Author: Dr. William Rassman

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Hair Loss InformationPsoriasis in Donor Area – Hair Loss Information – Balding Blog

I have psoriasis (as know, non-curable) in a part of my potential donor area. Does this rule me out as a candidate for a transplant from that location? Is it possible to use other parts of the donor area since I have good overall density?

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Psoriasis does not move, so it stays where ever it originally was (in the donor area in your example) and will not be transplanted to the recipient area. The psoriasis needs to be under good control if one is to use the skin from impacted areas for the donor site. One could be selective where the donor is taken from, but this will reflect supply and demand relationships for the donor supply and the size of the bald area.

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Hair Loss InformationDermatologists Specializing in Alopecia? – Hair Loss Information – Balding Blog

In one of your comments you noted that there are certain dermatologists that specialize in the treatment of alopecia areata. Could you please provide the names of any that you are aware of (particularly those on the east coast as I live in the DC Metro area). Thanks.

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You need to go to your family doctor and ask that question. Each doctor in each city has worked out the referral patterns for their patient’s best interests. I have a good doctor referral that has built a reputation — Dr. Richard Strick at UCLA in Los Angeles. You might check with the National Alopecia Areata Foundation for other sources.

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Hair Loss InformationMaturing Hairline Questions – Hair Loss Information – Balding Blog

Hey, thanks for taking my question. I’d like to know if I’ve got a maturing hairline or if I’m going bald. I’m 20 years old and I’ve recently noticed my hair is thinning away around my temples, and that on the right side of my head the hairline is beginning to rise a little bit higher than it is on the left. The rest of my hair is as thick as ever. Just a few questions:

1. Is this probably a maturing hairline? I’ve read other questions and I noticed you said it develops between 17-29. Seeing as I’m on the younger end, does it make a difference how long it takes? Meaning, if you develop one at 17 do you start continued balding faster than a person who develops it at 27?

2. Do hairlines mature symmetrically?

Thanks!

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Hairlines often do not mature symmetrically. If you do not have balding, then the maturing hairline will develop when it develops. No two people develop it at the same rate. My youngest son took 9 years to evolve, yet others will evolve it in a matter of a year to two. I do not know if Propecia will slow it down, but it is logical that this could be a side effect of Propecia.

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Hair Loss InformationMy Grandfather, Father, and I All Have the Same Mature Hairline – Hair Loss Information – Balding Blog

Hi Dr,
I have a mature hairline (since 15) , and my dad and his dad both have the same hairline. No one on my mom’s side has/had a mature hairline. Is this an indication that I will take after my father?(he still has lots of hair)

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Sounds like it. Is there balding in the family on either side? That could impact what will happen to you if there is.

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Hair Loss InformationAny Speculation on Worst Case Scenario of Dutasteride Side Effects? – Hair Loss Information – Balding Blog

Ok I know you can’t give me a complete answer for obvious reasons, but based on your currently knowledge and educated speculation, what do you think are the most likely possible side effects from using Dutasteride in the worst case scenario? Would it simply be a case of Finasteride x 10 (i.e. loss of libido)? I really wouldn’t mind just hearing your speculation, as i’m well aware that it hasn’t been fully tested yet.

Also would it be a simple case of getting a prescription from my local GP?

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Dutasteride is a selective inhibitor of the type I and II isoforms of 5-alpha-reductase, the intracellular enzyme that converts testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison, finasteride acts as an inhibitor of only type II 5-alpha-reductase, and as a result, it is more specific, target oriented, and has less side effects.

If you are taking dutasteride for other indications, keep on taking it and you may get some hair growth as side effect. Based on current evidences, I can not recommend dutasteride solely for the prevention of hair loss, because:

  1. It has not been well studied for this purpose and as a result is not FDA approved for hair loss treatment.
  2. The optimum dose of dutasteride for hair loss prevention is not determined.
  3. The side effects of dutasteride are much more compared to finasteride.
  4. And finally, if you are considering its cost effectiveness, this is not in the picture anymore with new price reduction of finasteride (thanks to generic 5mg).

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Hair Loss InformationCortical Steroids and Effects on Hair Loss Medication – Hair Loss Information – Balding Blog

I have been reading that many skin problems, such as seborrhoeic dermatitis, may be associated with hair loss in balding males. For instance, the scalp can become itchy/flaky in regions of the hair thinning/loss. The application of cortical steroids (Luxiq, etc.) are often given to ameliorate the symptoms of the dermatitis, however can they have a deleterious effect in furthering your hair loss?? Do you know if these cortical steroids act to aid or hinder the effect of typical hairloss medications, such as Propecia?

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SnakeYes, steroids can be a cause of hair loss in some people. Hair is a skin organ, but hair is only part of the skin elements. When the surface of the skin turns over faster than normal (we shed skin slowly and uniformly on a daily basis and replace from below, what is lost on the surface). Compare this to a snake, which sheds its skin all at once and replaces it before the shedding occurs. When skin is shed more rapidly, it builds up flakes of skin and some people call this dandruff. When it gets bad, it is called seborrhoeic dermatitis. It can be caused by external factors such as infections and fungal diseases as well. Steroids work well to control the autoimmune elements of the seborrhea, when it occurs, and antifungal agents or other treatments are needed (for example) when infections are present.

Many people think that seborrhea or dandruff is associated with hair loss, but this is not true unless the person picks on the skin and produces traction alopecia. When a scalp becomes balder, it becomes dry more easily. When there is hair present, flaking builds up in the forest of hair, so that when the skin turnover occurs more rapidly, the dandruff becomes a real social problem. For those interested in the chemistry of the relationship between cortical steroids and hair loss, please see:

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Hair Loss InformationUlerythema Ophryogenes and Hair Transplants – Hair Loss Information – Balding Blog

1.I have a condition called Ulerythema Ophryogenes, i was thinking of getting hair transplants but i was wondering would they just fall out.

2.Also how often do eyebrow hairs usually fall out and regrow

Thank you for your help

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According to eMedicine: “Ulerythema ophryogenes, a rare cutaneous disorder, is characterized by inflammatory keratotic facial papules that may result in scars, atrophy, and alopecia. This disorder has been described in association with other congenital anomalies such as Noonan syndrome, Cornelia de Lange syndrome, or Rubinstein-Taybi syndrome.”

Unfortunately, this is a rare condition that not many doctors (especially hair transplant doctors) have significant experience with. That being said, if you have this condition and also have genetic androgenic alopecia (or male pattern balding) your donor hair (in the back of scalp) should be considered permanent hair. There is no reason for me to believe that a hair transplant may not be successful. There may be a slight increased risk of scarring or discoloration on the recipient area.

With respect to the eyebrows that may be lost with this condition, a hair transplant may also work, but with the same caveat as outlined above. The growth rate (or the cycle rate) of eyebrow hair is different than that of scalp hair and it follows a one to two month cycle.

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Hairline Lowering Procedure – Hair Loss Information – Balding Blog

can you lower a woman’s hairline without transplants?

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Yes, the hairline can be lowered by a technique that differs from hair transplantation. In this technique, a strip of skin is removed from just below the frontal hairline and a trichophytic incision will be used to blend frontal hair into any scar that forms. The cosmetic result of a lowering hairline surgery is immediate and it is less labor and time consuming compared to hair transplantation. One disadvantage of this technique is the possible presence of a linear scar at front of the hairline. The scar could be hidden with a minimal delicate hair transplant surgery in front of it for a better cosmetic result if it is a problem. See other posts on this subject here.

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Difficulty Concentrating When Taking Propecia – Hair Loss Information – Balding Blog

I have been on Propecia for just over 2 weeks. This second week, I have experienced notable fatigue and a cloudy head with a lowered ability to concentrate. My lifestyle has stayed the same; if anything I’ve been getting more sleep than normal.

Have you heard of this type of side effect? Is it something that might go away as my body adjusts? Should I decrease my dosage from 1mg to .5mg?

Thanks for any advice you can provide.

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I have not heard your type of complaint before from any of my patients. I would wonder if you have been too focused in looking for changes on this drug. If you look hard, you can make these changes occur on a psychological etiology. If you were my patient, I would advise you to ‘stay the course’.