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What doses of the B vitamins are needed?

The role of the B vitamins is not entirely clear. For some vitamins, such as biotin and vitamin B12, it seems that unless one is truly deficient in the particular vitamin, supplementation is not going to help.

Whether that is true for all the B vitamins is not clear. It certainly may be that some B vitamins are beneficial for hair growth even if the patient has normal levels. In patients with excessive shedding (telogen effluvium) in which an underlying cause can not be found, I often recommend 50-100 mg of vitamin B5 (pantothenic acid) and the same dose of B6.

Administration of vitamin B5 and vitamin B6 appear to have some benefits in human and animal studies.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Lysine and Hair Loss

When Can Lysine be Helpful?

L-lysine is an amino acid, which are the building blocks of proteins. Lysine is one of the more difficult amino acids to get in foods but it is found in meat, fish and eggs.

L-lysine has an important role in iron and zinc absorption. In 2002 D.H. Rushton demonstrated the benefits of l-lysine to increase iron and zinc levels and to reduce hair shedding.

Ruston reported 14 women who were deficient in zinc and showed that 1000-1500 mg of Lysine daily led to an increase in zinc levels from 9.7 to 14.6 umol/L - even without these women consuming zinc pills.

Similarly with iron, Rushton showed that 100 mg per day of iron in 7 women with chronic telogen effluvium did not change ferritin levels at all. However, when combined with L-lysine (again at 1000-1500 mg per day), ferritin levels increased from 27.4 to 58.6 ug/L. This was associated with a decrease in the proportion of hairs in the telogen phase from 19.5 to 11.3.

L-lysine is an important amino acid and I often recommend it for my patients with chronic shedding abnormalities and those with deficiencies of iron and zinc that don't respond to routine supplementation. If I do recommend L-lysine, the dosing is typically 500 mg twice daily, and rarely three times daily for short periods.

Reference

DH Rushton. Nutritional factors in hair loss. Clin Exp Dermatol 2002

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Thinning in crown

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Thinning in crown


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Thyroid hair loss

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Thyroid hair loss


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Biotin and Hair Loss

Why Does the World Love Biotin So Much?

Biotin is a well-known and popular supplement for treating hair loss. Let's face it - the world loves biotin. However, true deficiencies in biotin are rare given the ability of bacteria in the gastrointestinal system to produce biotin. Nevertheless, many individuals and physicians turn to biotin in the search for treatment options. 

Soleymani and colleagues from New York University School of Medicine set out to critically examine the evidence for biotin use for treating hair loss. Their findings point out that there are no randomized trials to support the use of biotin in treating hair loss and that the public’s interest in biotin over the past decades is not supported by medical evidence. 

There is really no evidence to support routine biotin supplementation for individual’s with hair loss. Exceptions do exist, of course, and true biotin deficiency may be considered in individuals who are elderly, pregnant, using anticonvulsants or chronically using alcohol. 

Reference

Soleymani T et al. J Drugs Dermatol. 2017 May 1;16(5):496-500


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Hair pulling

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Hair pulling


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Vertex balding

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Vertex balding


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Hair loss

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Hair loss


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Options 24 M

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Options 24 M


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Lash growth

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Lash growth


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Tea tree oil shampoo for treating seborrheic dermatitis: What is the evidence?

A number of shampoos have emerged on the market containing tea tree oil. I sometimes recommend it to patients who are looking for more natural products to treat their seborrheic dermatitis.

Of course, I would not recommend a treatment unless it was backed up by some kind of reasonably conducted study. A study from 2002 by Satchell and colleagues examined the benefits of a 5% tea tree oil shampoo compared to a placebo shampoo is 126 males and females with seborrheic dermatitis.

Patients used either shampoo daily for 4 weeks. What were the results? Well, individuals using tea tree oil had a reduction in severity of the seborrheic dermatitis and less itching and greasiness.

Conclusion

There is evidence to support use of tea tree oil as a treatment for seborrheic dermatitis. More studies are needed and to evaluate how tea tree oil compares with standard seborrheic dermatitis treatments such as ketoconazole, zinc pyrithione and selenium sulphide.

Reference

Satchell et al Journal of American Academy of Dermatology 2002.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Recognizing Grief

Recogizing Grieiving in Patients with Advanced Hair Loss

Dr. Elisabeth Kubler-Ross was a pioneer in understanding how we grieve. Further studies and observations over the years has shown that the way we grieve is similar regardless of what it is we are actually grieving. 

As Dr. Kubler-Ross first described nearly 50 years ago, grieving commonly occurs through 5 stages that include 1) denial and isolation 2) anger 3) bargaining 4) depression and finally 5) acceptance.  Not all stages have the same length and don't necessarily occur one after the other like the chapters in a book. Of course, there is tremendousvariation in how people grieve but Kubler-Ross's model has served as a valuable model for decades.

 

Grieving in the World of Hair Medicine

There is not a lot written about grieving and hair loss. You'll never hear about the topic at any meeting. It has become increasingly clear to me over the years that some forms of hair loss lead to such profound changes in a person's appearance that they trigger the same grieving responses as one might have with any illness or cosmetic alteration in appearance. Patients with rapid alopecia areata, scarring alopecias, hair shedding disorders as well as androgenetic alopecia often grieve the loss of an appearance they once had. For many, hair loss brings profound changes in one's self-identify and overall self confidence. Many affected patients also progress through the grieving stages of denial, anger, bargaining, depression and acceptance. The difference with grieving hair loss and other types of grieving is that the potential exists for some types of hair loss to improve with treatment - and therefore the loss might not be permanent. This too affects how a patient might grieve loss of something that might only be temporarily lost (but might not be).

As a physician my goal is not only to help diagnose and treat a patient's hair loss but also to support them in their loss. We don't often talk about it in our profession but I am well aware that patients with hair loss do grieve. Some patients are angry,  some have come to accept their hair loss, some deny that it is much of an issue, some are depressed and just aren't themselves. In other words, all the stages of grieving are present if we care to ever take a look.  Often as physicians we are focuses on the diagnosis and prognosis and what treatment plan is best that we forget about the human sitting in front of us who wishes they had the hair of their youth.

 

Recognizing Patterns in the Clinic

I am interested in better understanding the emotional and psychological responses that people have when they lose hair. As part of the earliest stages of grieving (denial and anger) I frequently see several patterns of grief expressed bypatients. I believe we must learn to recognize these patterns so that we can better help our patients cope.

 

Examples

Let me share some examples of the subtleties of these patterns of grieving. These are helpful reminders to physicians of what signs we should be watching for in patients who need support.

 

1. Order Lab Tests

An example of one of these patterns starts out with a simple request by a current patient to have a few lab tests ordered. The request usually comes unexpectedly and the patient asks for a new blood test requisition "lab form" to be mailed out to them in hopes that something else shows up on the next set of results. The patient usually feels that a particular test they have heard about from a friend or read about online will provide valuable information to aid in their diagnosis or treatment. 

 

Comments from patients might include:

I would like all my hormones checked. Can you order for me?

I want all my labs checked again. Is that okay?

I have read that additional thyroid tests may be helpful?

You did not order test X, and my research suggests it is important, can you order for me?

 

Could this simply be a patient who has done their research rather than a patient who is expressing any degree of grief? Sure. But the pattern is common among those who are grieving loss of their hair.

2. Appointment Cancelling

Or consider the patient with an advanced form of hair loss who cancels their appointment only to rebook again several months later. This pattern too is seen from time to time. During the months between the cancelled appointment and the rebooked appointment the patient may visit other clinics, and even search online for various treatments and purchase various pills, shampoos and tonics. Of course, there can be some genuine desire on the patient's part to solve the hair loss issue themselves.  This is very normal and in some cases it can even be a healthy and appropriate response to solving one's health issues. Usually, though, it gets taken too far. Some patients who are grieving their hair fall prey to unscrupulous tactics and false promises and may spend considerable money. How do I know? Some share all these events mentioned above with me. Most of course, don't.

As Dr Kubler Ross's 5 stages of grieving remind us, there is often some degree of denial that enters into how patients think and view their experiences in the clinic ("I could not possibly have this condition my doctor is saying because nobody in my family has it" or "The condition the doctor is saying I have looks nothing like the photos I see online." There may also be some bargaining ("If I just use a better shampoo brand everything will all be okay" or "If I just start eating better and cut out the junk my hair will improve." The stages of grieving must always be considered.

 

3. Doubting the Diagnosis

Some patients are more open with me about sharing their doubts. Sometimes a patient will ask me if there is a possibility that the diagnosis was wrong. Sometimes they will inform me that I am wrong. This is quite normal and healthy and I encourage patients to do all the doubting they want and need.  Some patients, however, go to great efforts to cast doubt on their diagnosis. Their may be exchanges of emails, print outs of various sources of information from the internet. Various opinions from the patient's friends, colleagues and family only add to the doubt the patient feels and the time they spend in this cycle.  As a physician, I am always open to the possibility my diagnosis is wrong. 

 

Anger & Grief

Some patients who are grieving are angry.  They may be angry at the physician or the anger may be directed at only a single member of the physician's team.  We must always recognize this and understand that anger is not always directed in the right way. One's diagnostic skills must not be swayed by the degree of doubt or anger from the patient. I can tell you that it is quite normal for some individuals to be very angry as they grieve. That is something you don't hear much about at a hair meeting or conference but it's part of being a hair physician.

 

Conclusion

Patients who rebook their appointments, ask for more tests or doubt their physician's diagnosis may simply be just that. A busy parent, an inquisitive patient or a doubting skeptical person in general. Not everyone is grieving. But unless one has their mind clear and open to the possibility, it will usually be missed.

Today as I am writing this, I received a request from a patient to mail out another blood test form in a patient with a progressive scarring alopecia.  The patient's condition is refractory to many treatments. It is progressively difficult to hide the hair loss. Extensive blood tests have been ordered in the past and were normal (as they often are in these particular conditions). "Is this a patient who actually needs more blood tests? or could it be a grieving patient who simply needs our help? "

As a physician, I consider it important to be aware of my patient's response to the physical and emotional changes that come with hair loss and work hard to let go of my own emotional response in order to best help them. It is not always easy to help those patients who are angry at us (we are not hardwired as humans to want to help angry people) but that is indeed what we must do for those who are grieving. It is not easy to support those who do not believe our diagnosis but these patients often need out support as much as (and perhaps even more than) any other patient. I have learned to enjoy the challenges that come with patients who carry significant doubt as they often teach me a great deal about the diagnosis of hair loss.

We must support our patients as they grieve the loss of their hair and the changes they see in the mirror. It's easy to mistake grieving for simply an "angry patient."  or a patient who challenges their diagnosis as a "difficult" patient.  But recognizing the variety of patterns that come with grieving is important. More studies are needed to understand the emotional and psychological impact of hair loss in men and women.

 

 

Reference

Kubler Ross. On Grief and Grieving 2007.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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