Hair Blogs


Nail Changes in Patients with Hair Loss

Nail Lichen Planus

We will finish this week with a closer look at the importance of examining the nails in patients with hair loss. 

I generally ask about nail changes in most new patients I see in my office. I often describe hair and nails as "cousins" and it should therefore come as no surprise that many conditions that affect the hair also affect the nails. Patients with alopecia areata, lichen planopilaris, telogen effluvium, drug related hair loss, psoriasis may have changes in their nails.

Some patients with scalp lichen planopilaris have nail lichen planus (LP). The clinical features of nail LP depend on where in the nail the disease is attacking (i.e. whether the matrix or nail plate are involved). Longitudinal ridging and splitting are the most commons clinical signs of nail matrix LP. This is shown in the photo. The splitting often extends right to the end as shown in the picture. However, a wide range of additional nail findings are also possible.

Some forms of nail lichen planus lead to rapid scarring and loss of the nail - (very similar to what is seen in the scalp). Other forms only lead to minor changes that may be difficult to differentiate from age related changes. Some patients have resolution of nail disease even without treatment.

There are a variety of treatments are possible including topical steroids (with occlusion), steroid injections (0.5 to 0.1 mg/nail), intramuscular steroids every 30 days (0.5 mg/kg) and oral steroids for 3 weeks. Antimalarials (i.e. oral hydroxychloroquine), oral retinoids, psoralen, tacrolimus are also used. About 1/2 of patients will not improve despite any type of treatment.


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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Minoxidil and the cat

Minoxidil is FDA approved for treating male and female androgenetic alopecia. It has been studied in humans for over 35 years. 
However, it is not well known among users of minoxidil that minoxidil may have a unique toxicity to cats. That is not to say that cat owners can not use minoxidil - but important lessons come from a 2004 study in the veterinary literature.

DeClementini and colleagues reported 2 cats who died after their owners applied minoxidil to areas of hair loss on the cat. The first cat was a 3 year old cat had just one drop applied to an area of hair loss . That cat had trouble breathing, high heart rate, water in the lungs (pulmonary edema and pleural effusion) and showed increased liver enzymes. The cat died 15 hours later.

The second cat was a 7 year old cat and the owners applied an unknown amount of 5 % minoxidil solution to an area of hair loss and left the home for three days. Upon returning to the home, the owners found the cat also having difficulty breathing. Veterinarians confirmed pulmonary edema and pleural effusions. That cat died 10 hours later despite supportive care.

These are important lessons. Minoxidil must not be applied to cats and cats should not have the opportunity to play with the hair of owners who have applied minoxidil for their own hair loss. Most of what is needed though is just common sense. It is possibly to have a cat and have minoxidil users in the home.

Minoxidil may be uniquely toxic to cats and less toxic to other pets like dogs. A 1997 study involved the application of 3 % minoxidil to hairless puppies (descendants of Mexican hairless dogs) for 31 days. Side effects were not observed. However, minoxidil should never be applied to any animal. 

Reference
Suspected toxicosis after topical administration of minoxidil in 2 cats. Journal of Veterinary Emergency and Critical Care 2004; 14:287-292


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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Trichodynia

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Trichodynia


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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Scalp Injury

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Scalp Injury


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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Is It possible for seb derm to cause hair loss

Seborrheic dermatitis and the closely related condition "dandruff" are two scaly scalp conditions that are common in the general population. I'm often asked if these conditions can cause hair loss. It is a fact (not a speculation) that seborrheic dermatitis can cause an individual to experience increased hair shedding (telogen effluvium). This has been shown many times in various studies. 

Dr Pierard- Franchimont and colleagues have done very interesting research in the area of seborrheic dermatitis and dandruff. They showed about 10 years ago that the more seborrheic dermaitits a person has, the more shedding (telogen effluvium) a person will experience. This is important information to know because it tells us that individuals with severe seborrheic dermatitis are likely to have a severe telogen effluvium. Dr Pierard Franchimont and others have also shown data that the inflammatory reaction can even accelerate male balding in some cases making it important to aggressively treat seborrheic dermatitis in patients with hair loss. 

There is no doubt about the relationship between seborrheic dermatitis and shedding. Companies that manufacture dandruff shampoos study shedding patterns to determine if their shampoo is working. Anti-dandruff shampoos can reduce shedding. 

In summary, seborrheic dermatitis can certainly cause a telogen effluvium. This photo shows the scalp of a patient with moderate seborrheic dermatitis. Numerous upright regrowing hairs (URH) are seen, which is a typical sign of a hair cycling abnormality (telogen effluvium).

Reference
Dandruff-associated smouldering alopecia: a chronobiological assessment over 5 years.
Piérard-Franchimont C, et al. Clin Exp Dermatol. 2006.


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 calibre

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Hair calibre


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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TE

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TE


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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Sunburns and TE

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Sunburns and TE


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 in women

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Hair loss in women


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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