Appearex

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

Hi,
I’m a 40 year old female experiencing severe hair loss. I’ve had problems with hair loss for the past 13 years but last summer I went to a local salon to have the graying covered with some highlights. Whatever she used burned it because after that the hair strands are very thin and dry. I use alot of conditioner and it doesn’t help. I noticed that when after she washed the hair that it was severly tangled which resulted in her having to cut 3 inches from it to get the knots out from the burning. My hair was at that time past my knees with very few split ends. It is now around knee length and I keep it pulled up in a clasp. I have enclosed some photos to show the hairline-thinning-damage. I’ve been prescribed (Appearex) and don’t know much about it. Does this product actually help the hair as it states on the box that it’s a nail product? I have taken Lupron injections in the past and not sure if those created some of the hair loss but the problem is getting much worse and I don’t have a clue what to do about it. Thank you for taking the time to help others, and any advice you could give would be greatly appreciated.

Appearex is a dietary supplement. Its generic name is biotin. Biotin is a water-soluble vitamin component of the vitamin B complex. As an essential nutrient, biotin acts as a coenzyme for the body’s carboxylation reactions and is a factor in maintaining healthy muscle, hair, nails, and skin. If you are Vitamin B complex deficient, then this may help your problem, but few Americans have such Vitamin problems with any reasonable American diet.

Because dietary supplements are essentially unregulated in the United States, you can not be sure what you are getting when you buy an over the counter supplement product. There are many preparations on the market (prepared or manufactured with different techniques that are not fully disclosed or regulated with different additives). With different preparations, the same supplement may not have the same effects or equal potencies. Because there is no regulation, the efficacy or the validity of such ingredients cannot be guaranteed. That is why you sometimes hear it is a “buyer beware” market.

There are many causes for hair loss. You should be evaluated by a medical doctor to rule out a medical cause for hair loss. If you are still not satisfied, you should see a hair transplant doctor to map your hair for miniaturization and a possible pattern for your hair loss.

My Hair Is My Beauty and I’m Running Out Of It

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

I am a 21 year old African American female who has been dealing with Seborrheic Dermatitis and eczema since the age of fourteen. I have used everything from Mycolog, Desonide lotion to Selenium sulfide based shampoos. Now don’t get me wrong the do relieve me from the itching and greasy scaling of the skin. However in 2004 I noticed that the back region of my hair was thinning out. Also the right side had become infected due to constant scratching and became inflammed. About 2 weeks later the hair in that surrounding area started to fall out. I decided to do a biopsy so they could see exactly what was going on and hopefully remove the extra skin. I was later told that it was growing so I could either leave it in the state it was right now or try again. I chose to wait because it has really been frustrating for me and I didn’t want to make it worse than it already was. The only thing that bothers me is that I’m a young adult and I hide because of my appearance. It’s just a well known fact that a woman’s hair is her beauty and I’m running out of it. I just need some help and guidance and was wondering if you would point me the right direction. I was wondering will my hair ever grow back and how will I restore so it doesn’t happen again.

It seems you are being followed by medical doctors for the cause of your hair loss. If there is an infection on your scalp complicated by your dermatitis and eczema, most medical doctors are well trained to address your problems. I realize hair loss can be a devastating experience for both men and women, but it is my opinion to treat the underlying medical condition and your hair should return once you get your medical problem solved.

I Was Told To Put Vaseline on My Transplanted Grafts

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

VaselineI am a 33 year old female and just had a hair transplant 3 days ago. I was told that I had to put vaseline on the grafts and on the donor site twice a day for about a week. This keeps my whole head really greasy and I can’t go out without a bandana or hat on. I washed my hair with shampoo (very lighly where the grafts are) but it seems that it doesn’t get clean. Is this really necessary? How can I get the vaseline off my hair? If I could have clean hair, I would be able to go out and it would “hide” my transplant but I feel like the vaseline just plasters my hair to my scalp and the “wet” look really makes the transplant stand out. What would you recommend?

I never use or recommend Vasoline, because it is difficult to manage and remove. The general purpose of the Vasoline is to keep the grafts moist to prevent crusting, but I generally believe that it is best to take off the crusts by a good washing technique before they form and get fixed in place. It is impossible for me to get to you in a timely manner and it would be inappropriate for me to give you advice on a piece-meal basis without a doctor/patient relationship established and the internet is not the place for this activity. As you have a doctor, best to follow his recommended course. You might ask him why he does what he does so that you can understand his/her thought process.

Dreadlocks Causing Hair Loss in Woman?

/by William Rassman, M.D./15 /

I have a dear friend, young, beautiful girl (caucasian) who has come to believe that her really long dreadlocks – which she has been growing for 7 years…is causing perhaps permanent bald spots on her scalp. She is really beside herself about it, and wondered what she could do to be sure, and if so – to cure the problem.

Dreadlocks can produce traction alopecia (hair loss from constant pulling). The best thing for her to do is to get rid of them and then wait for recovery of the hair. After 7 years, the hair loss may be permanent, but until the pulling stops, you will not know one way or the other. Recovery from traction alopecia may take up to a year.

Repeated Bleaching Causes Follicle Damage?

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

Bleach - art

Is it possible that hair follicles could have been damaged/destroyed by hair chemicals, such as repeated bleaching of hair? If so, is it possible to restore damaged hair follicles?

Hair follicles grow through the skin. These follicles arise from the bulb which is located 5-6 mm below the skin edge. Between the skin edge and the bulb, there is a ‘tunnel’ which allows the waxy sebum to rise out of the follicular unit to the skin. In theory, this tunnel could become a two way highway allowing chemicals, dyes or bleach to find their way deep into the hair follicles (note: the drawing is simplistic for illustrative purposes only). Through this route, it is possible to damage the machinery that grows hair either by killing it, or damaging it so that the hair that grows out might be a smaller gauge hair that has a different character to it. The question you ask is whether or not this process be reversed, and the answer really depends upon how much damage was produced. Generally the hair is quite a robust organ and will recover from insults. Hopefully in your case, the damage is such that it is reversible.

Facial Hair from Rogaine for Women

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

Hi,
I am 26 years old, female, and hair loss seems to run in my family. After turning 21 my hair started to fall out. My hair is very thin now all over, but more noticeable on the crown. I beleive I have diffused hair loss. I have tried Rogaine but, unfornately had unwanted facial hair growth. The hair grew in but fell out a month later. I also plan to have a child in the next year and hear that hair loss is associated with pregnancy. Is there any other treatments (pills or topical) besides Rogaine than can regrow hair? How much hair loss is expected and will it grow back?

thinning and desperate

Rogaine does get absorbed through the skin (as will any medication you apply to the skin) and facial hair is a rare but known side effect.

There is no way to tell if you will lose hair with pregnancy and I would not revolve my life around what may happen. A baby is a major life changing experience. If you lose hair with pregnancy, you will probably grow it back and I would expect that regrowth to match what you had prior to the pregnancy within a year or so. Unfortunately, there are few good solutions for women in your situation at this time.

Wellbutrin, Xanax, and Hair Loss

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

I am 49 years old, female. I take both Wellbutrin and Xanax. My hair has thinned in the front and top. It could be from either of the drugs or hormonal. If I stop taking the drugs, will my hair grow back? How long might it take?

Many drugs are known to cause hair loss, including the ones you just mentioned. Before thinking it may be drug related, it is my opinion that you should see your primary care doctor to find out if your hair loss may be health related. Health related causes of hair loss (such as hypothyroidism) can be treated and must be properly evaluated.

Teenager With Graying Pubic Hairs

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

I’m a fifteen-year-old girl. In may last year I noticed I had a few gray hairs. Then in July I noticed I was losing more hair than I normally do. This has continued right up untill I’m writing this. I have a few gray pubic hairs and under arm hairs. The mojority of hairs I have are still my natuaral colour, dark brown. My hair has become very thin and less shiney too. Most of my hair loss in at the front of my hair line, where I have two bald patches. I have not been suffering from any particuler stress and I can’t work our whats causing this.
Thanks

If you are experiencing unexplained hair loss in patches you may have a condition known as alopecia areata. It is impossible for me to diagnose you with an email. You should be evaluated by a good medical doctor (such a your primary care doctor or a dermatologist) for other medical causes of hair loss.

With respect to your gray pubic hair, it is often normal for a brown hair person to have a few random white hairs. Sometimes they can start in teenage years. I have seen men and women who are gray by the time they are 25, and if you have never seen these people walking around, that is because they ‘hit the bottle’ (the dye bottle).

Seborrheic Dermatitis and Artificial Hair

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

I am female and have had seborrheic dermatitis for several years and have consistently scratched at it over several years causing gradual hair loss that I have recently noticed, which has led me to stop scratching despite the itching. Is it possible to regrow my hair after such an extended period of time? If not, I was wondering if you might know the cost of artificial hair surgeries, NOT hair transplants.

Scratching your hair can cause Traction Alopecia, which sounds like the diagnosis. Wait out a period of 6-12 months without scratching and see if it returns.

With regard to the artificial hair, the process has been banned in many countries (it is not FDA approved and is known to cause many problems). First, you would have to find a country that lets the product be used at all, then finding a doctor is the second problem, but worse is that many of the people who get artificial hair, get infections in the scalp so the cost must include the costs to control infection and replace the rejected hair (almost a daily process). I do not have information on costs, however.

Spironolactones and Hair Loss

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

I posted a question some time ago but didn’t hear back from you so here goes. I am a 33 year old female with hair loss for the past year and 7 months. Started to notice the loss after going off the birth control pills. I went to see a hair loss expert at Duke University who said it was TE. Still hasn’t stopped thinning. I am back on the pill and spironlactone. I also have Hashitmoto’s disease. No family history of female hair loss although my dad has lost his hair. My testosterone levels recently came back at 86 which my doctor thinks is high and probably due to some PCOS. I have several questions. First, could the spiro be making my hair loss worse? What can be done to combat the high testosterone levels? I have a diffuse loss but also hair loss at the sides of my forehead (what I consider the temples) and my hair line has receded (which is what bothers me the most). Thanks for any insight.

The cause of your hair loss seem multifactorial. Birth control pills has been linked to hair loss even if you have stopped taking it. In other words, stopping or starting birth control pills may have ‘triggered’ your hair loss process. Hashimoto’s Thyroiditis is also a reason why you may have hair loss, because of its autoimmune process (your body may be attacking your hair). Polycystic Ovary Syndrome (PCOS) may also be related to hair loss by the virtue of hormone imbalances that this disease produces. Spironolactone, which is a common blood pressure lowering drug, can also be the cause of your hair loss as much as a help for it (now that sounds crazy, but it does say much about its value). Some doctors believe that Spironolactones may also grow hair, because spironolactone works by inhibiting a hormone called aldosterone, which is similar to testosterone (note: this is a very simplistic way of putting it). To my knowledge, there is no reliable scientific evidence of using spironolactone to grow hair. Most importantly spironolactone is not approved by the FDA to treat hair loss. Finally, your high testosterone levels should be addressed by your primary care doctor or a specialist who knows your complete medical history. PCOS can cause virulizing traits, and with high testosterone, that will just accelerate these traits. You may have already guessed, but spironolactone is commonly used to treat PCOS to decrease the androgenic hormone (testosterone) levels.

You seem to be doing the right thing by seeing the appropriate doctors. Unfortunately, sometimes there are no solutions.

Using Grafts from Other People

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

I am a 49 year-old African-American female. My mother and her two sisters suffer from female pattern balding. They are all in their 60’s. None of them have balding to the degree that I have. My two sisters still have the very thick hair we all had as children. I have general thinning all over. The top of my scalp and the sides have very thin, and in some cases bald spots. I never permed my hair. I am now wearing my hair in dread locks. Short of shaving my head, I don’t know what else to do. I would like to see if I am a candidate for transplant. Not the strip kind. Maybe the very small graft units. Do you have any experience in using hair grafts from other people. Or is this science fiction. I do not know if I have enough hair to transplant.

I do have experience transplanting hair from different people but they were identical twins. Otherwise, the difference in our individual genetic makeup will reject the ‘foreign’ hair.

My Hair Keeps Breaking

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

My hair keep breaking off in the same place (back and top of head); what can i do to stop the breaking?

It is normal to lose 100-150 hairs a day. However, if you are experiencing abnormal hair loss, you should consider being evaluated by a hair transplant doctor or dermatologist. If what you are talking about is that the hair only grows to a particular length and then breaks off, then you might work with your hair stylist and try to address the cause. Dryness could be the cause, so you might have to use a wetting agent, or if it breaks because you are rough in brushing it, use a thicker wide-tooth comb and be more gentle. Try various shampoos and conditioners, as there are many out there that may help.

Finasteride for Female Hair Loss?

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

Ok doc, I just saw on the news (and the found it on the web) where it says Propecia is basically ok for women. Please comment on this new study.

Female hair loss treatment hope
Oral Drug for His Hair Loss May Also Help Her

My concerns for this treatment are the following:

  1. The study is very limited to only 37 women.
  2. The “new pill” is finasteride 2.5 mg (which is 2.5 times the strength of Propecia for men) with an added birth control pill to prevent pregnancy because of the high risk of producing abnormal babies, a known side effect of finasteride in pregnant women.
  3. Finasteride for women is not approved by the FDA for female hair loss. We know that in 1 out of 200 or so men who take the 1mg dose of finasteride, that there is some breast nodules (gynecomastia) as a side effect and this makes me wonder what the effect might be on women who carry genes for breast, ovarian or uterine cancer or who may have an early version of these cancers already growing in their body. If they take finasteride as used in this study, what will happen here? Safety is critical to FDA approval for a particular use, so I would worry that without adequate statistics, we will not know about this risk.
  4. The study was not a double blind randomized control study. Which in short means there can be a bias in the study.
  5. These stories are sensationalistic at its best, causing great interest for desperate women and providing misinformation to the non-medical population. Another example of media hype was this story from a few years ago: Lemon juice ‘is HIV-killing spermicide’.
  6. These articles will, without a doubt, drive doctors and women to gather and exploit finasteride for the treatment of hair loss. We will know, the wrong way, about cancer and other such risks in these women when it appears in the courts.

Desperate for a Transplant But Low on Money

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

I have been loosing my hair for about 8 years now but did nothing due to lack of finance. I went to a hair transplant facility and they said that they could help me for about $8000. With that in mind i throw in the towel because i could not afford it. Recently i had a free cosultation at another clinic in Manhattan and i felt they were more honest with me for less. The team said that i could get about 1,000 grafts but i also had a limited supply of donors. He suggested that i tried monoxydil at this time before considering the grafts. My hair is still thinning in the top of my head and i’m still low on funds but desperately need to do something fast. He said the 5% monoxydil would be better than the 2%. Please reply with helpful advice. THANK YOU

Be wary of doctors who are willing to transplant hair, matching their recommendations to your budget. I do not like your desperation, because you are a set-up for being taken advantage of. Hair transplantation in women, such as yourself, rarely works as well as you’d hope and putting money into such a procedure for a female without good cause and a solid diagnosis is just plain foolish. Your first stop should be your primary care doctor or your dermatologist to possibly find a medical cause for your hair thinning.

2 Year Old Daughter Has Bald Spot on Crown

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

My 2 year old daughter started with a bald spot on the crown of her head and now it is really thin on top. She pulls out her hair when she gets mad but not often enough to cause this. She wont eat well and vitamins dont seem to healp the situation. Can you please tell me what is wrong?

First of all, your pediatrician should be central to your daughter’s management of her ‘hair loss’. Young children go through varying quality of hairs at different ages. Have you noticed that many children are almost bald under the age of 1? This is not really balding, but rather a migration from a baby’s fine hair to a child’s thicker hair that occurs in the first few years of life. Could you daughter be in such a transitional phase, assuming that the bald spot is not really a spot but rather an area that appears bald? Although there are many causes of hair loss in children (infections, genetic and autoimmune diseases, etc.) you have to be sure not to overreact. See your pediatrician.