Diffuse Thinning in Female

Dr. Rassman – I am a 41 yr. old female and have been experiencing diffuse thinning. I noticed this happening about 5 months ago and have been on an endless quest ever since and no one can seem to offer help. I have been told to try everything from hair transplants to ScalpMed, (which I saw your response to), Rogain and then not to use any of those treatments. I have seen 3 dermatologists, 1 holistic doctor, 2 GP’s, and an endocrinologist. I have had every blood test as described and nothing has been found. My 2 uncles on my mothers side are bald although my parents, sister and brother do no have thinning. I have scalp psoriasis mainly on the crown and sides of my head. I recently had a scalp biopsy and interestingly enough the pathology report stated that, “on the basis of this punch boipsy, the favored finding is psoriasis/sebopsoriasis, findings of alopecia are not present in this biopsy, and negative for scarring alopecia, lupus or any known inflammatory dermatosis (other than the psoriasis). I am currently using Clobex shampoo and lotion, not at the same time, and I know that I can only be on these for short periods of time due to the side effects, and that they can cause hair loss. I have sent photos to Dr. Bauman in Florida and he suggested the hair transplant. If someone would have told me 6 months ago that I needed a hair transplant, I never would have believed them. My problem is my hair is still thinning, and before I lose it all I would like to stop it. I am losing about 150 hairs a day and I have heard anything over 50 is extreme. I have done extensive research and still I have no answers. I understand that when the plaques get bad enough it can cause hair loss and that I need to get the psoriasis under control, however I have received so much contradictory information, I don’t know who or what to believe anymore. Is there someone that you can recommend here locally that may help? This entire situation is taking a toll on my health and marriage. Thank you.

First, I would like to acknowledge that you have a problem significant enough to affect your mental health. I have dealth with many patients in your circumstance. In your case, Psoriasis does not cause hair loss unless you pull on the scales, thereby producing traction alopecia. What you have done (including the biopsy) seems reasonable. If you have diffuse hair loss impacting even the sides and back of your head, and continue to shed hair, I do not recommend hair transplantation, for you will be transplanting some of the impacted hairs, not just the recipient area. Doing a hair transplant for a patient who is currently experiencing active Telogen Effluvium is bound to fail. Through the internet, it is impossible to treat you without examining you. If you live in California, consider visiting one of my offices (in Los Angeles or San Jose). If not, send me photographs to the email address on the Contact page and I will see if I can help you any further. Please avoid hair transplants until there is a clear plan in front of you.