Hair Blogs


Dry Shampoos

Dry Shampoos: What are the benefits?

I often recommend dry shampoos. They are helpful for those situations where my patients want more volume and want to remove oils but don’t want to shampoo with water. There’s no specific number as to how often they can be used but once or twice weekly is fairly normal for many of my patients. Dry shampoos have many benefits. I recommend them to some patients who are looking for ways to hide greys or even add colour to their hair. Some patients can get a similar hold to the hair without needing to use hairsprays. They are great for use after a workout. It takes a bit of time to get use to dry shampoos but many of my patients use twice weekly between shampoo days. 

 

Recent Article in Elle Canada

I was recently interviewed by Victoria DiPlacido from Elle Canada on dry shampoos. For a link to the article, click here:

Could dry shampoo be ruining your hair?

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Platelet rich plasma (PRP) for the treatment of genetic hair loss

PRP for the treatment of genetic hair loss

prp1.jpg

Platelet rich plasma or "PRP" is a non surgical method of treating hair loss for men and women.   PRP relies on the growth factors in a patient's own blood to help stimulate hair growth.  A number of studies have been published supporting its effectiveness in treating genetic hair loss. Both my Vancouver and Toronto practices offer PRP. 

How is PRP performed?

As part of our protocol, 120 mL of blood is taken from the patient and spun down (centrifuged) for 15-20 minutes. During that time the patient's scalp is numbed with local anesthetics so that the PRP injections will be more comfortable.

From start to finish, a PRP session takes 45-60 minutes. PRP does not help everyone, but helps 30-40 % of men and women with genetic hair loss. I also use for patients with alopecia areata, and less commonly for patients with telogen effluvium and scarring alopecia.  

 We just finished publishing a report on PRP in the journal called JAAD Case Reports and more are underway as we learn more and more about PRP in treating hair loss.

 

CLINICAL STUDIES RE: THE EFFECTIVENESS OF PRP

Cervelli et al. The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation. Biomed Res Int. 2014;2014:760709. 

Gkini MA et al. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period. J Cutan Aesthet Surg. 2014;7:213-9. 

Kang JS et al . The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2014;28:72-9. 

Khatu et al, Platelet-rich plasma in androgenic alopecia: myth or an effective tool.  Cutan Aesthet Surg. 2014;7:107-10.

Park et al. Letter: Platelet-rich plasma for treating male pattern baldness.  Dermatol Surg. 2012;38:2042-4.

Schiavone G et al. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014;40:1010-9.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Steroid injections - an essential part of the hair loss toolbox

Steroid injections are a key part of the hair loss physician's toolbox. Without steroid injections, I am severely limited in treating certain types of hair loss - especially those associated with inflammation.

The conditions shown here are associated with some degree of inflammation and steroid injections can help.

Side Effects

Few hair loss treatments cause the amount of fear that steroid injections cause. When used appropriately, steroid injections can be very helpful and safe. Anyone thinking about steroid injections must speak to their physician about all the risks and benefits. Steroid injections can cause slight discomfort when injected and can cause a temporary dimpling of the skin. Very little gets absorbed into tue body, but nevertheless can be important in those with diabetes, high blood pressure and a few other medical issues. All in all steroid injections can be extremely helpful in the treatment of many hair loss conditions. There are several different compounds used for such injections including triamcinolone acetonide shown here. A physician will choose a variety of concentrations ranging from 2.5 to 10 mg per mL.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Minoxidil helps the top AND front in men

Does minoxidil only help the back?

Minoxidil is FDA approved for treating genetic hair loss in men? Early studies showed that it helps the top of the scalp in men which created confusion regarding its role in the front of the scalp. 

Minoxidil can help the frontal hairline. It may not restore it to the 'original' density. But it certainly can help. Two studies in the past year really helped clear up the myth that minoxidil doesn't help the frontal hairline. 

 

STUDY 1: Drs Hillman and colleagues

Hillman K et al published a study in 2015 evaluated the efficacy of twice daily 5% minoxidil foam in the frontotemporal region of male patients with genetic hair loss after 24 weeks of treatment compared to placebo treatment and to the vertex region.  Study results indicated that hair counts and hair caliber increased significantly compared to baseline in both the frontotemporal and vertex scalp.   Furthermore, patients actually using 5% minoxidil foam rated a significant improvement in scalp coverage for both the front  and top areas.

  
 
STUDY 2 - Drs Mirmirani and colleagues

In another study, Mirmirani et al  performed a double-blinded, placebo controlled research study of minoxidil topical foam 5% (MTF) vs placebo in sixteen healthy men ages 18-49 years with genetic hair loss. Study participants applied treatment (active drug or placebo) to the scalp twice daily for eight weeks. Again, similar to the previous study, results showed that minoxidil improved frontal and vertex scalp hair growth of AGA patients.

Conclusion

There is little doubt now that minoxidil can help some men with frontal hair loss. It does not help everyone, and doesn't return the hair back to the original density. But it certainly can help. 


STUDIES REFERENCED

Hillman K et al. A Single-Centre, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men. Skin Pharmacol Physiol. 2015;28:236-244.  


Mirmirani et al. Similar Response Patterns to 5%Topical Minoxidil Foam in Frontal and Vertex Scalp of Men with Androgenetic Alopecia: A Microarray Analysis. Br J Dermatol. 2014 Sep 10. 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Frontal Hairline Changes in Women with Afro-texture hair.

Traction alopecia in young women

I posted a new video about the traction alopecia as a cause of hair loss in young women with afro textured hair.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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PRP for treating alopecia areata

Our new manuscript to be published in September

In addition to genetic hair loss, platelet rich plasma also an option for treating alopecia areata.

A 2013 study in the British Journal of Dermatology showed the PRP may be as effective as low dose triamcinolone acetonide in treating patchy alopecia areata

I have an interest in understanding the role of PRP in a number of hair loss conditions. In the September 2015 issue of the Journal of the American Academy of Dermatology Case Reports, I described a patient with alopecia areata who did not regrow with traditional treatments (steroid injections). The use of platelet tich plasma (PRP) ultimately prompted regrowth of hair. 

 

REFERENCE
JAAD Case Reports 2015; 1:305-7


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Minoxidil for the Eyebrows.

Minoxidil use in the eyebrows

Minoxidil is not formally approved for the eyebrows but many physicians have different ways of using it. There's no specific way that minoxidil must be used in the eyebrows.  For anyone considering using minoxidil for the eyebrows, I recommend to speak to a physician first to review all the risks and benefits. A 2014 study (referenced below) did show that 2 % minoxidil was helpful in stimulating eyebrow growth for some individuals.

 

Methods of Minoxidil use for the brows

1. 5 % minoxidil twice a day

2. 5 % minoxidil once a day

3. 2 % minoxidiil twice a day

4. 2 % minoxidil once a day

5. Minoxidil 5 times per week

6. Minoxidil alternating with bimatoprost (Latisse)

There are many causes of eyebrow loss. Without seeing a given person's eyebrows and knowing more about his or her medical history and history of eyebrow loss exactly, it's hard to know if minoxidil could work and which of these protocols might work best.  Minoxidil side effects include headaches, dizziness, heart palpitations, shedding in the first 8 weeks. The medication must never be used by women who are pregnant or breastfeeding. 

 

Reference of Interest

Lee S et al. Minoxidil 2% lotion for eyebrow enhancement: a randomized, double-blind, placebo-controlled, spilt-face comparative study. J Dermatol. 2014 Feb;41(2):149-52. 

 

 

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Twins and Hair loss

Two types of twins

There are two types of twins: identical twins and fraternal twins. There are two types of twins. In identical twins, the DNA is the same. In fraternal twins, the DNA is different just like any other siblings. 

Identical twins' hair may look different with age

The hair of identical twins look similar at young ages and may look different when older. Genetic hair loss has a lot do to genetics, but not everything. Smoking, ultraviolet radiation, medical conditions (ie. thyroid disease), obesity, and stress all affect the process of genetic hair loss.  

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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PRP for Genetic Hair Loss: What is the evidence?

TREATMENT OPTIONS FOR GENETIC HAIR LOSS

Minoxidil and Finasteride are two FDA approved treatments for genetic hair loss. Other treatments like low level laser therapy (LLLT) and platelet rich plasma (PRP) are also possibilities. 

What is PRP?

Platelet rich plasma is a treatment whereby a patient's own blood is used for treating his or her hair loss. We no longer live in a world where we wonder if PRP works. We have now entered an era where we have evidence it does something and now need to figure out how well it works and who it works in.  

To date there have been approximately seven studies on the role of platelet rich plasma in treating genetic hair loss. These studies include:


1) Schiavone et al 2014 

  • Number of patients in study: 64 patients
  • Design: PRP every 3 months
  • Results: At 6 months, 40.6% to 54.7 % had clinically significant change


2) Cervelli et al 2014 

  • Number of patients in study: 10 patients
  • 18 mL blood
  • Design: Randomized half head study
  • Results: Significant increase in terminal hairs at 3 months


3) Gkini MA et al 

  • Number of patients in study: 20 patients
  • Design: 16 mL blood; 3 treatments q 21 days and at 6 months
  • Results: Hair increased; 7 out of 10 satisfaction rating

4) Park et al 
 

  • Number of patients in study: 1 patient
  • Design: Weekly treatment x 4 week
  • Results: Hair grew faster


5) Kang JS et al 

  • Number of patients in study: 13 patient
  • Design: One treatment
  • Results: Improved number of hairs and thickness


6) Khatu et al, 2014 

  • Number of patients in study: 11 every
  • Design: 2 weeks x 4 treatments
  • Results: Improved thickness & hair counts by 22.09 FU per cm2


7) Betsi et al 2012 
 

  • Number of patients in study: 42
  • Design: 16 mL blood
  • Results at 3 months; High patients satisfaction 7 of 10; Improvement in hair volume 


REFERENCE LIST


Cervelli et al. The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation. Biomed Res Int. 2014;2014:760709. 

Gkini MA et al. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period. J Cutan Aesthet Surg. 2014;7:213-9. 

Kang JS et al . The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2014;28:72-9. 

Khatu et al, Platelet-rich plasma in androgenic alopecia: myth or an effective tool. Cutan Aesthet Surg. 2014;7:107-10. 

Park et al. Letter: Platelet-rich plasma for treating male pattern baldness. Dermatol Surg. 2012;38:2042-4. 


Schiavone G et al. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014;40:1010-9.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Scarring Alopecia - October Lecture

Do you have scarring alopecia? Join us Oct 5th in Toronto

If you or someone you care about has scarring alopecia, you might consider joining the Canadian Association of Scarring Alopecia for its Fall Meeting. I'm honoured to be invited to speak to the Group Oct 5th at 6 pm on the topic: What's New in Scarring Alopecia?

There's been an incredible surge of new information. I'll be sharing research from our own studies as well as studies from around the world on frontal fibrosing alopecia, lichen planopilaris, central centrifugal cicatricial alopecia, pseudopelade, discoid lupus, folliculitis decalvans, dissecting cellulitis, acne keloidalis

Contact the Canadian Association of Scarring Alopecia for more information. 

See you then,

Jeff


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Hair Follicle Stem Cells: What are they?

A stem cell is a cell that has the ability to become many different types of cells depending on the conditions. In essence, it can wear many hats, take on many roles depending on the conditions. Once a stem cell changes into a new cell type there is no going back - it needs to keep its new job.

Once of the most revolutionary studies that changed the face of the field of hair medicine was Dr George Cotsarelis's study in 1990 that the hair follicle bulge area contains stem cells. Dr Cotsarelis is Professor at the University of Pennsylvania in the United States


REFERENCE
Cotsarelis G, Sun TT, Lavker RM. Label-retaining cells reside in the bulge area of pilosebaceous unit: implications for follicular stem cells, hair cycle, and skin carcinogenesis. Cell. 1990 Jun 29;61(7):1329-37.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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THE NOCEBO PHENOMENON

What is the nocebo phenomenon?

Some people get side effects from a drug because they know if could be a side effects. It's simply a part of being human. And we see it with many drugs. Now imagine males being warned about a drug that can cause erectile dysfunction, decreased libido and other sexual issues. How many will develop issues simply from this advanced knowledge and warning?

These are precisely the low but well known uncommon side effects of the male balding drug finasteride. How common are sexual issues from finasteride simply from the warnings? Well, a study from Italy set out to test this in 2007. Patients were divided into two groups - one group which got a warning and one which did not. 

So, what were the results?

Results showed that about three times more men reported side effects when they were given advanced waring compared to me who did not receive any such warning. Erectile dysfunction and decreased libido was reported in 31 %  and 24 % of men who received the warning compared to only 10 % and 8 % of men who were not counselled about this side effect.

 

Conclusion:

The so called Nocebo Phenomenon is powerful and needs to be remembered in interpretation of all studies and evaluation of all clinical data. 

 

REFERENCE

Mondaini N et al. Finasteride 5 mg and Sexual Side Effects: How many of these are related to the Nocebo Phenomenon? J Sex Med 2007; 4: 1708-12

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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New molecules for future research in androgenetic alopecia

New pathways for androgenetic alopecia: A look at IGF-1

We still don't fully understand the cause of genetic hair loss (aka androgenetic alopecia) and how best to treat it. Of all the cytokines & growth that have been postulated to play a role in hair follicle, insulin-like growth factor-1 (IGF-1) is known to be regulated by androgens. It's not clear if IGF-1 is altered in any way in the course of androgenetic alopecia.

 

Is IGF-1 altered in the balding scalp?


Prior to 2014, it wasn't well understood if IGF-1 levels are altered in the scalp's of patients who are experiencing balding.  In a recent 2014study, the  expressions of IGF-1 and its binding proteins from dermal papilla (DP) cells were compared in balding and non balding scalps. 

Interestingly,  cells from balding scalp follicles were found to secrete significantly less IGF-1, as well as the binding proteins, IGFBP-2 and IGFBP-4 (P < 0.05).

 

Conclusion and Comments

While this study does not prove that IGF-1 plays a direct role in androgenetic alopecia, it certainly is interesting. Further study is needed. It will be interesting to research whether PGD2 levels (which are known to be elevated in androgenetic alopecia) somehow impair IGF-1. 

 

REFERENCE

Panchaprateep R1, Asawanonda P. Exp Dermatol. 2014 Mar;23(3):216-8. Insulin-like growth factor-1: roles in androgenetic alopecia.

 

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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The FOUR "S's" of hair loss

SPEED, SYMPTOMS, SHEDDING AND SUPPLEMENTS

The fascinating thing about hair loss is that every single piece of information from the patient is 'potentially' relevant to their hair loss. That's a lot of 'potentially' - and potentially a great deal of frustration ..... unless one is prepared with a strategy to decipher all the information being given to them!

 

Is the fact that a patient's hair got worse after starting a job in the bank relevant? Maybe. Maybe not. 

Is the fact that a patient's hair got worse after starting a new vitamin relevant? Maybe. Maybe not. 

Is the fact that a patient's hair got worse after changing shampoos relevant? Maybe. Maybe not.

 

The four S's of hair loss 

I use the 4 S's of hair loss every day. It's an extremely important tool to keep track of what is important and what is less important when acquiring information about a patient's hair loss. The four 's stand for SPEED, SYMPTOMS, SHEDDING AND SUPPLEMENTS.

Everything piece of information about hair loss is potentially important to gather from patients.

 

1. SPEED.

How fast is the hair loss occurring (speed)? A patient who looks different month to month does not have genetic hair loss as the main issue!  A patient who looses massive (near total) amounts of hair in 3 days likely has alopecia areata or has had chemotherapy.  The speed of hair loss is important. 

 

2. SYMPTOMS

Does the patient have itching, burning or pain in your scalp (symptoms)? I never get too concerned about a bit of itching; however burning and pain raise alarm for something inflammatory and concerning. I generally perform a scalp biopsy in patients with significant itching, burning and pain.

 

3. SHEDDING

Is the patient shedding more than your normal? Is there hair on the pillow in the morning? Is their hair in the patient's food? Hair shedding is a normal thing but once it becomes excessive a patient notices. If shedding patterns are different for a given patient than they once were, this is abnormal shedding. plain and simple!  We get too hung up on counting hairs - Is it less than 100? Is it more than 100? This is important I agree. But the most important question is : Is the patient's daily shedding patterns different than they used to be!

 

4. SUPPLEMENTS

Finally, what pills or supplements does the patient take (supplements)? Many pills have the potential to cause hair loss but so do all supplements - including those for treating hair loss, blood pressure, weight loss, body building, depression.

 

I ask about the four S's - everytime !


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Chronic scalp pain (trichodynia)

Trichodynia  A Challenge

Many part of the being a hair specialist are challenging.  Treating some forms of hair loss, for example, can be challenging. Performing a hair transplant in someone with extensive burns can be challenging. 

But one of the most challenging areas of hair medicine is treating chronic scalp pain.  Some patients have pain and unusual sensations in the scalp for which a cause can not be found. They've had biopsies and blood tests and full examinations head-to-toe and scalp pain is still present. We all these scalp pain syndromes the "trichodynias". 

I often work with neurologist, pain specialist for such patients.  Ideally, collaboration between 2 or 3 specialists is the way to go and the way I prefer to assist patients with scalp pain.  Treatments which block nerves from sending aberrant signals are likely to be associated with side effects.  This is a profound change in the body to trick nerve signals - not an easy task.

In general terms, treatments available include:

  1. gabapentin
  2. pre-gabalin
  3. capsaicin (topical and shampoos)
  4. tricycylic antidepressants - Amitriptyline and Nortriptiline
  5. other antidepressants (SNRI type)
  6. anti-convulsants - carbamazepine, valproic acid, phenytoin
  7. anti-anxiety medications - clonazepam
  8. certain analgesics
  9. nerve stimulating devices (including radio frequency neuromodulators)
  10. nerve blocks
  11. botox

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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What is a Trichologic Emergency?

Can hair loss be an emergency?

photo 1-6.JPG

This morning, I read a publication this morning by hair loss dermatologist Dr Jerry Shapiro from New York University about scarring hair loss conditions. Dr. Shapiro coined the term 'trichologic emergency' which essentially means 'hair follicle emergency."

Hair follicle emergency? 

When you think about it, and emergency is a state whereby if one does not take action immediately - then irreversible and irreparable damage will occur. That's precisely what happens in a group of conditions known as the scarring hair loss conditions. 

What kind of conditions comprise scarring hair loss conditions?

The scarring hair loss conditions include conditions with names such as lichen planopilaris (LPP), pseudopelade of Brocq (PPB), central centrifugal cicatricial alopecia (CCCA), frontal fibrosing aloepcia (FFA), folliculitis decalvans (FD), and dissecting cellulitis (DC).  Unusual names indeed. 

Scarring hair loss conditions are not common. Certainly, as a group, they are far less common than genetic hair loss - male and female hair thinning.  But I see many hundreds of patients with scarring alopecia every year. 

Treatment for scarring alopecia - Put a pause on hair transplants 

The treatment for scarring alopecia requires medicines not surgery. Hair transplants become an option only when the condition becomes quiet.  First and foremost, medical treatments are required to stop the conditions. The treatments are different for the different scarring conditions so there is not one catch all treatments for all.

 

REFERENCE

Siah TW and Shapiro J. Scarring alopecias: a trichologic emergency. Semin Cutan Med Surg. 2015 Jun;34(2):76-80. d 

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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"Lonely" Hairs - What are they? What do they signify

Lonely Hairs in Hair Loss

Believe it or not, hairs can be "lonely". The term "lonely hair" is a term often used in context with individuals with a diagnosis of the scarring hair loss condition known as frontal fibrosing alopecia or "FFA". Lonely hairs can also be found in other diagnoses as well, including the closely related condition call lichen planopilaris. Even in genetic hair loss (male pattern balding and female pattern thinning), it's not uncommon for a few hairs to be outside the main area.

 

What exactly are lonely hairs?

Lonely hairs are single isolated hairs seen at some distance from the main groupings of hairs. Here in this photo you can see an isolated hair in the frontal hairline that is quite some distance from the main grouping of hairs.

 

Why are lonely hairs important?

IN conditions like frontal fibrosing alopecia, lonely hairs are important because they help with diagnosis. Also, I pay particular attention to "lonely hairs" - as their disappearance over time indicates the hair loss condition is likely 'active'. Those patients with active FFA need additional treatments if they wish to stop the disease. Hair transplants are not an option for those with active scarring alopecia  


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Overharvesting of the Donor Area -

How many hair follicle units are there in the donor area?

The donor area refers to the area in the back of the scalp that hair follicles are taken from during a hair transplant.

The density of the typical donor area is around 80-120 follicular units per square centimetre. Measuring length x width, it's easy to determine that a typical person has about 20,000-25,000 follicular units covering the back of the scalp. 

How many follicles can we take?

But if we were to take all 20,000 follicular units, the patients would be bald and the whole point of doing the hair transplant would be lost. 

In general, we can harvest , we can usually extract 15-20 % of the grafts in an area without any concern for the area looking thin or "bald". With a 1 mm FUE punch we can extract up to 20 follicular units per sq cm and with a 0.75 mm punch we can extract up to 25 follicular units per sq cm. I rely on a careful measurements to guide surgery.

or most donor areas, this works out to be 5000-7000 follicular units. Sometimes more can be harvested, sometimes not. 

The term for excessive harvesting of hairs in the donor area such that the area starts to look abnormal and cosmetically unacceptable is 'overharvesting'

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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Treatment Options for Hair Shedding in Women

Hair shedding in Women

Hair shedding problems are common among women. For various reasons they are more common in women than men. The medical term for hair shedding is "telogen effluvium"

Anyone with hair shedding needs careful evaluation. Blood tests are mandatory, essential, "a must" - but not enough. A careful and detailed history is needed. A full examination is needed, including an up close exam using dermoscopy. 

What are the main causes of hair shedding in pre-menopausal women? 

1.  low iron levels

2. thyroid problems

3. crash diets and nutritional deficiency

4. starting and stopping birth control

5. early stages of genetic hair loss

6. high stress

7. systemic illness - rare

8. autoimmune hair conditions (alopecia areata, lichen planopilaris) - rare

 

What blood tests are needed in women with hair shedding?

Blood tests for basic blood counts, thyroid levels, iron (ferritin) are mandatory for any female with increased shedding. However, a whole array of other tests might be helpful too depending on the info uncovered  during the appointment. These include: inflammatory markers (ESR), tests for hormones (LH, FSH, DHEAS, free and total testosterone, androstenedione, estradiol, prolactin). A scalp biopsy is usually not needed for most women. 

 

What do I sometimes recommend for hair shedding problems in women?

Well first and foremost, any abnormalities in the blood work must be corrected. Iron levels must be brought up if low. Thyroid levels improved if low. Other treatments can be considered too : minoxidil, low level laser therapy, biotin, L-lysine, Viviscal, platelet rich plasma and sometimes cysteine.

Do these treatments help everyone?

No.

Do they help some?

Absolutely. 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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What are the features "up close" of alopecia areata?

AAphoto

Alopecia areata: what are the features?

When seeing any patient with hair loss, the first question that needs to be answered with 100 % certainty is - what is the diagnosis? Only with the proper diagnosis can the right treatment be planned. 

So what is the diagnosis here?

This individual in the photo to the right has alopecia areata. Most of the short hairs are exclamation mark hairs (arrow0. The long hair in the photo is a very long exclamation mark hair that has not yet broken. For this hair, we use the term tapered hair rather than exclamation mark hair. Black dots (representing hairs broken at the surface & shown with * symbol) and yellow dots (representing hair openings packed with keratin and shown with # symbol) can be seen. In trichotillomania, hairs of different lengths are seen. Black dots are also a feature.

What other diagnoses did I consider?  

The most common causes of hair loss in 7 year old are: alopecia areata, loose anagen syndrome, trichotillomania, traction alopecia, tinea capitis and telogen effluvium. Features of trichotillomania like flame hairs, v-sign, hair powder and tulip hairs not seen in this photo. There are no signs of tinea capitis such as corkscrew hairs, comma hairs or zigzag hairs.

What is the treatment for alopecia areata?

Hair transplant are never an option for alopecia areata. Treatment for alopecia in a 7 year old is different than for 17 year old or 47 year old because we don't start with steroid injections. Class 1 or 2 topical steroids are the way to go (and one can consider occluding it). Generally speaking, I always use minoxidil with all treatments for alopecia areata. If topical steroids don't work to help regrow hair, the next treatment would be anthralin, diphencyprone or squaric acid (all of which serve go create irritation and/or allergy).


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair restoration. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a consultation in Toronto, please call 416-921-4247. To schedule a consultation in Vancouver, please call 778-960-4247.
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