Daily Hair Loss: What is normal?

Assessing daily hair loss

Ah, the drain catcher. To fully understand hair loss problems, one must be able to interpret what patients explain about their hair loss in the shower. Normally, we lose 50-65 hairs per day. But what if it's 88? What does it mean? What if they are mostly short hairs? mostly long hairs? Hairs with a white bulb? What if the patients shampoos weekly not daily?

I pay particular attention to changes in the daily rate of hair loss. If a patient normally loses 50 hairs per day, but now is losing 100, this may be abnormal. If a person's normal rate of loss is 35 hairs per day but now loses 85, this may be abnormal.  Changes in the daily shedding rate are important. 

Using Minoxidil Concentrations above 5 % : Is it worth it?

Minoxidil Concentrations beyond 5 %

Everyday, patients come into my hair transplant office with all sorts of minoxidil compounded solutions other than the standard 2 % and 5% concentrations that are FDA approved. Some ordered online, some from their home countries.  You name it, and I've seen it!

 

But is it safe?

It's true a small number of patients swear by it. That going form 5 % to 10 % really helped a lot. But the reality is that increasing the concentration significantly increased the chance of side effects. These include:

1. headaches

2. dizziness and blood pressure instability

3. heart palpitations

4. swelling in the face

5. pins and needles

6. hair growth in unwanted places

FDA: Cracking down on higher minoxidil concentrations

The US Food and Drug Administration (FDA) is now cracking down on companies selling the higher concentrations of minoxidil - out of simple recognition that they are not safe for some people. 

All in all,  for those considering minoxidil,  sticking with 5 % minoxidil concentration is not only  the safest option at present, but also the best option at present. 

Are women good candidates for FUE hair transplant procedures, including ARTAS?

FUE or FUSS: What's the best type of hair transplant procedure for women?

Nowadays, there are two common methods of performing a hair transplant: Follicular unit strip surgery (FUSS) and Follicular unit extraction (FUE).

Which is better for women? Does one clearly win out over another?

Well let's review, and you'll see why I nearly always recommend FUSS for women - and avoidance of FUE.

 

 

1. Follicular unit strip surgery (FUSS). 

With FUSS, the hairs in a small region in the middle of the back of the scalp are trimmed and those hairs and the accompanying skin are removed. Removal of that piece of skin requires placement of stitches or sutures. A small scar (about the thickness of the lifelines in one's palm) will ultimately form as the area heals. However, as soon as the patient walks out the door on day 1 - nobody can tell there has been a surgery in the back of the scalp. The stitches are completely hidden. 

SUMMARY of FUSS METHOD

- NO SHAVING of SCALP IS REQUIRED

- STITCHES ARE REQUIRED

 

2. Follicular unit extraction (FUE)

With FUE, the back of the scalp is shaved and follicular units are removed from the back of the scalp 'one by one.' These tiny circles heal on their own and stitches are not required.  Contrary to what is often (unfortunately) advertised, FUE is not a scarless procedure - the areas simply heal with tiny circular microscars that soon get covered as the hair grows out.  It takes about 10 days for the hair to grow back to cover the scars but it takes 1 month for the hair to grow 1 cm. For women with 30 cm hair, it takes about a 2 years for the hair to grow back to that length. 

SUMMARY of FUE METHOD

- SHAVING of SCALP IS REQUIRED

- STITCHES ARE NOT REQUIRED

 

Summary: FUE is not the ideal hair transplant technique for women

Based on current technology, I don't believe FUE is the best technique for women. I don't recommend Neograft, I don't recommend ARTAS, and I don't recommend manual or motorized FUE for women considering hair transplants. I do not recommend FUE. 

I have yet to meet a female patient who prefers to shave their head over a small scar which is hidden within their hair.  

For man who normally wear their hair very short, FUE can still be a good technique - and certainly a large proportion of our cases are FUE. But 99.5 % of our female hair transplant patients undergoing moderate sized hair transplant cases prefer strip surgery (FUSS) with placement of stitches.

Is ACell/Matristem available in Canada yet?

ACell/Matristem in Canada: What's the status?

For a 2016 update click here

I've received many inquiries directed to our Platelet Rich Plasma (PRP) Program about the use of a product called "Matristem" sometimes also called "ACell". In this week's blog, I'll discuss Matristem, a unique product from the company ACell  - and it's current status in Canada

ACell is a US based company that creates products for regenerative medicine. One of these products is Matristem. Matristem is a  “porcine urinary bladder matrix,” (essentially a purified product from from pig bladder cells). The Matristem product is helpful in wound healing and is used by wound care specialists. Given the close relationship between wound healing and hair growth, many physicians have been exploring whether Matristem can be combined with platelet rich plasma to enhance results.

Matristem/ACell: Still not allowed to be used in Canada!

Despite it's FDA approval in the United States, ACell/Matristem is not available in Canada and I'm unable to offer it to Canadian patients. I've had numerous discussions with Health Canada and physicians in Canada are not allowed to use the product. Unfortunately there are no exceptions to extend to my patients!  There are no exceptions to anyone for regular use. Physician often ask me if it's possible to use - the answer is no! It's against the law to use a product that has not received clearance!

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 done, need to be published and need to be verified. 

ACell's Matristem is a unique product and I look forward to it someday being available in Canada for me to use. Right now, we're constantly modifying our own PRP technique to optimize 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

It doesn't come up now - but when it does, I'll look forward to reviewing the evidence as to whether it helps or not before offering it to my patients.

Switching from Minoxidil to Finasteride

Minoxidil and Finasteride: Making a Switch

Minoxidil and Finasteride are both FDA approved for treating androgenetic alopecia (male pattern hair loss) in men.  In general, those individuals who get an improvement with minoxidil and then stop - all the newly acquired hairs will be lost.

Can adding finasteride now prevent this loss? 

And the answer is that it can for some men - but not all. In fact, a 2003 study confirmed that adding finasteride does not always block the hair loss that comes with stopping minoxidil.

In short, a given individual will know in 4-6 months if they are one of the individuals that finasteride can block the hair loss after stopping minoxidil - or not. I often advise my own patients to simply overlap the two treatments (Finasteride and minoxidil together) for 4 months and then stop minoxidil.

Reference
Tosti et al. Finasteride treatment may not prevent telogen effluvium after minoxidil withdrawal. Arch Dermatol. 2003 Sep;139(9):1221-2.


 

Is my treatment working?: The Power of the 1 cm Rule

How do I know if my treatment is working ?

So you've started a new treatment and you're wondering if it's helping your hair. How do you know?

Well, it's important first figure out the answer the following questions:

What type of hair loss do I have? Am I supposed to get more hair with my treatment? ....or is the purpose of the treatment to STOP further loss?

For many types of hair loss, the goal of treatment is to stimulate new hair growth. Because hair only can grow about 1 cm per month maximum - one would expect a number of 1 cm hairs after the first month of treatment and a number of 2 cm hairs after two months. Generally when I invite patients to meet with me at 6 months - I expect to see a number of 6 cm hairs.  I like to call this the "1 cm rule of hair regrowth"

However, sometimes treatment is designed to thicken existing hairs and improve quality rather than trigger new sprouts of hair. So the main factor to assess in this case is hair density - and improvement in overall scalp coverage. Careful assessment for 1 cm, 2 cm and 6 cm hairs is less important in these cases.

For some types of hair loss, particularly the group of conditions known as scarring hair loss conditions, the primary goal of treatment is to stop the hair loss - not to regrow hair. Therefore, if a patient looks the exact same in 6 months, the treatment is rated as a success.

Should I get FUE or strip hair transplant surgery ?

FUE is not always a good idea

There is a wave of excitement in the world with hair transplant surgery done via follicular extraction or "FUE." I'm excited too - I enjoy doing FUE and a great deal of our procedures are FUE. In fact, about one-half of our procedures this coming week will be FUE and one half will be strip procedures (FUSS).

 

But FUE always a good idea? No !

Not at all. The main concern about FUE is that it frequently involves removal of hairs from regions in the back of the scalp that might thin out in the future. For some patients FUE and strip are equally good - the patient can go ahead and choose!!! For other patients, FUE is an inferior method - strip is the only method I'll do! For other patients, strip is inferior method and FUE is the only method I'll do! 

In many cases, the decision as to whether to have a hair transplant done via the FUE method or via the strip method is not left up to the patient to decide, nor is it left up to the hair transplant surgeon to decide. It is a complex decision that involves discussion of numerous factors.

For 20 % of patients who walk in the door, strip is the only option. For 20 % of patients, FUE is the only option based on the information they provide during the interview. For 60 % of patients, it's up to them!

As an example, let's consider two 29 year old identical twins (TWIN 1, TWIN2) with the same amount of hair loss. These 29 year old male twins have a lot of hair loss at the front of the scalp. I estimate they needs 3000 grafts for a nice result.  They have some thinning in the top of the scalp too. They do not want to use minoxidil or finasteride. The  dad is fairly bald, and the grandparents are bald. The twins other older brother just had a hair transplant at age 42. Let's pretend for the sake of discussion that we did a hair transplant via FUE for one of the twins and a hair transplant via strip method for the other twin- now let's fast forward from age 29 to age 55 and see how each twin is doing. 

What I hope you'll come to understand is that the twin who had a hair transplant via strip method looks similar at age 30 but much, much better age age 55. The twin who had FUE at age 55 likely lost a good proportion of the grafts that were transplanted

 

TWIN NUMBER. 1: HAIR TRANSPLANT VIA FUE

Fast forwarding 25 years, twin 1 is disappointed. Hair looked good at one year following his transplant and even looked good at 5 years following the transplant. But now 25 years after his transplant, he's disappointed that his brother looks better! Many of the hairs that were transplanted back age age 29 have thinned out- they were taken from areas of the back of the scalp that were destined to undergo balding.

TWIN NUMBER 2 : HAIR TRANSPLANT VIA "STRIP SURGERY"

Fast forwarding 25 years, twin 2 is happy. Hair looked good at one year following his transplant and even looked good at 5 years following the transplant. And now 25 years after his transplant, he's quite tickled that he has better hair than his brother ! TWIN 1 attributes the better hair of TWIN 2 to less stress and a healthier diet - but in reality that has little to do with what we're seeing. The reasons is simple. Twin 2 has better hair because were taken from areas of the back of the scalp that was quite unlikely to undergo balding.

FUE is a wonderful technique. It's just not for everyone. 

What is DUPA (Diffuse Unpatterned Alopecia)?

DUPA: Why it matters?

DUPA is the short form for the term 'diffuse unpatterned alopecia.' This is a subtype of hereditary hair loss, or androgenetic alopecia. DUPA can affect both men and women.  Today, we'll focus on DUPA in men and why it is critically important to identify men with DUPA and to separate this pattern of hair loss from all others.  In order to understand DUPA, it is important to understand the normal pattern of hair loss in men. 

The Hamilton Norwood Scale

Hair loss in many men follows the so called Hamilton Norwood scale whereby men first lose hair in the temples and/or crown. The seven stages of the Hamilton Norwood scale is shown in the diagram on the right. Over time, some men will develop hair loss over the the entire frontal, mid-scalp and crown  - this defines the Advanced Hamilton Norwood Stages (Hamilton Norwood scale VI or VII).

Not all men with hair loss follow the Hamilton Norwood scale. 

 

 

DIffuse Patterned Alopecia (DPA)

In diffuse patterned loss, patients thin across the entire frontal scalp from front to crown. All of these hairs undergo miniaturization. The back and sides however - are spared. Treatment for diffuse patterned alopecia includes both medical and surgical treatments. Because the back of the scalp is unaffected in diffuse patterned alopecia, and therefore rich in good hairs hair transplantation is a good option.  Finasteride, minoxidil, low level laser and platelet rich plasma may also be good options.

Diffuse Unpatterned Alopecia (DUPA)

With this basis, we can begin now to understand a relatively uncommon pattern of hair loss in men called Diffuse Unpatterned Alopecia or "DUPA". About 2-6 % of men have this pattern of hair loss, so it is relatively uncommon.  Patients with DUPA develop hair thinning not only in the front and top of the scalp, but also in the sides and back. In men with DUPA, the majority of hairs on the scalp are undergoing miniaturization or will at some point undergo miniaturization. The importance of recognizing DUPA is the fact that hair transplantation is not an option. Hairs at the back are not of good quality to move as they are (or will someday become) miniaturized.  If a hair transplant is attempted in a patient with DUPA, it may look good for a few years, but the transplanted hairs are at very high risk to thin out and be lost over time. The only treatment for patients with DUPA is medical treatment - minoxidil, finasteride, low level laser and platelet rich plasma.

How do women's eyelashes change with Age?

How do eyelashes change with age?

Have you ever wondered what happens to eyelashes with age. Well, a recent study set out to examine changes in eyelashes among 179 Asian, Hispanic, White, East Indian and Black women women between ages 22 and 65.  

Key points of the study:

The authors found that THREE parameters DECREASE with age:

1) eyelash length

2) eyelash thickness

3) eyelash darkness  

 Comment

This simple yet well helpful study confirms what women tell us: their eyelashes change with age. Cosmetic product such as bimatoprost (Latisse) can enhance eyelash length and thickness and sometimes darkness as well. 

Reference

Glaser et al. Epidemiologic Analysis of Change in Eyelash Characteristics with Increasing Age in a Population of Healthy Women. Dermatol Surg 2014; 40: 1208-13

The HairMax Laser Comb: How Well Does it Work?

Low Level Laser Therapy in Real Practice:  

There are many treatments for androgenetic hair loss (female pattern hair loss). That said, there are only a limited number of treatments with good scientific evidence to back them up. With the publication of an independent study in the American Journal of Clinical Dermatology last January regarding the benefit of the HairMax Laser Comb, I've been increasingly incorporating these devices into my treatment algorithms for men and women.  

Researchers from Brazil and Switzerland recently performed a study to evaluate the benefit and safety of the HairMax Laser Comb for treating androgenetic hair loss,  either as a solo stand alone treatment or in combination with other treatments.  Patients from the authors’ practices used the HairMax laser combs and were assessed with global photographic imaging.

Of 32 patients (21 female, 11 male), 8 (25 %) showed significant, 20 (62.5%) moderate, and 4 (12.5%) had no improvement. Improvement was seen both with monotherapy and with concomitant therapy and observed as early as 3 months. There were no side effects.  

The HairMax Laser Comb provides benefits 

This is yet another of a growing number of independent post marketing studies to support the role of the HairMax laser comb for treatment of both male and female AGA. Treatments appear synergistic and additive and further studies are needed to understand how combination treatments with minoxidil, finasteride, and LLLT may enhance hair growth.

Reference

Munck A et al. Use of low-level laser therapy as monotherapy or concomitant therapy for male and female androgenetic alopecia. Int J Trichology 2014; 6: 45-9 

Creating recipient sites in hair transplantation

Different sized needles for different purposes

A hair transplant is a cosmetic procedure whereby hairs are moved from one area of the body (usually the back of the scalp) to another area of the body (such as the front part of the scalp, or eyebrows or beard.  

In order for new hairs to grow in a newly chosen area, small tunnels called "recipient sites" must be made. These tunnels are just 3-5 mm in length and must be created with the perfect depth. The tunnels must also be the perfect width to accommodate the new hair.

Choosing size of recipient sites

I use a sharp instrument to create the recipient sites. Usually I use needles, but sometimes I also use blades. The photo to the right shows different sized needles which are used for different purposes.  For delicate work on the eyebrow, for example, I might use a 22 gauge needle or a 23 gauge needle. For the frontal hairline of the scalp, I might use a 20 or 21 gauge needle. If I am creating recipient sites to accommodate big 3 and 4 haired grafts I might use a 19 gauge needle and very rarely an 18 gauge needle as well.  The smaller the gauge size the bigger the tunnel that is created.

Careful attention to the size of recipient sites is important so that new grafts can grow properly.  

How common is hair loss after bariatric surgery?

Bariatric surgery: Loss of hair is common

I've seen dozens and dozens of patients these past few months experiencing hair loss after bariatric surgery. This hair loss is mostly of the telogen effluvium kind and a large proportion of the hairs are expected to grow back. A proportion of people don't quite regain the same density as they once had -  a phenomenon whereby hair shedding episodes are said to accelerate the development of androgenetic alopecia. 

How common is hair shedding after bariatric surgery?

I enjoyed reading a new study from Brazil which showed that quality of life is enhanced greatly following the weight loss from bariatric surgery. In the study, hair loss was common following the surgery and occurred in nearly 70 % of those that have surgery. 

REFERENCE

Silva PR et al. Nutritional status and life quality in patients undergoing bariatric surgery. Arq Bras Cir Dig. 2014;27 Suppl 1:35-8.

'Metabolic syndrome' and why it matters for those with genetic hair loss?

What is metabolic syndrome?

Metabolic syndrome refers to a cluster of medical issues such as high blood pressure, high cholesterol, diabetes, and excess fat around the waist. Essentially many of the factors that are known to increase the risk of heart attacks and stroke.

It's been known for a while that individuals with androgenetic alopecia "AGA"  (also called male pattern balding and female pattern hair loss) are at increased risk to develop metabolic syndrome.  Researchers from China recently reviewed all of the studies relating to the issue. They identified four case-control studies and 2 cross-sectional studies including 950 AGA subjects and 3056 control subjects.

What were the results of the study?

The study showed that taken all together, AGA was significantly correlated with developing metabolic syndrome - in fact the risk was raised about three times.

Conclusion 

The medical field has not yet embraced this concept and we have a lot of work left to do. There is good evidence now that men and women with AGA (especially early AGA are at risk to develop metabolic syndrome.  We urgently need to protocols ways to screen patients and identify those at highest risk. 

Reference

Wu Dx et al. [Association between androgenetic alopecia and metabolic syndrome: a meta-analysis]. 2014 Sep 25;43(5):597-601.

 

Is FUE better than strip surgery?

Many patients wonder if FUE is better than strip? FUE is not necessarily better technique - it's just different. It's critical that patients considering hair transplant surgery understand the unique differences in these two procedures.

With FUE (follicular unit extraction) there is no 'linear scar'  but contrary to popular belief there is a scar! However, it's just a tiny tiny circular "microscar". It's hard to see and that's the great thing about FUE. But it is a scar nevertheless. Because the area heals with a microscar, it is often possible for one to wear their hair very very short. The International Society of Hair Restoration Surgery has cracked down on clinics choosing advertising scarless surgery. 

What are the downsides of FUE? 

There are some important considerations with FUE. For example, if an individual is likely to go on to develop more significant balding in advanced ages, then it's possible that with FUE surgery will involve taking hairs from an area in the donor region that might not truly be permanent hairs. 

Take two men at age 29 with thinning in the front of the scalp. Both are destined to go on to develop a Norwood VI pattern without surgery. One gets 2500 grafts with strip and one gets 2500 grafts with FUE. Both look great one year after their surgery and both look good 10 years after. But do both look good 30 years after their surgery? There is a slightly greater chance that the man who had strip will have "fuller" hair at age 57. 

It's important for all men consider hair transplant to understand this concept. There are benefits to both strip and FUE. 

Should you get a blood test for DHT ?

Measuring DHT not useful for most men and women 

 Androgenetic alopecia is one of the most common types of hair loss. In men, it is known as male pattern balding and in women it is known as female pattern hair loss.

The exact cause remains to be worked out but it is thought that in those affected genetic factors make the hair follicles more sensitive to the hormone dihydrotestosterone. Such sensitivity causes those hair follicles to get skinnier and skinnier with time - a phenomenon which is called 'miniaturization'

Measuring DHT : A good idea or not?

If DHT is so important, a common question is whether doing a blood test for DHT has any value in the evaluation and management of androgenetic alopecia. 

A recent study set out to evaluate the usefulness of DHT level in patients with androgenetic alopecia. The study comprised 49 individuals, including 9 men and 19 women with androgenetic alopecia. The control group consisted of 17 healthy women and 4 men without hair loss.

What were the results of the study?

All in all, increased serum concentrations of DHT were observed in both patients with androgenetic alopecia and in those without. More importantly, the differences in mean values of DHT were not significant according to two groups and increased serum concentrations of DHT were not correlated more severe hair loss.

 

What are the conclusion of this study?

Although DHT plays an important role in the pathogenesis of androgenetic alopecia, asking patients to do a blood test is not useful for most patients.

Reference

Urysiak-Czubatka I et al. Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia. Postepy Dermatol Alergol. 2014 Aug;31(4):207-15. doi: 10.5114/pdia.2014.40925. Epub 2014 Sep 8.

Platelet Rich Plasma for Men and Women: Results of the Largest Study to Date

PRP requires a small amount of blood to be obtained. The blood is then separated to obtain platelet rich plasma or "PRP" that is then injected into the scalp

PRP FOR HAIR LOSS

Platelet rich plasma remains an area of active interest for the treatment of androgenetic alopecia (AGA).  A number of growth factors present in the PRP are known to stimulate hair growth and stimulate activation of dermal papilla cells. A handful of studies to date support a role for PRP in treating AGA.

 

New study supports a benefit of PRP

In a new study, US and Italian researchers designed a study investigating the role of PRP in men and women with AGA.  PRP concentrations 3.5 to 4 times above baseline were used in the study. A 1mm deep Scalproller was used to further induce cutaneous inflammation.  Injections were repeated at a 3 month time point and clinical evaluation was performed at the 3 month and 6 month interval. 2 investigators assessed the response of patients via before and after photographs.

64 patients enrolled in the study, including 42 men and 22 women. The median age of males was 28 and 32 in the female group. None of the patients were allowed to start new therapies other than the PRP.

What were the results of the study?

Overall, results favored the use of PRP for treating AGA. One investigator deemed 62/64 patients to have improved and the second investigator felt 64/64 improved.  Investigator 1 deemed 40.6 % to have a clinically important difference and investigator 2 felt 54.7 % had a clinically important difference. There was no difference in responses according to gender, age, number of platelets or the degree of hair loss at baseline.  Interestingly, a greater degree of improvement was found in those with a more severe hair loss.  There were no adverse effects noted such as allergic reactions pain, fever or prolonged redness. Post operative telogen effluvium was not noted.

Conclusion:

This is an exciting study which further supports a role for PRP in the treatment of androgenetic alopecia.  Like other studies, this study supports the notion that PRP concentrations should be 3-5 times above baseline in order to stimulate improvement. There are numerous PRP machine on the market and numerous distinct techniques. Further research is needed to understand which components and modifications are most important.

Reference

Schiavone et al. Platelet-Rich Plasma for Androgenetic Alopecia: A Pilot Study. Dermatol Surg; 2014; 40:1010-1019.

What is pressure alopecia?

Hair loss from pressure?

Pressure alopecia doesn't refer to hair loss caused by stress! Rather if refers to hair loss from prolonged positioning on one's back, usually during prolonged surgeries (cardiovascular surgery, gynaecological surgery, abdominal surgery.)

Nowadays, it's pretty standard in the operating room for someone to be in charge of making sure the patient's head is turned frequently during surgery. If not, the tiny blood vessels get occluded and skin ulceration and hair loss can occur.

Hair loss on post op day 7

Hair loss occurring a 7-14 days after the surgery from the middle back of the scalp usually indicates pressure alopecia. Patients may develop tenderness and crusting a few days before the hair loss. Fortunately for most - the hair loss is temporary and grows back in 1-2 months. However, for a small number of individuals the hair loss is permanent. Hair transplantation provides an option to restore density. 

Reference

Davies and Yesudian. Pressure alopecia. Int J Trichol 2012; 4(2): 64-68

Do you know about pumpkin seed oil?

Pumpkins and Hair Loss: 

Reflections on pumpkin seed oil for hair loss during my recent visit to the pumpkin patch

As October rolls in, it seems appropriate to discuss pumpkins and one of the oils from the seeds - pumpkin seed oil (PSO). 

Surprisingly, pumpkin seed oil (PSO) has been shown in previous studies to block the action of the enzymes 5-alpha reductase and to have antiandrogenic effects on rats.

Korean researchers undertook a randomized, placebo-controlled, double-blind study was designed to evaluate the efficacy and tolerability of PSO for treating male patients with mild to moderate androgenetic alopecia (AGA).

How was the study designed?

76 men with AGA received 400 mg of PSO per day or a placebo for 24 weeks. Four outcomes were closely followed in the study: assessment of standardized clinical photographs by a blinded investigator; patient self-assessment scores; scalp hair thickness; and scalp hair counts. Reports of adverse events were collected throughout the study.

What were the results?

At the end of the 24 week treatment, self-rated improvement score and self-rated satisfaction scores in the pumpkin seed oil-treated group were higher than in the placebo group (P = 0.013, 0.003). The PSO-treated group had more hair after treatment than at baseline, compared to the placebo group (P < 0.001). Mean hair count increases of 40% were observed in PSO-treated men at 24 weeks, whereas increases of 10% were observed in placebo-treated men (P < 0.001). Adverse effects were not different between the two groups.

Comments

Further studies are needed to understand the benefits of pumpkin seed oil in promoting hair growth. These results are encouraging, especially in light of their relative safety.

 

Reference

Cho YH et al. Effect of pumpkin seed oil on hair growth in men with androgenetic alopecia: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med. 2014;2014:549721. doi: 10.1155/2014/549721. Epub 2014 Apr 23.

 

Traction alopecia & Greenland

Beautiful view of Greenland from my seat, where traction alopecia first got its name in 1907

Traction alopecia refers to a type of hair loss due to pulling forces. Women who wear their hair back tightly in pony tails or those using braids weaves or cornrows are also susceptible to traction alopecia.

Some men are also susceptible to traction alopecia, such as Sikh men who use turbans. 

 

1907: Traction Alopecia introduced to scientific literature

Traction alopecia has probably been seen for thousands of years, but it was first described in 1907 in West Greenland. Hair styles at the time in Greenland resembled the modern 'pony tail' and lead to hair loss.  It was termed "Alopecia Groenlandica" by an Austrian dermatologist. 

Traction alopecia has many different appearances but often appears as an area of hair loss along the frontal scalp.

In the early stages of traction alopecia, hair can regrow to some degree if the hairstyling practices are stopped (pony tails, braids, weaves). If left, and the traction alopecia is present for many years, hair regrowth is not possible with medications. 

Hair transplantation for traction alopecia

Restoration of the frontal hairline in a woman with traction alopecia. Photo: 12 months post op.

Hair transplantation can be a very good option for treating traction alopecia - provided the pulling forces have been stopped.

The photos on the right show typical before and after photos following hair transplantation. Most patients achieve final results by 12 months following their procedure.

Reference

Hjorth N. Traumatic marginal alopecia; a special type: alopecia groenlandica. Br J Dermatol 1957. 1957; 69: 319-22

Thinking about starting a treatment for hair loss? My Rules of Safety

Doc, have you ever heard of this treatment?

There are literately thousands of treatments available for hair loss and hair care and literately thousands of them of have no clear benefit or have marginal benefit only.   Suppose you are sitting at a restaurant and you overhear someone comment at the next table comment that rinsing of the hair twice daily with the extract of 4 specific vegetables has done wonders for the hair.

Should you try it out?

At first thought you might think... 'It probably can't hurt... and if it helps... great!" But what if I told you that I've seen over 150 patients in the last 2 years alone with hair loss that never recovered because of treatments they thought "couldn't hurt."

When it comes to deciding on hair loss treatments, I generally advise my own patients and the public to think in terms of these principles.  I call them my Rules of Safety.

Rules of Safety

If the treatment has been reported in the medical literature to have clear benefit in more than 1500 patients, AND has more than 10 scientific publications to back up the claim that it “works”, AND has been around more than 5 years AND has FDA approval

 ask your general physician, dermatologist or hair specialist about whether you should use it. I like to call it a group A treatment.

If the treatment has been reported in the medical literature to have clear benefit in more than 75 patients, AND has more than 4 independent scientific publications to back up the claim that it “works”, AND has been around more than 5 years

ask your dermatologist or hair restoration specialist whether you should use it as an ‘off label' treatment.  I like to call it a group B treatment.

If the treatment has been reported in the medical literature to have benefit in less than 75 patients, AND has less than 3 independent scientific publications to back up the claim that it works,   

ask your dermatologist or hair restoration specialist whether there are clinical trials or clinical studies available for you to participate in. I like to call it a group C treatment.

If the treatment has never been reported in the medical literature to have benefit and there are no independent scientific publications to back up the claim that it "works"   

ask yourself… “Why am I doing this?”

I like to call it a group D treatment as a reminder - don't  !