Dr. William Rassman – Page 1646

April 3, 2007

Psoriasis, Picking, and Maybe Even Traction Alopecia? – Hair Loss Information by Dr. William Rassman

First, I have to say what an amazingly informative site this is! I am a female in my mid-twenties. On and off for the past 10 years I have suffered psoriasis on my scalp. It gets scaly and itchy. Usually I am able to avoid picking it; however over the past 8 months I went through a very difficult period and was under tremendous stress. Unconsciously, I began to pick at my scalp and it has now turned into a persistent bad habit. I have noticed that as a result my hair is thinning. I have always had thinner hair at this point the hair loss is not blaringly obvious but it is getting to the point that I have to avoid certain hair styles all together and harder and harder to hide. I had assumed that this was a result simply from pulling at the scalp and playing with my hair. Now after reading more on your site I am concerned that I am suffering traction alopecia in addition to the psoriasis. I know that controlling the picking is the first step and I am assuming this is a psychological issure but I have not found anyone to help with this. I saw a Dr. who prescribed me Fluocinonide, which helps moderately with the irritation. Is there another course of action you recomend? A way to help the scalp heal and perhaps prevent traction alopecia?
Thanks!!!!

You are right. You must first treat your obsessive disorder and stop picking at your hair (trichotillomania). Without that, nothing is going to work, because even if you help your hair grow by other treatments, you will most likely continue to pull the hair out. If you could stop picking at your hair, your hair will grow in 4 to 6 months provided that you did not do so much picking that you have developed true traction alopecia.

Also see: I Am Pulling My Hair Out and Need Advice

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April 3, 2007

Young Teen Girl With Hair Loss Questions – Hair Loss Information by Dr. William Rassman

Hello. Lately I have been experiencing excess hair loss. I am only 13 years old (female), and nobody in my family has had any hair loss problems. Everyone has a full head of hair. I still have tons of hair, but more hair is coming out than it used to. I lose probably about 150 hairs a day. Is this normal? Should I do something?

QUESTIONS:

Can a dry scalp cause hair loss?
Am I losing the right amount of hair?
Is there anything I can do to stop it?
Can going through puberty cause hair loss?
I am stressed because of my hair loss, and hair loss is caused by stress. WHAT DO I DO?!

PLEASEPLEASEPLEASEPLEASEPLEASEPLEASEPLEASE help.
Thank you

To answer your questions in the order in which they were asked –

Dry scalp does not cause hair loss.
It is normal to lose the 100 hairs a day. Sometimes more. There are other hairs growing at the same time.
There is nothing you can do about it. (sorry)
Puberty may be a factor in your hair loss situation.
Stress can cause hair loss and stress of losing hair can be a vicious cycle (to a certain degree).

If you are a regular, healthy teenage girl, it may only be just a phase, but if this bothers you that much, you should see your primary care doctor. Get your parents involved. Let them know what’s going on and have an appointment setup with your physician. This might not be anything to be concerned about, but if you are worried, best to get it checked out with an in-person exam.

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April 2, 2007

Sterile Folliculitis – Hair Loss Information – Balding Blog

For the past six or seven years, I’ve been getting folliculitis on the back of my scalp only during the winter. My new dermatologist claims that I have ‘sterile folliculitis.” Apparently, when I get haircuts, the hairs regrow skew and my immune system attacks them as if they were foreign. I have two questions 1) why does this only happen in the winter and 2) why is there a time lag between the emergence of the hair from my skin and the onset of inflammation (my hair is already 1-2 inches long when pus starts to form around the follicle…I would expect the pus to form just as it was emerging, not a couple of inches later). Thanks for your help.

P.S. I’m a medical student and would love technical details about the inflammatory response against my hair because I find the whole thing sort of mystifying, assuming the diagnosis is correct.

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A good friend of mine has the same problem that you mentioned whenever he gets a haircut, and I have a similar problem around the winter months (when I am in colder weather).

As a medical student you should know that this is the “practice” of medicine… and not the “science” of medicine. There is no solid scientific explanation, but doctors are keen to ‘describe’ what they see and give it fancy names (sterile folliculitis sounds good, and I am supposed to be an expert in the field).

My personal theory is that in the winter months, your skin is more dry; dry skin promotes irritation to the skin. I suspect your neck/back of scalp is more sensitive to dry skin.

With respect to haircuts and folliculitis, I suspect that the short haircuts irritate your skin (the same way dry air/weather does).

You must remember it is not all about the diagnosis, but what you do with it and how you treat it. We can all try to be intellectual and talk about the immune system and the mediators such as IL2, IL4, TGF, B cells, T cells, etc, etc (immunology), but in the end it seems cold weather and short haircuts just don’t agree with you. Avoid short haircuts and try moisturizing cream.

April 2, 2007

Body Hair Transplant Results – Hair Loss Information – Balding Blog

Hello doctor, long time no talk. I recently found this on the internet regarding a hair transplant where the patient took hair from his leg and arm. The results look good.

Caution: Some pictures might be a bit bloody for some readers

http://hairsite.com/serendipity/authors/27-sofarsogood

Also, I notice that a lot of patients who have HT’s seem to grow their hair longer after the transplant and keep it that way. Is it because they want to cover up the other balding areas with the long hair? Can you get a HT and keep your hair short and still have that “full look?”

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I am having difficulty with the first picture on the referenced site. This is not a hair transplant, but someone with a thick, natural head of hair. From a legal point of view, the inference that this representation of a transplant is fraudulent and violates consumer laws in most states. It may have just been an example of what the patient wanted, but to have it presented in the same reference with before and after photos is poor form.

Many hair transplant patients elect to comb their hair back or to the sides and keep it long. Longer hair covers better, but with good densities transplanted, short hair is not unreasonable. I tell patients that when they get a hair transplant, they create the illusion of hair, not the reality of it. Long hair with good grooming goes a long way to do this. The illusion I am talking about is basic to the math in hair demand/supply hair economics (see Patient’s Guide — How Many Grafts Will I Need?). If a person loses 60,000 hairs and gets a transplant that makes him look good with 10,000 hairs, then this is clearly an illusion, not reality. I have found that in people with good hair characteristics, low contrast hair to skin color, wavy, and coarse hair can get great results with as little as 20% of their hair returned through transplants. That, of course, requires an artistic surgeon and the budget to afford the process.

With regard to your situation with 15 hair transplant procedures, you may be running out of hair. Body hair may be a solution, but there really is not good data on it so you would have to be a guinea pig for human experimentation. This is not standard care. I would give you a one on one consultation if you are in the California area.

April 2, 2007

Minoxidil and Propecia Have Worked for Me! – Hair Loss Information – Balding Blog

I wanted to say that alot of people seem to get discouraged with propecia and minoxidil but I am a 35 yr old male who stated Minoxidil 2 years ago and Proscar (quatered) 4 month’s ago and before I started I had very thin hair a small bald patch up top and receeding hairline. Since then my hair has gotten back thick the bald patch is no longer visible and even got some of the hairline back. These products work but just take time. Hang in there guys and Dr. thank you for being out there for us.

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Good for you!

Many doctors recommend BOTH finasteride (Propecia) and minoxidil (Rogaine) for the treatment of male pattern hair loss. Many believe that BOTH of these medications when used together will provide a synergistic benefit. I tend to believe in the “try-one-at-a-time” method so that if you do see results, you will have a good idea which of the two are giving you the benefits. Otherwise, you’ll be using both for life when you could possibly just use the one.

April 2, 2007

What is a Flowbee? – Hair Loss Information – Balding Blog

what is a flowbee? Does it help keep the hair healthy?

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Flowbee According to Wikipedia:

The Flowbee is a vacuum-powered device made for cutting hair invented by San Diego carpenter Rick Hunt in the late 1980s. The product was touted as being capable of performing “hundreds of precision layered haircuts” and was frequently displayed on late-night television infomercials.

It does nothing for hair health — it is simply a way of cutting your hair evenly at home. Their official site is at Flowbee.com.

April 2, 2007

Anemic Teen Girl Losing Hair – Hair Loss Information – Balding Blog

i am an 18 year old girl and for about 6 months my hair has been falling out-particularly in the shower. it used to be fairly thick and now has become so much thinner. The doctors have said i am anemic- with very low ferritin in my blood. i am on iron pills and have been for two months. how long should it take to restore these levels and thus stop my hair loss? i have no problems with thyroid and no genetic history of premature balding if balding at all. what else could you suggest and is it worth buying any hair loss products? please help!

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Iron deficiency in one of the medical conditions that could lead to hair loss or could accelerate hair loss due to other causes. Its treatment is not always easy and it may take a few months. You need to be checked with blood work periodically to assure that you are heading in the right direction with your treatment. When the iron deficiency is treated, your lost hair may re-grow within a few months.

April 2, 2007

Bacteria on My Scalp – Hair Loss Information – Balding Blog

Dear Dr. Rassman:

I have been suffering for approx. six months with a bacteria in my scalp. I have been to a dermatologist and he gave me antibiotics for two months. It gets better then it comes back. My scalp breaks out and I am losing my hair a lot and it is very thinned out. The scalp is very itchy. I have been also using Scalpisin. It only gives me temporary relief (one to two hours only. My hair has been thinning and I have to have my hair up all of the time. I feel a crawling sensation too. Since my scalp is so itchy, I sometimes have to scratch. I wash my hands to avoid a rash of breaking out on my face.
Please help me.

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I would need to examine you to put the pictures together. We all have bacteria on the scalp and that is normal. What is not normal is what you are telling me about. Recurrent infections could be caused by aggressive pathologic bacteria and this can be cultured and with a good culture, it can be better understood.

April 2, 2007

Prolactin and Hair Loss – Hair Loss Information – Balding Blog

I’ve recently read that prolactin can potentially cause hair loss. Do levels have to be exceptionally high for this to occur, or can even moderately high levels contribute to thinning hair?

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An abnormally high level of prolactin (hyperprolactinemia) is a condition characterized by elevated serum levels of the hormone prolactin in non-pregnant individuals. Hyperprolactinemia may cause progressive pattern hair loss due to an indirect effect on increasing free testosterone level.

April 2, 2007

Mixed Connective Tissue Disease and Hair Loss – Hair Loss Information – Balding Blog

My husband was diagnosed with mixed connective tissue disease. He is 55 and is currently on prednisone (20mg) and celcept. He is seeing a rheumatologist who is trying to get him off prednisone with very little success. All other medications he has tried are causing severe side effects. He has been in the hospital 3 times since being diagnosed 5 months ago. His hair is thinning and we told his doctor but he has not said much about what to do about it. His disease is still not managed. We would like to get a second opinion. Anyone in San Francisco area or bay area?????

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Unfortunately, I do not have any suggestion for you on treatment. Autoimmune diseases can have hair loss as a side effect and the use of steroids can also be a cause. Ask your doctor for a second opinion. For the readers that wish to learn more about this rare disease, please see MayoClinic.com.