February 2008 – Page 6

February 20, 2008

Histopathology of Non-Scarring Alopecia – Hair Loss Information – Balding Blog

Hi Dr. Rassman, I was wondering if you knew the histopathology of non-scarring alopecia in a 21 year old male? My dermatoligist said I had diffuse hair loss and non-scarring alopecia and prescribed me Propecia; I am also taking Rogaine. Additionally, what do you think of spirinolacatane as a topical treatment as an anti-androgen for this type of hair loss?

Thanks

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The histopathology of non-scarring alopecia is just as it states — When you look under a microscope of your scalp biopsy there is often cells seen that reflect some autoimmune disorder, but no scarring where there is hair loss. Examples include anagen effluvium, androgenetic alopecia, chemical alopecia, folliculitis (mild), inherited disorders of the hair shaft, telogen effluvium, alopecia areata, and traumatic alopecia.

Of the list above, the most common non-scarring alopecia is genetic balding (otherwise known as androgenic alopecia — AGA; otherwise known as male pattern baldness — MPB). And since your dermatologist prescribed Propecia for your non-scarring alopecia I would guess that your dermatologist thought you had MPB. It probably would’ve been much easier if you were just told that you have male pattern baldness. If you have diffuse unpatterned alopecia (DUPA) then the donor area behind your head would have substantial miniaturization. Speak with your doctor about how he/she arrived at the conclusions.

Finally, spironolactone has anti-androgenic properties, but clinically there is little good evidence that it helps with MPB.

February 20, 2008

My Dermatologist Prescribed the Following for My Female Hair Loss… – Hair Loss Information by Dr. William Rassman

For the past several months, I had noticed my scalp progressively showing through just behind the crown of my head. During this time, I had not noticed excessive hairs falling out, in my hairbrush or in the shower. I’ve been doing my hair in a ponytail for the last 2-4 years. I first went to see my GP a few weeks ago, she did my bloodwork and referred me to a dermatologist. At the time of the appointment, the dermatologist had not yet received the bloodwork results. He spent a few minutes with me and prescribed the following:

Rogaine 5% for men daily at night

DHS Free and Clear shampoo daily for 6 days per week

Salex shampoo 1 day a week

Betamethasone valerate cream after shampooing.

Appearex Biotin 2.5mg daily

Vicogen 1 daily (a multivitamin)

A few days later, I received my bloodwork results which are all in the normal range. I am a 44 year old female. I am not sure if I should start this treatment plan or not. My GP had mentioned that the dermatologist may do a biopsy of the hairs, but he did not talk about that and when I mentioned it, he said it was not necessary.

Please advise, thank you so much!

It looks like he’s just throwing everything at you and hoping something will work. Ask him directly and try to find out:

What his diagnosis is
What his expectations are for your use of these medications

I do not know what your dermatologist’s line of thinking was.

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February 20, 2008

Is My Son Losing Hair from LSD or MDMA Use? – Hair Loss Information by Dr. William Rassman

Hello
My son is 21, he believes that his hair is thinning at the crown and at the hairline. He has also been complaining about an itching, tingling, burning sensation on the top of his head. I personally do not think that it is thinning as both sides of the family have a long line of full heads of hair. He has a long history of depression and chronic anxiety, he is also a hypochondriac. However about a year ago i discovered that he had taken large amounts of estradiol, in the form of my estrogel, a month or so prior to me discovering it missing. He stopped after i confronted him about it. Approximately six months later he took LSD while at a friends, then he took MDMA, overdosed and had a seizure. My question is could his hairloss be due to either of these? I am very concerned about him, he has always been depressed and lossing his hair would be a huge blow on his self esteem.

I can understand young men experimenting with drugs, as illegal and harmful as they may be, but it is strange that a young man would knowingly be taking female hormones. Does he have gender identification issues?

Hair loss can be a source for depression for many young men, but I would be less concerned about your son’s hair loss when there are potential life threating issues such as: depression, anxiety, illicit drug abuse, seizures, etc. Your son sounds like he needs help and I do not think hair loss ranks near the top of the list.

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February 20, 2008

I Stopped Taking Finasteride for 10 Days While On Vacation! – Hair Loss Information by Dr. William Rassman

I stopped taking finasteride for 10 days while on vacation and believe my hairline receded as a result. Does that seem right or is 10 days too short a time to see any hair loss after taking the product for years?

There is tissue fixation of the drug that may last up to a week. I would doubt that you’d see a major impact from the 10 day finasteride-free vacation, but you should do better planning next time.

February 20, 2008

I Just Got Married and Finasteride is Giving Me Libido Issues! – Hair Loss Information by Dr. William Rassman

Dear Doctor,

I have what seems to be a desperate situation – I was married just 2 months ago, and am having serious libido issues. I have been on Fincar (generic for Proscar) for about 9 months. I have experienced positive results, BUT ALSO the often reported side-effect of reduced libido, which really snuck up on me, and hopefully, is not a permanent condition, though this has been reported. I just begun taking PassionRx to counter the effect.

Should I discontinue the drug and live with the hair loss? (My assumption and hope is that my libido will return).

Or, is it possible to maintain positive effects but through a reduced blood-level of the drug vis a vis taking it less often, or cycling on and off and allow for return of libido at the same time?

Put another way, given the 3-6 month time-frame for “catch up” hair loss, can I cycle my use of Fincar, retain benefits, and restore libido?

Married You need a doctor to talk with, one on one. There are many causes of libido issues, and although finasteride may be the reason, you should not just assume it.

I often tell my patients to stop the finasteride for a week, the go on a half a Propecia a day (that would be 0.5mg of finasteride) and see if the libido issue was solved in the week off of the drug. If it is, maybe half a pill will work for you as it is 80% as effective as a full 1mg tablet. If you’re taking a full 5mg generic finasteride, you’re taking more than the 1mg recommended hair loss treatment anyway.

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February 20, 2008

I Had My Eyebrows Partially Removed with IPL — Will They Grow Back? – Balding Blog

I had IPL on my eyebrows 1 year ago – only 2 sessions. I now only have the medial part of my eyebrow on both sides because she removed too much hair. I was very upset and she assured me they would grow back. They haven’t. Will they eventually?

Essentially, the person that did the hair removal on your eyebrows screwed up and got rid of too much hair. If you haven’t seen any regrowth after a year, it is likely that they may not grow back on their own. If they do not grow back, hair transplants into the eyebrow will work well. For those curious about IPL, see the intense pulsed light listing at Wikipedia.

February 20, 2008

Does Dying Gray Hair Lead to Faster Graying? – Hair Loss Information by Dr. William Rassman

How true is it that when you color your grey hair, you will grow more grey hair faster than not coloring. I have been getting different answers from the web. I need your opinion. Thank you.

It’s not true at all.

Hair color is the result of pigmentation due to naturally occurring chemicals (primarily melanin). These chemicals are present at different levels, thus giving hair its distinctive color. The more melanin present, the darker the hair; the less melanin, the lighter the hair. Hair color changes as we age, going from their natural color to gray and then white. The color change occurs when melanin is no longer produced in the hair root and new hair grows without pigment. Coloring the hair has no effect on the rate of graying and on the deposition of melanin in the hair shaft — it just affects the hair above the skin.

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February 19, 2008

How Do So Many Older Rock Stars Still Have Such Great Hair? – Hair Loss Information – Balding Blog

I always find it amazing how rock and roll stars in their 50’s and 60’s still have hair like 20 year olds. Could there be something they are doing or is it just the lack of stress of being a rock star has enabled them to keep their youthful look. Just some examples would be Sammy Hagar,Mick Jagger, Robert Plant and Steven Tyler.

Thanks

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Rock and roll I can not comment specifically on any of these men, but I am personally aware of a few musicians that use either hair extensions or hair systems to give the appearance of a full head of hair. Long hair seems to be for musicians like hair was to Samson and I have been told over and over again, that without the appearance of hair, they can not perform well. Perhaps it is a confidence issue, perhaps it is something else entirely.

February 19, 2008

Lexapro and Female Hair Loss – Hair Loss Information by Dr. William Rassman

Dear Doctor,

I’m a 35 yr old female who was put on Lexapro to combat mild depression last Thanksgiving. After two weeks of taking the drug, my hair began to fall out in large clumps leaving me with bald spots. I contacted my doctor and she told me to stop taking the Lexapro as it this is a known side effect. I am not taking a replacement drug as my depression was only mild and the hair loss has scared me enough for now. The hair stopped falling out 7 to 10 days after I stopped taking the Lexapro. Luckily, I had long thick hair and even though I lost about 15% to 20% of my hair it was not extremely obvious. However, I have been waiting patiently for my hair to start growing back, but the bald spots are still bald. How long should it take before the hair starts growing back as it has been over ten weeks? I would think that by now I’d see at least some stubbles of new hair growing back. Also, I have a friend who told me that after she had chemotherapy treatment (breast cancer) her doctor told her to take Biotin vitamins and use Nioxin shampoo. Should I use these products to try and speed things up?

Thanks in advance for any help and suggestions!

Telogen effluvium may take from 2-6 months to reverse. Assuming that this is a drug induced TE, you should wait out the process for at least 6 months and then if you still have bald spots, you need to see a specialist. The medications used by your friend may have value. Also, the use of minoxidil 5% may help.

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February 19, 2008

Is It Ever Too Late to Start Propecia and Minoxidil? – Balding Blog

I am 36, have been balding since 21 and now seem to have a pretty full head full of hairs in the advanced miniaturization, with some hairs in the moderate miniaturization phase. Not a lot of normal hairs at all.

Area of balding pretty much covers the entire area; T1, T2 = Temples
F1, F2 = Frontal
M = Middle
V = Vertex

When is it considered too late to start a regimine of Propecia/ Minoxidil? Can these miniaturized hairs be saved, or is it already too late? In the past, have used minoxidil with some results, with the middle and vertex becoming much less visible. More pigment, thicker hairs, but threw in the towel after a year.

It is never too late. I like the fact that you now have a baseline measurement to know what these medications will do if you start them again. Go for it!

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