Author: Dr. William Rassman

Snippet from the article:

When patients present with hair loss, dermatologists should focus most heavily on patient histories, according to an expert who spoke at the 72nd Annual Meeting of the American Academy of Dermatology.

Many dermatologists perform a cursory exam and order a battery of blood tests, says Leonard Sperling, M.D., chairman and professor of dermatology, Uniformed Services University of the Health Sciences, Bethesda, Md. Dermatologists often dread these encounters, he adds, because they can burn daylight and often reveal problems that can’t be treated successfully.

Read the rest — Patient history is key when assessing hair loss

Few dermatologists use the modern tools for assessing hair loss (hand microscope to map for miniaturization and the HairCheck device for measuring hair bulk). Most dermatologists don’t like to do hair assessments if they can not tell if a patient is balding or not.

A good example was in a 17 year old that came in to see me last week. I had seen him a year ago at the age of 16 where I did the HairCheck bulk analysis. His family history is significant as his father is a Norwood class 7 patient and two of his three brothers are also balding. One year ago, his bulk analysis showed 55% loss of hair in the front and 30% loss on the top. The crown showed no hair loss. On the visit last week, bulk measurements showed that his hair loss in the front increased to 75% and on the top it increased to 60%. Most significant was his hair loss in the crown, which was 50% of his bulk.

His hair was black, his skin was white, and the hair was medium-coarse, so that to the naked eye he showed only frontal hair loss. I already know that he will probably be a class 7 pattern balding patient like his dad. Without these instruments, I would not have seen any hair loss last year if I had not measured it, but even a year ago, it was evident that he was balding. Last week, we knew what pattern of balding he will probably be developing. He was placed on Propecia 1 year ago, but it did not stop his hair loss. He took the news well and we spent some time discussing a future Master Plan on what he might want to do as his hair loss becomes more evident. Shaving his head once he gets into college might be an option (with or without SMP).

I am a 30 year old male with some hair loss problems. I have been suffering from seborrheic dermatitis for about 2 years. My scalp is naturally quite oily due to this problem. I recently went to a trichologist and he suggested that oiling scalp is a must, no matter how oily the scalp is. My questions are

1. Is it good for me to oil my hair despite greasy scalp? Would it not aggravate seborrheic dermatitis?
2. Trichologist recommends washing scalp daily with a shampoo containing saw palmetto extracts. Do you recommend daily washing?
3. Can I resort to options like Finasteride? Minoxidil again would probably aggravate seborrheic dermatitis?

Thank you ..

I think that the trichologist should be the one to speak with for questions #1 and #2. I don’t know why those recommendations were made. Finasteride and/or minoxidil will not help your seborrheic dermatitis.

If you have hair loss issues and want and medical treatment or assessment, you should see a physician. From a medical point of view, oily hair or scalp does not cause genetic balding and shampoos (even with saw palmetto) do not treat genetic balding.

Hi Doc,
When I was 18, I started losing massive amounts of hair follicles. The funny thing was that the hair loss was uniform throughout the entire scalp, even the permanent zone. I probably lost 50% of my fullness in one year. Then mysteriously the hair just stopped falling out. I’m 30 now and my hair hasn’t changed since then at all. What was happening?

What you’ve described is highly unusual, particularly with the hair loss being uniform and in the permanent zone. Without examining you, I can not tell what happened to you. Since it happened a dozen years ago, I would say that the loss doesn’t seem to be telogen effluvium or some other temporary loss (though I suppose that is obvious by now).

If you are not alright with your hair fullness, then I would be happy to see you and provide an opinion about what your options might be. But at this point without an exam, I would just be doing you a disservice by guessing as to what happened.