November 2006 – Page 14

November 3, 2006

Topomax and Lamictal Causing Hair Loss? – Hair Loss Information by Dr. William Rassman

I am on Topomax and lamictal for epilepsy and have been experiencing hair loss problems since starting the topomax that seem to be worsening. I have been told it is a side effect of Topomax. Will this stop on its own? Is there anything I can take or anything I can do to mitigate the impact of topomax on my hair?

This is a subject you and your neurologist need to discuss. Many of these medications do cause hair loss. Drugs like minoxidil may work for men and women, and if you are a man, then Propecia may also help, but when the medications are working away at your hair as a side effect of the drug, then alternative drugs may be worth trying. This is a difficult problem, but you can not sacrifice your health for your hair.

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November 3, 2006

Too Much Chlorine and Hair Loss? – Hair Loss Information by Dr. William Rassman

Hello doctor,

My building water supply has too much chlorine in it in the ‘hot’ water. I have to take head bath with luke warm water so I have to mix hot and cold.

Is this the cause of my increased hair loss and thinning on the crown since moving to this building?

Does your opinion agree with traditional Ayurveda on this?

Swimmer Chlorine in our tap water and hot water should not cause hair loss or increase your hair loss. It is an urban myth. If it was true, a disproportionate number of professional swimmers would be bald, as they are in a chlorinated pool all day long.

For readers that aren’t familiar with Ayurveda, it is a traditional, holistic treatment of medicine from India. From Wikipedia — “Ayurveda deals with the measures of healthy living, along with therapeutic measures that relate to physical, mental, social and spiritual harmony. Ayurveda is also one among the few traditional systems of medicine involving surgery.”

So if you’re asking if I agree with Ayurveda that chlorine is causing your hair loss — no, I do not.

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November 3, 2006

Nourkin and Toppik – Hair Loss Information by Dr. William Rassman

Are Nourkrin and Toppik ok to use together?

I’m female aged 23 and have been suffering from hair loss for 3 years. I have been using both products for a few months so far.

Nourkrin is a food supplement which contains marine based extract of proteins and polysaccharides, Vitamin C, Silica, Horsetail, and IgG. It is mostly used in UK. Toppik is a topical medication and contains Keratin, Ammonium Chloride, Silica, DMDM Hydantion, and Iodopropynyl Butylcarbamate and it is in particular (fiber like) form that sticks to the hair follicles to make them look fuller. There should be no negative impact with using them both, but you need to always remember that even these simple substances have risks at some level.

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November 3, 2006

Is Propecia Stopping My Beard from Growing? – Balding Blog

Dear Dr. Rassman
I’m 20 years old, and I’ve been using propecia for one year. I would like to know, if one side effect of propecia is stopping the development of my beard-hair. I’ve heard that DHT is responsible for the development of beard hair and finasteride stops the production of DHT. Is this right?

That is an interesting question. Beard hair develops as you go through puberty as a secondary sex characteristic and DHT is one of the agents that cause its growth at puberty and beyond it. I have heard reports from a few patients that beard growth has been slowed by finasteride as was a maturing hairline slowed. It would not be what I would expect and neither are reported as a known side effect of finasteride. When I started Propecia, it did not reverse my nose hair, ear hair, my beard (which I hate) or my excessive chest hair (although one patient did report to me that his chest hair went away with Propecia).

November 3, 2006

Healthy, Thick Hairs Are Falling Out – Balding Blog

Hi Dr. Rassman and Dr. Pak,

I am 29 years old male, taking Propecia for about 4 months now, and have 10% miniaturization, hair loss is not really noticeable. Also I am using a shampoo called Nioxin. But I see that a lot of hairs fall out when I am taking showers, combing my hair and just generally during the day. The hairs that fall out are healthy, thick hairs, but there are a lot of them, 200, maybe more! My questions are:

Why is this happening? And is there any way to stop shredding so much hair?

Another question I have is that, in recent years, my hair density seems to be thinner at the top of my head compared to the sides and back, even though the hair strands themselves are of same thickness. Is there a method to increase the density besides just taking Propecia?

Thanks very much!

You need to see your hair stylist for compounds that thicken the hair. Many of these compounds add water to thicken the hair as it is hydrophilic (water loving) and substances that cling to the hair follicle will increase the value of what you have. Usually, miniaturization of less than 10% is not really the classic miniaturization that we see in balding conditions. These miniaturized hairs may actually be the normal vellus hairs that are part of the follicular units in everyone. You should not be losing 200 hairs per day. If that keeps up you need to be evaluated by a hair expert as there may be a reason for that degree of hair loss. You say that the hairs that you are losing are healthy, thick hairs — well, healthy, thick hairs that fall out will not fall out in that quantity. There is a hair pull test which can be performed by an expert that will define if you are really losing hair at the rate you think.

November 2, 2006

Scarring in Donor & Recipient Area, Body Hair, FUE – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m considering going in for a FUE hair transplant and I understand that there is minimal scarring involved. I was reading up on the New Hair Institute web site and noticed there are many “mini” scars. Will these scars be only in the donor area or where there is transplanted hair?

I’m also considering using body hair as a viable source for donor hair. I’ve seen a few surgeons doing this. Have you personally performed such an operation? I would love to hear your thoughts on this procedure.

Best regards.

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Follicular Unit Extraction (FUE) produces very small scars in the donor area, usually less than 1mm (there are 25mm to an inch). The only way most people could see these scars is a complete shave of the head (not a short hair cut, which probably would not show any of these scars). In the recipient site, the grafts are always trimmed (in our office, anyway) to cut away the unnecessary skin so that these grafts should not produce any visible scar in the recipient area. My understanding from the recent ISHRS meeting in San Diego, is that most surgeons doing FUE do not trim the grafts and therefore may get very small recipient area scars.

I have commented on body hair transplants before, but I’ll recap the biggest problem with them. Due to the short growth cycle, body hair will not show up very well (quantity) because for every body hair that is transplanted, less than half of them will be in growth phase at any one time. That means that less than 50% of the hairs will grow according to what you can see. At the meeting in San Diego, one doctor who does a lot of body hair transplants showed two patients who had them done. The growth in numbers was far less than 50% of what the two patients and the doctor reported was put in at the time of the surgery. The only good news about what I learned at the meeting with regard to body hair is that the length of the hair does double to what the person had in the chest or back (natural position). I would want to have a face to face meeting to understand your focus on the body hair, why you wanted it, and to see what else was available to meet your needs.

November 2, 2006

Bald Spot Just Appeared on Back of My Head – Hair Loss Information – Balding Blog

I am a 21 year old Male who up until a few months ago had no problem with balding. I was getting my hair cut relativly short and my hair dresser noticied I had a bald spot on the back of me head about the size of a quarter. I kinda ignored it figuring it would grow back but it has been about 5 months now and my hair is longer but the bald spot is balder then bald and seems to be getting bigger according to other people (as I cannot see the back of my head). I was just wondering what the cause for this is and if it can be anything serious or just stress related possibly? Thank You very much.

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Send me a photo of the spot you’re talking about so I can see what you’re referring to. At 21, you are relatively young for crown balding. I have some important questions for you:

Is the spot in the center of the head where the swirl is located or is it off to the side?
Is there still some hair present in this bald spot?
Is there any balding or thinning any place else on your head?
Do you have a family history of balding in the crown (back) of your head and if so, at what age did it happen?

A good doctor may be able to diagnose a possible cause, such as ringworm, alopecia areata, etc. There is not substitute to a good doctor’s examination for you. If this is genetic balding, you would want to get your hair mapped out for miniaturization, as genetic hair loss has patterns of thinning which appear before developing a bald spot.

November 2, 2006

My Dermatologist Stopped Prescribing Proscar for Hair Loss – Hair Loss Information – Balding Blog

I’m a male, age 27. When I began seeing a dermatologist 4-5 yrs ago, he prescribed finasteride 5 mg and had me cut it into quarters.

That went on for about a year or so, but then he said that there was some sort of regulation restricting physicians from doing this. Since then, I’ve been paying the higher cost of the daily 1 mg tablets. Was the doc telling the truth? I understand that the clinical indication calls for a 1 mg tablet, but are doctors really not allowed to prescribe the higher dosage with the understanding that the patient will do his part and cut the pill into the appropriate size?

thanks

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Many doctors prescribe medicines for off label use. Proscar (finasteride 5mg) is a medication marketed for benign prostatic hypertrophy. Propecia (finasteride 1mg) is a medication marketed for androgenic hair loss (male pattern hair loss). They are the exact same drug with different strength dosing. That being said, if someone (or a computer, such as your insurance company) sees that you have been prescribed Proscar, they may think you have a prostate problem even if you were prescribed it for the intention of using it for hair loss. This is a story that is told by my Propecia drug representative – so there is obviously a bias there and I am not sure how true this story is — but it is plausible.

I give a choice to all my patients and do not favor one or the other, because they are the same medication in different dosages.

November 2, 2006

Rogaine Not Proven to Work Past 48 Weeks? – Hair Loss Information – Balding Blog

I noticed on the pamphlet with my rogaine bottle that it says the medication has not been proven to work past 48 weeks. Does this mean that Rogaine doesnt work pass that many weeks or that the study was only conducted for 48 weeks? I have been using rogaine for 4 months and have seen fantastic results. Before then I was only using propecia without any results, now I use both.

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I found the following statement, “hair regrowth has not been shown to last longer than 48 weeks in large clinical trials with continuous treatment with 5% minoxidil topical solution for men”. This implies that the study only went out 48 weeks. I have seen people on this medication for years and years and when and if they stop it, they lose hair. This phenomenon suggests that the Rogaine held the effect and benefit for the years it was used.

November 2, 2006

Not Seeing Results from Finasteride After 9 Months – Hair Loss Information by Dr. William Rassman

Dear sir, I am 29 years old. My hair loss(from crown moving to the left frontal area) started 4 years back. I have been taking Finax(Finasteride)for last 9 months. I have not seen much or benefit from it, instead there is increase in my see-through hairs on the right side when i see it from the top in the mirror. I do not think it is working, still I am not going to stop it. My question is if my hair loss is still progressing and I am not a candidate for transplant, what are my options in the long run. Please reply.

If is my belief that finasteride (assuming that the medication is really finasteride) always works to slow down the natural course of male pattern hair loss. You are right to stay on the medication, but as the medication is not coming from Merck (drug company in the U.S.), then you should be sure that the company who makes the version you are taking is really that medication. I’m still not familiar with the various brands of finasteride that are available in other countries (or the legitimacy of those brands). I’m a U.S. based doctor, and as such, I am familiar with what is available to my patients here. If you still see progression of the hair loss, then this drug may not be strong enough. Hair transplants may be the only option for you.

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