven’t seen any instances of DUPA, and both my brothers seem to have been spared this condition. I took propecia for a year and it did nothing.

Are there any leads on possible underlying causes of DUPA, since it has become rather apparent that it is not [entirely] related to DHT levels/sensitivity? Could I possibly benefit from a visit to an endocrinologist or other specialist?

I do not know if you will benefit from an endocrinologist or other specialist unless you have actually been diagnosed with diffuse unpatterned alopecia (DUPA) by a physician. Are you diagnosing yourself with DUPA because you have thinning of your hair? Some people do have thin hair, but that is not DUPA. There’s no underlying cause of DUPA that is known at this time, so nothing you can really be on the lookout for. We simply don’t understand the condition all that well.

I also do not understand why you would be taking Propecia without a diagnosis of androgenic alopecia. Are you self treating? At the least you need a good examination and a diagnosis.

Tags: hairloss, hair loss, dupa