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ACell/Matristem in Canada: still not allowed in 2016

ACell in Canada: Physicians still not allowed to use

ACell is a company that creates products for regenerative medicine.

Matristem is one of it's products. Matristem is basically a purified product from from pig bladder cells. The Matristem product seems to be helpful in wound healing.

Some countries use ACell with PRP. This is done with the thinking that there is a close relationship between wound healing and hair growth.

Matristem/ACell: Illegal in Canada & Physicians CAN NOT use

I've been in contact wth Health Canada for some time down to discuss the use of ACell. Despite it's FDA approval in the United States, ACell/Matristem is not available in Canada and no physician is able to offer it to Canadian patients. Unfortunately there are no exceptions to extend to my patients!  I'll continue my discussions with ACell and Health Canada in the months ahead.

Overall, I'm not too concerned about these restrictions as there has yet to be good comparative studies of Matristem/PRP vs PRP alone. So it remains anyone's guess whether ACell really adds benefit to PRP for hair loss. These studies need to be  researched, need to be shared in medical journals and need to be verified. 

ACell's Matristem is a unique product and I look forward to it someday being available in Canada (if it proves useful in treating hair loss).  Until that time, we continue to modify our PRP technique to further improve results for men and women with hair loss.

 

Check on the status:

Interested individuals can check on the status of Matristem anytime, by entering Matristem into the search criteria of the Health Canada guide:

http://webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp

 


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 with gastric bypass surgery

Hair loss with gastric surgery

Hair loss is common with various forms of gastric surgery. The surgery itself and the micronutrient deficiencies that occur all can lead to hair loss.

 

What blood tests are important to order with gastric surgery?

Iron, zinc are the most important, but I also check B12, selenium, copper, thyroid status (TSH), 

 


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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Focal atrichia: A worrisome sign of AGA

Focal atrichia: What is it?

Focal trichina is a term which  refers to a specific observation seen on the scalp of patients with androgenetic alopecia. Those with focal atrichia have small circular areas devoid of hair.

This is a feature of advanced male balding (androgenetic alopecia) and also female pattern androgenetic alopecia. The finding is very important to recognize. Focal atrichia occurring in patients under 30 is worrisome for me as it is associated with a higher risk for progression to more extensive 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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The Nevus Sebaceous.

Nevus sebaceous

This is an uncommon scalp growth that is noticed at birth. The affected newborn has a hairless patch and the area remains devoid of hair for life.

The area is typically slightly yellow, orange or pinkish color. The area can change in appearance over time, especially at puberty. At puberty, the nevus sebaceous becomes much more bumpy.
 

Additional Changes in the NS

A number of benign and malignant tumors may occur in the nevus sebaceous. The most common benign tumors are the trichiblastoma and syringocystadenoma papilliferum. In fact, about 10-30 % of nevus sebaceous develop these benign tumors.



Surgical excision: Should these be removed?

Years ago, most individuals with a nevus sebaceous of the scalp were booked for surgery to have it removed out of concern for malignant transformation. The approach is different nowadays. Now the rate of transformation is understood to be very low (less than 1 %) and routine monitoring (rather than excision) is more common.


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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Excessive Daily Shedding of Hair : Telogen effluvium

Telogen effluvium (TE).

Telogen effluvium refers to a hair loss condition associated with excessive daily shedding. 


The actual amount of increased shedding experienced by the patient can vary. For some, shedding is only slightly increased. For others, shedding can be massive.


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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Black dots in alopecia areata

"Black dots" represent hair follicles broken off at the level of the skin surface. Black dots are also referred to as cadaverized hairs.

Black dots correlate with disease activity in alopecia areata and are a negative prognostic factor.

Black dots are seen in other conditions besides alopecia areata, including dissecting cellulitis, trichotillomania, tinea capitis and chemotherapy induced alopecia.


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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Latisse and eye color changes

Can bimatoprost (Latisse) change eye color?

Bimatoprost (Latisse) is a popular product for growing longer lashes. Users of the product are likely very familiar with the fact that the drug was originally used for glaucoma to lower eye pressures. 

The actual drug stimulates pigmentation in the iris because of  the ability of bimatoprost to  increase in pigment granulates in melanocytes. This side effect is mostly observed when individuals put the bimatoprost drops right into the eyes (as is done for those using the medication for glaucoma).

Pigmentation of the iris is not typically observed with those used bimatoprost for the eyelids or eyebrows. However, pigmentation of the surrounding skin can be observed.

 


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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LPP: a type of scarring alopecia.

Lichen planopilaris (LPP)

LPP is a type of scarring hair loss condition.

The cause is unknown although several treatments are possible to try to stop the condition from progressively destroying hair follicles.


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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Lichen planopilaris of the beard area

LPP of the Beard

Lichen planopilaris (LPP) can affect any area of the body that has hair. When it affects the scalp, it's often red, itchy and scaly/flaky.

When LPP affects the legs, arms facial hair, eyebrows and eyelashes, it's often completely asymptomatic and the patient simply notices hair has disappeared.  Occasionally, a bit of redness is seen in the area too as seen in this photo of the beard area in a man with lichen planopilaris of the facial hair.


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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Broken hairs vs new growth?

Is my hair breaking off? Or is it new growth? How can I tell?
 

Short small hairs can be confusing. So many times when short hairs are seen a conclusion is made that these hairs are short on account of breaking off.


New growth is pointy

In many situations, a careful and magnified view of the hairs will reveal that they are actually newly regrown hairs rather than broken hairs. Newly regrown hairs can be readily identified by their "pointed" ends. Broken hairs on the other hand have blunt often jagged ends.


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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Alopeciology: The study of hair loss

In 2012, I created the term Alopeciology as a new word in the hair loss lexicon. "Alopecia" refers to "hair loss" and the root 'ology' refers to the "study of" or "science of". To me, Alopeciology was a great term to describe the study of all things hair. 

And so I gave a lecture in 2012 to doctors in training termed "Basic Skills for the Developing Alopeciologist."

Patients, doctors, and family members all study alopeciology in one form or another. In the grand view, the (yet unwritten) imagined textbook of "Alopeciology" has many chapters - including those that describe what it's like to have and live with alopecia. Those chapters are mainly read by patients and families - but need to be read more often by doctors and heath care providers. The textbook also has chapters on the diagnosis and treatment of hair loss and the science behind hair loss conditions. These chapters are read mainly by doctors and health care providers - but more needs to be done in the world to do a better job to convey this information to patients. 

We are all students of Alopeciology. 


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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Which hairs should be taken during a scalp biopsy?

What is a scalp biopsy? Which hairs should be taken ?


A scalp biopsy is a 15-20 minute procedure that helps the dermatologist obtain a small piece of tissue for analysis.  The sample is processed in a history laboratory into thin sections and mounted on glass slides for review by a pathologist under the microscope.  A scalp biopsy is not required for most patients with hair loss. When the diagnosis is uncertain, it can be very helpful.

FOR DETAILS ON THE SCALP BIOPSY, CLICK HERE
 

Which hairs should be included?
 

First, an area of the scalp containing hair follicles should always be included in a biopsy. A scalp biopsy specimen from a completely bald area is not helpful!

Second, the hair follicles obtained should be taken from an area showing the specific abnormalities thought to be in keeping with the hair loss condition in question. If no such features are present, hair follicles might be obtained from an area of the scalp where the hairs are easily extractable (positive pull test), or from an area having the most symptoms (itching, burning or pain).

The key point is that obtained a scalp biopsy from a random area on the scalp does not usually yield useful information.


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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Broken hairs in scarring alopecia

"Broken" hairs have blunted, straight or jagged ends. In contrast to newly growing hair, they are not pointed.

This particular photo shows a broken hair in a patient with lichen planopilaris.


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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What is considered "normal" hair shedding?

Normal daily shedding


Normal daily shedding is often quoted as "anything less than 100 hairs per day" but that has never been carefully studied and documented. The reality is that there is quite a range of "normal" and somewhere closer to 50-60 is probably closer to what most people experience (or at least can collect).

Of course, there is a wide variation on what is considered normal shedding.

It is incredibly challenging (and incredibly emotional) to have to count daily shedding each day. There are many methods (brushing, shampooing, collecting) to try to measure daily loss. They are helpful and I often use a variety of such methods, but they each have their limitations.

Even those with a clear "telogen effluvium" (increased shedding) sometimes return with 45 hairs collected in a particular day (rather than the magic number 100). Are they shedding excessively? Absolutely. Are they able to measure it properly and capture what is happening? No.

A key principle of shedding is if one is certain they used to lose 30 and now lose 65 hairs per day - this is likely abnormal and warrants further consideration.


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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Can alopecia areata occur at the location of a hair transplant?

Can alopecia areata develop at the site of a hair transplant?
 

Alopecia areata affects 2 % of the world. It is an autoimmune hair loss condition whereby the immune system targets the hair follicle causing it to fall out. Alopecia areata can develop anywhere on the scalp - and anywhere on the body where there is hair such as eyebrows, lashes, etc. 

In previous published reports, alopecia has been documented to occur at the site of a hair transplant. However, proving there is a direct link between the two is challenging. Alopecia areata usually develops in most people without trauma or injury.
 

Is a link plausible for some?

It is certainly not impossible that some sort of a more direct link could exist between alopecia and injury. I have many patients with autoimmune type reactions in the donor area following hair transplantation - including alopecia areata and lichen planopilaris. It's just really difficult to prove a direct association.

This photo show "black dots" and vellus hairs that are typical of the scalp in patients with alopecia areata. The photo also shows the scar from a previous hair transplant done using follicular unit strip surgery (FUSS).


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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How common are musculoskeletal problems among hair transplant surgeons?

MSK Issues in Surgeon. 

Musculoskeletal concerns among hair transplant surgeons have not been the focus of significant study. Injuries are talked about among colleagues but numbers have not been collected. 

To explore the frequency, exact nature and extent of possible injuries,  a questionnaire which was e-mailed to 100 surgeons practicing in the hair transplant field more than 5 years. 38 surgeons completed the study, and most who did were males between 50-69 years of age. 50 % reported musculoskeletal issues during or after the procedure, including both pain and fatigue. The reported frequency of pain and fatigue was higher for FUE than FUT (strip) procedures and lasted longer during FUE than strip procedures.

Two thirds of surgeons indicated that they had moderate/severe pain during FUE procedures, compared to one third of surgeons during strip excision procedures. Seventy-five (75%) percent of surgeons indicated they had moderate/severe pain immediately after FUE procedures compared to 29% of surgeons immediately after strip excision procedures.  Moreover, one-third of hair restoration surgeons had pain, fatigue or discomfort lasting more than 12 hours after a procedure.  

Only 30 % of surgeons used any type of ergonomic support such as an ergonomic chair. 

 

REFERENCE

Williams K et al. Ergonomics in hair restoration surgeons. J Cosmet Dermatol 2016; 15: 66-


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 biopsies for hair loss: Is it always needed?

Is a scalp biopsy always needed to determine the cause of an individual's hair loss?


The answer of course is no. A biopsy is only needed if the diagnosis is uncertain. 
In tough hair loss cases, I often like my patients to go a few days without shampooing the scalp. This allows the highest chance of some of the key features of the "suspected" condition to be present on the scalp (and not washed away by a recent shampooing).

Where does one biopsy?

I always biopsy an area which has the most features of the particular hair loss condition I suspect. For scarring alopecias, I often try to biopsy areas that cause the patient's scalp to be itchy, have burning or areas that cause pain.


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 breakage in alopecia areata

Broken hairs in AA

Hair breakage is very common in individuals with the autoimmune condition alopecia areata. 


Broken hairs can either be a few mm in length or broken hairs can break at the level of the scalp (in which case the hairs are termed black dots).


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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Telogen Effluvium

Understanding Telogen effluvium (TE)

TE is a from of hair loss whereby the affected individual experiences higher than normal levels of hair shedding day to day.  For example, instead of losing 40, 50 or 90 hairs in a given day (i.e. what is considered normal shedding) individuals experiencing telogen effluvium lose well in excess of 100 hairs on any given day.
 

Triggers of TE

Telogen effluvium occurs when some "trigger" causes hair follicles to leave the growing phase of the hair cycle and enter the resting phase. So, what exactly are the triggers that "send" a hair follicle out of the actively cycling (growing) phase and into the undesired shedding phase? I teach health professionals the easy to remember memory cue "SEND"

 

COMMON TRIGGERS OF TE:

Stress
Endocrine problems
Nutritional issues
Drugs


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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What causes a red, itchy and bleeding scalp?

Redness, Itching and Bleeding

There are quite a few causes of a red, itchy and bleeding scalp. Anyone with such a trio best see a dermatologist to guide them.

 

Common conditions


Conditions such as psoriasis and seborrheic dermatitis are common in the population and must be placed at the top of the list of possibilities. Other causes include folliculitis decalvans and other scarring alopecias, infections, bites, infestations, allergy and irritation. 


Pinpoint bleeding in this photo tells me right away that the patient I am examining may be quite itchy. As it turned out, they were! 

I often prescribe a topical steroid to help reduce itching.


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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