Category: Hair Diseases

Dear Dr. Rassman
I was curious if one is diagnose with MPB on the hamilton scale. Is it possible for that person to later develop DUPA in the future randomly. Or once you have MPB that the route you will go according to the hamilton scale. Hope that makes sense. thank you (great blog site by the way)

That is a great question. To give you a specific response, I’d need to know if you had miniaturization study done (and the results of this). For a more general answer, although male pattern baldness (MPB) and diffuse unpatterned alopecia (DUPA) are both classified as androgenic alopecia, it is unlikely that you would go from MPB to DUPA — although I suppose anything is possible. DUPA is more common in women.

Dr Rassman,
I am a 24-year old male, I have always had extremely fine hair from the time I was a small child. In the past six months or so, however, I’m not sure if I just noticed it more, or if I am actually going bald. I could always see my scalp when wet, in certain lighting, etc., but now I’m not sure if this is just the way I am, or if it is worse now. I have very little balding in my family. My dad has a full head of hair at 51, as do my uncles on his side (whom are all older). My maternal grandfather is a Norwood 4 or 5, but did not really start losing his hair till around the age of 50 my mom said. One of three uncles on mom’s side is balding however. He is a Norwood 3 or 4 at the age of 40 (The other uncles on mom’s side, full heads of hair.) My hair still has the normal hairline, and no balding at the crown, but instead its thinning throughout the whole top. This is not the same pattern that these two men’s hair has taken (which worries me more). My questions are, what is the likelihood of going bald without it really being in your genes? I have also been a vegetarian for 6 years, and am wondering if this could be a factor? Also if I am going bald, would’nt it most likely take the same pattern (and start at around the same age) as the uncle and grandfather who are experiencing this as well? Very sorry for the long question, and thank you so much for the time and reply.

You really can not predict with any degree of certainly what the pattern of hair loss would be or even when it might start. If your hair loss is really diffuse, then you might have Diffuse Unpatterned Alopecia (DUPA) and should be evaluated with mapping out your scalp for miniaturization. This will point directly to the diagnosis if it is DUPA or genetic hair loss. DUPA will show miniaturization in the donor area, while genetic hair loss will show a normal donor area without miniaturization.

I have a spot on the left side of my head. It appeared in the summer as small as a pea and know is about 2 inches. The hair that falls out looks like an exclamation point it is thick and then really thin near the scalp it also is discolored. My hair is dark black so the ends near the scalp are light brown. The bald spot is very smooth no hair or subble. What might this be and what kind of doctor should I visit my doctor has no clue.

I think that this is a test of my knowledge. ‘Exclamation point hair’ is a telltale sign found in certain diseases like alopecia areata (see Exclamation point hair). If the spot is expanding, then that may be your diagnosis. You need to see a dermatologist for your condition. Different diseases can cause this type of patchy hair loss, but the most common in western countries is ringworm (a fungal infection problem).

Alopecia areata is an autoimmune disorder in which hair is destroyed by the body’s defense mechanism. For those that have it, there is a genetic component which can be identified in the DNA. Hair loss could be seen anywhere in the body and is more obvious on the head and face, because of the density of hair in those areas. Recovery is spontaneous, but may take several months to years and it may not reverse. Some medications may facilitate recovery from this condition, but the best treatments are in the hands of a few doctors who have a particular interest in this disease.

Hello, I started receding about a year ago and recently its getting worse, everytime i go in the shower and wash my hair there is about fifty or so hairs on my hands which didnt happen about three months ago, my scalp also itches but i dont want to wash it too hard because more and more hair will fall out, i need help bad, im avoiding washing it at the moment, there is also some white stuff on my scalp in some places which i can scrap off with my nail and doesnt smell too good. can you give me some advice please. thanks

You need to see a dermatologist soon. Several conditions could be causing your hair loss. Having extensive dandruff and scalp itching is a sign of inflammation of the scalp and seborrheic dermatitis. Seborrheic dermatitis is an inflammatory disease that can involve scalp skin and other areas. Although seborrheic dermatitis does not generally cause hair loss, if you are genetically predisposed to baldness, inflammation can accelerate your patterned hair loss. Some other inflammatory conditions, such as infectious disorders of the scalp, can do the same to the follicles. Find a good physician who can diagnose and treat the condition so that you can limit your hair loss or even regrow your hair. For an accurate diagnosis of genetic hair loss, if that is what you have, you need to get your scalp mapped out for miniaturization.

My son has had alopecia areta past 5 years, we tried all kinds of medications ( from ayurveda, homeopathy, allopathic mecinines) but all in vain.. he is now diagnosed for opheosis…(alopecia totalis). We all are going through stress and depression.. and even our social life is getting affected becaause of all this.. is there any solution.. in laser therapy….
Please help…

Alopecia totalis is one of more advanced types of alopecia, in which hair loss spreads to involve the entire head. The mechanism of this disorder is similar to other more limited types of alopecia, like alopecia areata. Autoimmune reaction against hair follicles is suggested to be the cause of this condition. Although recovery could be spontaneous in a few cases, it may take months to years to appear.

Medications, such as minoxidil, have very limited success and topical immunotherapy is considered the most effective current treatment, but the response is not universal among all patients. You should have your son see a dermatologist who has special experience in treatment of this condition. If you are in the Los Angeles area, I can refer you to someone local.