Liposomal finasteride

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

Most of the topical finasteride sold today can get through the skin and its not the Liposomal preparation.  if the drug gets through the skin into the body and you are known to get side effects with the pill, you will get it with the normal topical finasteride. With the Liposomal preparation; however, the measured maximal absorption for topical liposomal finasteride was reported to be rarely in excess of 18% of the total dose. I hope that language better explains what I know. But I would be happy to review articles you might have as I always keep an open mind. Last week I had a patient with the ethanol/ PG base solution and he had bad sexual side effects and that is why he came to me to get the Liposomal preparation.

A Liposomal preparation of a drug puts the active drug inside very tiny, fat-like particles. This allows more localization of the drug.  Men who have measured their DHT levels found that with the topical liposomal finasteride preparations, their DHT levels did not change. 

Is microneedling below 1.5mm pointless?

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

The range where these stem cells are more heavily concentrated is the area between 0.5 and 1.5mm (Click on photo to enlarge).  If the needles get into this area, they will produce internal injuries to the fat in this area and that starts the cascade that induces stem cell response. I labeled it “Cycling Stem Cells” in the photo of a graft below. You should also notice that the actual hair shaft goes down much deeper than the Cycling Stem Cell area.

Baby hairs at hairline

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

Quick question do baby hairs grow all over head but are mostly apparent around the temples and nape and hairline?

There are short vellus hairs that never grow up and there are hairs that are early in anagen that appear short. I have seen men who get good response from finasteride who show short anagen hairs that will eventually grow out once they have a few months of growth. There are also some short hairs that are at the end of their life and are frequently found in a hairline that is being lost through miniaturization. Is that what you are talking about with the term baby hairs?

Hair loss from lichen planopilaris

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

Some folks don’t respond to 5AR inhibitors and find no other option but to quit and embrace baldness instead of consider the immunologic possibility of their hairloss. Could Lichen Planus and related illnesses be, in combination or by themselves, be accountable for hairloss on a relevant scale? Why aren’t we discussing this topic more?

The diagnosis of lichen planopilaris is a cause of alopecia. The diagnosis can be made using a trichoscope by seeing perifollicular erythema, milky-red areas, classic white and blue-grey dots. This is an autoimmune disease that kills off the hair. It is more common in women than men, although the diagnosis is being picked up more so in some men lately. If a surgeon doesn’t make the diagnosis and does a hair transplant, the transplant will fail. A costly mistake. A biopsy usually is the final authority for the diagnosis.

What is happening to me?

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

You are developing miniaturization leading to corner recession of the hairline.  It looks like it may extend to more of the frontal hairline than you are showing here.  This is the best time to begin treating it as reversal is possible.