April 2008 – Page 13 – Balding Blog

April 3, 2008

Hair Loss InformationFolliculitus Decalvans and Hair Transplantation – Hair Loss Information – Balding Blog

Doc,

I have something between reoccurring folliculitus or folliculitus decalvans, depending on which doctor (i’ve been to a few) you ask. I have had a biopsy. The problem is located on the crown of my head. Subsequently, there is bald spot on the vertex of my scalp (about the size of a dime). Assuming I can get the infection to go away, is this something that can be cosmetically repaired?

Thanks for your input

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If you have folliculitis decalvans and you can get the infection under control, any type of repair work in this area (i.e. follicular unit transplantation) could set off the disease process again and you have the potential of losing the transplanted hair and having to deal with the disease process all over again. This is your worst case scenario. I have had 3 such cases over my years in practice. Two ended up with reasonable hair growth, the third one is presently being diagnosed and treated. Good luck.

April 3, 2008

Propecia Vending Machine? – Hair Loss Information by Dr. William Rassman

Doc, what do you think of a Propecia vending machine?

World’s First Weed ATM

The article states, “AVMs are 24/7 machines housed in standalone rooms, abutting two dispensaries and protected by round-the-clock security guards — like ATMs for people combating psychological withdrawal with a physical one.”

It’s interesting, certainly, but I wonder how easy this is going to be to exploit. Prescription drugs in a vending machine… wow. I do think its an interesting concept. What else can I say? Technology is neat.

April 3, 2008

Noticed Regrowth Within 2 Months of My Treatment Regimen – Hair Loss Information by Dr. William Rassman

I find your blog to be an incredibly truthful gem floating in a sea of smoke and mirrors, and I thank you for that. Now on to my question(s)…

I have been searching all over the net for doctors of your calibur and style in my area (Chicago IL), but I have not been able to find anything. Can you recommend anyone? (I am currently not interested in transplants, just a general consultant and someone to check my miniaturization/progress). If not, perhaps you can help without seeing me. My current treatment is as follows: I take Propecia in the morning (started 4.5 months ago), I also use Revivogen at night (started 3 months ago), and I use the Hairmax lasercomb (used regularly for 2 months or so). At 2 months I had noticable hair regrowth at my temples.. this hair has since grown to about an inch long. There was a period of extreme itching/shedding (at 3.5mo), but it faded. Now for the past 1.5-2 weeks my head has been itching and shedding AGAIN.

I have done my best to look at all the hairs falling out and there are 2 main types of hairs visible… one is a strong and solid hair (about 50% of the fallout), the other is a weird thin/curly tipped hair but with a noticably stronger/straighter (I have very straight hair normally) base to it (50% aswell). Is it possible for someone to have positive regrowth in 2 months but then plummet back to balding again? Are these thin tipped+strong based hairs a good sign of Propecia reversing the miniaturization?

Also, I see very little progress at the crown, is it possible to regrow at the temples but not at the crown?

Any advice is greatly appreciated. PS: I’m a 24 year old male if it matters.

Generally, I rarely see any gain in hair growth at two months no matter what type of treatment. So you must be doing something that no one is aware of. In short, I really cannot comment on what is going on with your hair growth or hair loss, and I really don’t know why you have itching and shedding either.

With respect to hair growth cycles, it is a very SLOW process and nothing happens in one or two months. Hair grows for several years and hair sheds over several months. Unfortunately, I do not know of many doctors who routinely do miniaturization studies, though there is more and more doing it nowadays. I would consult with a good, caring dermatologist to see what is causing your itching and shedding.

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April 3, 2008

Can Propecia Cause a Varicocele? – Hair Loss Information by Dr. William Rassman

I have recently read some of your insights regarding hair loss and propecia on the internet. I wanted to ask you a question regarding propecia. I have been using the drug for about a two and half years with pretty good results. At first, the only side effect I experienced was testicular pain that eventually went away after several weeks of using the drugs. Recently, I felt discomfort in that area again and decided to get it checked out. It turns out that I have a vericocele. I was wondering if there is any connection between propecia and the vericocele. I am extremely concerned that I might be harming my body by taking the drug. If so, I would probably discontinue the drug and consider other options such as a hair transplant. If you could shed some light on these concerns I would greatly appreciate it. Thanks so much for your time.

The presence of a varicocele (abnormal enlargement of the veins in the scrotum draining the testicles) is found in many men that are not taking Propecia (finasteride 1mg) so I do not know if there is a cause and effect here. I haven’t read anything about a connection in medical literature. If the varicocele is causing you pain, your doctor may have to perform a minor surgery on it, though sometimes no treatment is required. Learn more about this at Wikipedia.

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April 2, 2008

Steroid Use Led to Libido Issues — I’m Worried That Propecia Might Make It Happen Again – Hair Loss Information by Dr. William Rassman

Hello Dr.,

I expermented with steroids about 2 1/2 years ago. I was told that dosage would cause no side effects but before I even ended my cycle there was significant hair loss and a decrease in sex drive. Even after the two years I am still recovering and have not had a regular libido and show significant thinning of my hair.

Since I had the low sex drive when experimenting with steroids is it possible that taking propecia I have a higher chance of it occuring again? Is there another drug that can be taken along with propecia? I am 28 years of age and in good health aside from the hair loss and irregular sex drive.

You need to have a doctor manage this process for you. Your low sex drive can be a result of your anabolic steroid use or just a naturally low sex drive (independent of steroids). Many men have low sex drives that go undiagnosed or they are not readily willing to face the problem and often try to find other causes like steroid use or Propecia (finasteride) use. My recommendation is to have a good physical exam by your primary care physician. I really cannot tell you if Propecia will give you a high chance of sex drive issues. Propecia in general has a side effect of decreased sex drive (1 to 2 percent) and an increased sex drive (10 percent), possibly because testosterone levels go up between 9-18% on Propecia.

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April 2, 2008

Seborrheic Dermatitis and Hair Loss – Hair Loss Information by Dr. William Rassman

If seborrheic dermatitis is left untreated, can it possibly cause hair loss or small bald patches?

If you let it build hard plaques on the scalp and then you pick them off, it can cause hair loss. Just flaking scalp does not cause hair loss, though. An extreme example of seborrheic dermatitis is the disease called psoriasis, which does not cause hair loss unless the victim picks off the plaques on a chronic basis. My advice is to seek out a good dermatologist and get yourself looked at carefully.

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April 2, 2008

Retin-A and Minoxidil After Hair Transplant – Hair Loss Information by Dr. William Rassman

I am a 25 year old male. I had a HT procedure about 2.5 months ago. What is the risk to the transplanted follicles from using a minoxidil + 0.025% retin-a formula? I use 5% rogaine foam and 1/4 proscar religiously, but I was wondering if the added retin-a might help. Any advice is much appreciated.

Retin-A is an acid and is sometimes used for the treatment of acne. It causes skin irritation that some believe will help with minoxidil absorption. There is no proof this works in helping with hair growth. It is a buyer beware market. I would speak with your doctor about this use after a hair transplant, but I do not recommend that my patients take it.

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April 2, 2008

How Many Grafts to Give Dick Vitale Hair Like Brad Pitt? – Balding Blog

Hi Doc, cool blog.

I was just wondering if hair multiplication became a reality, would it be possible to give a guy like Dick Vitale hair like Brad Pitt? If so, how many grafts woud it take, and what approach would you use? I’m sure if any surgeon could duplicate nature, it’s probably you. Thank you.

I am going to assume ESPN’s Dick Vitale is a Norwood Class VII, and he has an average hair density of 2. This equals about 1250 hairs per square inch, or 625 follicular units (FU) per square inch, assuming an average of 2 hairs per FU. The front and top part of the scalp on average cover about 16 square inches, the crown another 16 square inches, for a total area of coverage of 32 square inches. If we had unlimited source of hair (cloning, multiplication, etc) we would need about 20,000 FU or 40,000 hairs to give him coverage with a density of 2 in the transplanted area (for the head of hair that Brad Pitt has). However, as the gold standard is follicular unit transplantation, this would be the method I would use, even in the make-believe world we just described.

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April 2, 2008

Dry Skin, Clogged Pores – Hair Loss Information by Dr. William Rassman

Can dry skin in the mustache area clog the pores in which it stops the hair from growing or cause it to delay?

Clogged pores do not cause delay in hair growth.

April 2, 2008

Continuing the LaserComb Debate… – Balding Blog

Dr. Rassman

It is not my intention to be a “naysayer” or to engage in a continued point-counterpoint debate regarding the Lasercomb. I don’t have any ax to grind. But, in your wonderful site, your readers may not have the background to fully appreciate unusual statements in the Lasercomb response.

As a physician who is an experienced clinical trialist (I negotiated and presented clinical data resulting in drug approvals at the FDA for two major biotechnology companies over a period of 15 years) and a balding patient, the Lexington statement is not entirely forthright for your readers and does not fully address major concerns. It comes across to me as if it’s written by marketing folks rather than scientists involved in analysis and presentation of clinical data. Specifically,

It’s wonderful that “GCP”, “IRB approval”, etc was part of their clinical trial. For your readers, that means that the data was “real” (i.e., not fake or compromised), which of course is important when submitting data to regulatory agencies (FDA). But, the compelling question and real issue is presentation of data and accurate statements. For example,

Great that the single pivotal study is being written up for publication. This should have taken 1 week and been done a long time ago. It is highly atypical that a device or drug is approved without the study being published (before approval) in a peer-reviewed, scientific journal. This is truly the only way for physicians and patients to understand the effectiveness and safety profile, and make an educated decision. It is so atypical not to publish such data that the absence creates skepticism, whether deserved or not.

It is misleading for those not privy to drug/device approval processes to say that approval was based on the same statistical scrutiny as minoxidil and finasteride. What they mean is that statistical superiority had to be shown over a placebo control. The number of patients used, number of studies conducted, and duration of treatment, follow-up, and extent of the number of patients exposed paled in comparison to the aforementioned drugs. There is nothing wrong with this per se as a medical device should not be held to the same standards as a drug with potential systemic toxicity. But, again, it speaks to the clarity by which the company attempts to educate readers.

In the absence of publication of data in a peer-reviewed journal, the company gives only “partial data” on their web site and omits critical information (number of patients in the study, mean compliance, etc) that raises suspicion (even when no suspicion may be warranted). The presentation of clinical data on their web site is so poor that it appears to have been done by those not experienced in how to present data (and thus does not allow readers to be fully educated).

LaserComb may be the best thing in the world. The “real issue” is not, as the company states, that “people are not willing to move away from the “status quo.” That is ridiculous. The issue is that, in this age where data is often manipulated, spun, and marketed, companies touting products have an ethical and scientific obligation to provide detailed data of their clinical trials in public forums so that physicians and patients can make informed choices. When such data is not presented (or “in preparation”), a proper evaluation of risk/benefit can not be made, and skepticism abounds. Ironicaly if data is in a form for submission for regulatory approval, a few “cut and pastes” of several sections of the submission document should be all that is required to write up a small study.

The Lexington statement notes that “the hair growth, quality, condition, tensile strength, and manageability of hair” is enhanced by their laser. Data???? The company also makes statements based on their “extensive anecdotal experience over 20 years”. While anecdotal experience is not as valuable as placebo-controlled trials, it is still helpful. Let us hope that the company is also writing a manuscript “in preparation” summarizing this experience.

One P.S. The company needs to stops saying it “offers a money back guarantee.” As with presentation of their clinical data (so far), a half-truth. The company offers (beyond a month) a 60% refund if the comb is returned within 5 months. Their statement implies that those who find it not effective can return it, which is not the criteria. Again, nothing wrong with their policy. The issue is one of clarity of communication, which is missing for their clinical data.

We appreciate your excellent observations and input into such a controversial subject. I would hope that our readers take the time to reread your comments carefully, for in those comments there are many insights into the research process and when it is credible.

For more from this thread of critical back and forth, see:

And to read previous posts on the LaserComb, please see the list here.

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