Category: Uncategorized

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Dissecting Cellulitis of the Scalp

I am a family medicine resident finishing up my last year. I unfortunately have a condition which I discovered doing my own research called Dissecting Cellulitis of the Scalp. It is horrible!!! This is a rare condition that usually affects black men in their 20’s. It is a very painful, cosmetically disfiguring disease that I have dealt with for about 4 years now. I have tried all of the antibiotics and medical treatment that you can think of and have seen many dermatologists that in my opinion, are not really aware of how tough this is to treat. I have read some studies that state that Laser therapy has been used with some success and others that state that complete scalp excision is successful. Of course, I don’t want my whole scalp taken off, but I am willing to try Laser therapy if it really has good results. At this point, I am really ready to try anything. If you are familiar with this or can even refer me to someone who is, I would really appreciate it.

This is a rare condition and as you said it is very difficult to treat. Before going as far as having surgical excision of your scalp, I found a case study in which they had success in treating recalcitrant dissecting cellulitis with Nd:YAG laser. The study was published in Dermatologic Surgery in August 2004, Volume 30 Issue 8, and was written by Eric C. Parlette MD, Nathan Kroeger, EVictor Ross MD — Laser Treatment of Recalcitrant Folliculitis Decalvans.

Unfortunately, I can’t post the text here and the publisher charges a fee to view the text, but it may be worth looking into. Good luck.

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Propecia is Making My Face Age

Hello,

What do you know about the connection between finasteride (or DHT inhibition in general) and reduced collagen production, or premature aging and wrinkle formation? I have browsed some studies that seem to suggest inhibiting DHT also inhibits collagen production, leading me to believe Propecia could be responsible for my hollow, prematurely aging 23 year old face. (I’ve been taking finasteride for almost 5 years).

I realize this is a site to discuss and post hair loss related topics and its treatments, but Propecia is not the root of all your problems. You are 23 years old and you think Propecia is causing you to have premature aging?

To be clear, I am not suggesting Propecia is or is not the cause of what you are experiencing. However, I think there are many other factors that would definitely cause MORE symptoms of an aging look other than Propecia. Such factors include excessive sun exposure, drinking, smoking, marijuana use, drug use, partying too much, not enough sleep… in other words, many of the things a young man in their 20’s would be partaking in. I don’t know enough about your routine or habits to speculate further.

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Do Drs Rassman and Bernstein Disagree on Shock Loss?

I’ve studied a number of HT docs for hair loss info and I’d say you and Dr. Bernstein are at the top of my list as far as knowledge and being trustworthy. You say that shock loss or additional hair loss from a transplant is uncommon these day though Dr. Bernstein says that you will probably have some loss from the transplant itself. I think he said it would be unrealistic not to expect some loss. Obviously a confusing contradiction for me. Could you address this?

I also find your history with Dr. Bernstein interesting. How do you 2 originally connect? You were partners at one time?

Dr. Robert Bernstein and I do not disagree on much. Hair loss secondary to a transplant is what is commonly called shock loss (it is a matter of degree of loss) and I think that is where your problem is. Traditional shock loss has been satisfactorily treated with finasteride in young men, but hair transplants do damage some existing native hair. Hair that is miniaturized is what is lost first, so what you see may not be a radical change even if you lose some miniaturized hairs that did not contribute to the hair bulk you have.

As for the second part of your email — Dr. Bernstein worked at New Hair Institute with me for 10 years before he opened his own practice in New York. We are good friends and colleagues. We published many groundbreaking medical articles over the years.

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Propecia Stopped My Hair Loss and I Have Less Body Hair!

Hi.. I’ve seen a lot of people talking about propecia contributing to loss of body hair, yet it’s not really listed as a side effect. I’ve been taking fin for about 5 months now, and the hair on my legs is now patchy and thin, and very short. The hair on my back also seems much thinner, and I think there is less of it in general. I don’t care about either (I guess it’s kind of nice? that may sound weird). I have noticed my hair loss stopped pretty much at the 2 month mark.

Now my question is: Do you think this could be any indication of future regrowth or thickening?

Also is hair thickening considered regrowth (I’ve always wondered this)?

I love your blog by the way!

I have heard from a small number of patients who describe what you are going though with the less body hair growth, but after a few years of Propecia use. At least your scalp hair loss has subsided… and who could be upset about less back hair, right? Regardless, it doesn’t indicate any future regrowth or thickening, but may be one of those rare side effects.

Finally, hair thickening is not considered regrowth. Hair thickening is… hair thickening.


2010-08-03 10:04:10Propecia Stopped My Hair Loss and I Have Less Body Hair!

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Do I Have DUPA or Alopecia Areata?

29 years old, male. Around 1 1/2 year ago I started thinning all over, except for 3/4 of the neck area (the last inch), but even there i am sure it is somewhat thinner. I probably lost 50% of volume. I shed 50+ hairs just in the shower. We can call it DUPA. Blood analysis are ok: ferritin, diabetes, thyroid, hepathogram.

Now, the thing is that some months ago I had Exclamation-mark hairs. I would see that most of the shorter and thinner hairs in the shower were even thinner at the root (say 30 or 40% thinner). The Average hair was 3 or 4 cm long (1 inch and a half) and this tapered hairs 1 to 3 cm (0.5 to 1 inch). I thought it was just miniaturizating really fast. But now i know they can be a sign of alopecia areata. I don’t have them anymore. Now the roots are thicker than the distal end as it should be in a normal hair. They disappeared after a diet (no dairy, sugar, flour) or by coincidence. I thought I was improving because of that and because the dandruff decreased. But i still shed many hairs and I am still getting worse (maybe at a smaller rate, only maybe).

Is it just DUPA? Can I have DUPA with Tapering hairs? Could be areata? If not, what else should I check for? Considering that i dont have Tapering hairs anymore (maybe some long ones, but it is really not the same), would a scalp biopsy help to know?

Diffuse unpatterned alopecia (DUPA) and alopecia areata are both very rare in men, but I can not tell you what is going on without seeing you. An examination is necessary, so you should see a good dermatologist in your area who should be able to tell the difference.

I wish I could provide more info, but this isn’t something that can or should be diagnosed just based on your description.

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Propecia Worked Great for 10 Months, Then It Got Worse Than Before

Hi doc. I am a 22 year old male and I have been on propecia now for about 13 months. It has been working very well for me, and I was even getting some regrowth at my temples and along my hair line. however, around the tenth month my hair started to get worse, and I started to loose more hair and my hair looks as though it is miniaturizing especially along the hairline and my temples. This has been occurring for the past 3 months and my hair does not seem to be improving at all. Is it possible that propecia is causing my hair follicles to become more sensitive to DHT or that my body has up regulated androgen receptors in the hair follicles to make up for the low amount of circulating DHT? I just wanted to know what I should do? Thanks.

It would be highly unlikely that Propecia would be causing your hair loss. The most likely explanation is that your genes are causing your balding process to continue, and Propecia can only do so much to arrest the process. It is possible that the hair loss process has itself, accelerated.

Since you are using Propecia, you must have a prescribing doctor. You should ask him/her to do a miniaturization study of your scalp to get some metrics knowing at least from this point forward, where your miniaturized hairs are and to what degree they are miniaturized.

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Do I Need to Worry or Is It Just My OCD?

Hi Doctor,

I’ve sent a few blog questions through, so I do apologise for the influx of emails you’ve probably received from me.

I’m 21. I suffer from OCD, and I’ve recently been extremely worried about my hair. I’ve posted numerous pictures on various different forums to try and get an analysis of my hair, and I’ve been told my hair is fine. However, I’m still worried, but am unable to afford an appointment to go to a trichologist. So, I was wondering if you could take a look at my album of photo’s. There’s a fair few in here to get a decent look at my hair.

At first I was worried about my crown area/top of my hair, but was told that I’ve got a natural parting coming from my crown. Then I was, and am worried about my hairline, but was told I have a ‘mature’ hairline. Still, I was wondering if you could take a look for me and tell me how you think my hair and hairline is? What Norwood do you think I am. I also have seborrhoeic dermatitis so my scalp is quite inflamed/red.

Basically, do I need to worry, or is it just my OCD?

Oh, and feel free to post the picture album of my hair if this question get’s published. I don’t mind. Thanks.

Click the photos to enlarge:

 

Nothing I can say online is a substitute for a medical exam or seeing your doctor in person. As you state you suffer from obsessive compulsive disorder (OCD), I think you need to have that under control. Since you’ve posted these pictures on numerous forums and have gotten a reply that your hair is “fine”, I do not know how much more I can add. Your hair looks very good to me, but there’s only so much I can tell based on photos. Base don the pictures, the hairline looks strong and thick, as does the crown.

If you are still worried and your OCD is under control, make an appointment with a doctor you trust, especially one who can perform a HairCheck bulk analysis which gives a metric for the presence of hair loss. I’m not going to be able to assuage your OCD and hair loss paranoia, but I do thank you for letting us use your photos.

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Prostate Cancer Treatment Associated with Higher Risk of Heart Failure

Men with early-stage prostate cancer who receive androgen deprivation therapy are at significantly higher risk for heart failure, according to a study published in the British Journal of Cancer. After following a cohort of 7,637 men diagnosed with localized prostate cancer between 1998 and 2008, researchers found androgen deprivation therapy was associated with an 81 percent increased risk of heart failure in men without pre-existing cardiovascular disease (CVD).

SOURCE: https://www.cardiovascularbusiness.com/topics/heart-failure/prostate-cancer-treatment-associated-higher-risk-heart-failure?utm_source=CVNW&utm_medium=6c47c50623&utm_content=article&utm_campaign=newsletter_referral

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Do Vellus Hairs Turn Into Normal Hairs from Finasteride?

Is is safe to assume that vellus hairs turn into normal hairs on finasteride?

Vellus hairs stay as vellus hairs. In every follicular unit, there are one or two vellus hairs (short like stunted hairs). Miniaturized hairs, on the other hand, are terminal hairs (normal hairs) that lost their bulk and these are the hairs that get positively impacted from finasteride by increasing their shaft thickness when they are miniaturized.


2012-06-12 14:30:38Do Vellus Hairs Turn Into Normal Hairs from Finasteride?

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Psoriasis and Hair Loss

Hi,

I have male pattern baldness. it started at age 18 from my temples and has been receding terribly over the years, and more esp over the last 5 years. I am now 43. I used to have severe psoraisis on the face and scalp and was told the hair loss was because of that. Now the psoraisis has gone down considerably, alomost completely but the receding continues. i also have thick scabs on my scalp on and off that do not look like psoraisis scabs, i think it could be symptomatic of systemic yeast/eczema?

I used to have a very thick full head of hair, more than the average person so the hair loss over the years was more apparent to me than to others. Now, it is apparent to everyone. i just have a strand or two to cover my unnaturally high forehead, the hair on top is very thin, weak and sparse, there is more at the back but that too has recently thinned a lot.

In the last 3-4 months, my hair has been falling out in clumps, and is extremely coarse, dry and brittle. Please dont tell me it is age because this has been happening throughtout my adult life , but has has gotten much worse recently and esp since my first ever perm a year ago. But the frontal hair has been receding steadily since age 18. It has been very distressing and depressing for me, and nowadays, i dont even like to look in the mirror and see my unkempt hair. No matter what i do – hair oils, etc, it is as dry n weak as ever and receding all the time. help would be very welcome and appreciated.

This is an area where I have first hand knowledge, with the worst form of scalp psoriasis one can have. Mine, like yours, burned out in the scalp and I have almost none of if at this time. But I never lost hair because I was careful about not pulling off the plaques which would have almost certainly produced traction alopecia. Psoriasis does not cause hair loss unless the plaques are pulled off and the hair comes out with the plaques regularly.

With regard to hair transplants, I am frequently asked by people with psoriasis, if the psoriasis can be moved from one part of the scalp to another. In my experience, psoriasis can not be transplanted from the affected area to an unaffeced area, but any surgery done on active psoriasis, can make it worse, unless it is treated topically prior to the surgery.

You may have a skin condition and this must be defined by a good dermatologist. The rest of your needs are easily dealt with through traditional hair transplantation, which is extensively discussed in my book, The Patient’s Guide to Hair Restoration.


2005-11-10 13:35:41Psoriasis and Hair Loss