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
A new study, published in the recent edition of the Journal of the American Academy of Dermatology supports the generally poor prognosis of scalp melanomas. Dr Xie and colleagues from Australia retrospectively examined the survival of 900 patients with head and neck melanomas. 237 patients (26.3 %) had scalp melanomas.
In total, scalp melanoma had double the risk for mortality compared to other head and neck melanomas. Patients with scalp melanoma had a 5 year melanoma specific survival of 70 % compared to 88 % with other head and neck melanomas.
The authors concluded that scalp melanomas have poorer survival than other melanomas. They tend to be thicker at diagnosis and tend to largely occur in males. These types of melanomas are easily overlooked. The authors advised that clinicians need to carefully examine the scalp for scalp melanoma and excise any lesions that are atypical.
Xie et al. Impact of scalp location on survival in head and neck melanoma: A retrospective cohort study. J Am Acad Dermal 2017; 76: 494-8
Hair transplants can sometimes be a good option for women with androgenetic alopecia alopecia, but much less commonly than for men. I don't think this is well understood, even among the medical community. Here are the top 3 reasons why women are far less likely to be deemed good hair transplant candidates.
Many women have a pattern of hair loss whereby hair loss and thinning occurs at the top, dies and back. In other words, the hair thinning is affecting everywhere. We call this diffuse hair loss. Diffuse hair loss affects a large proportion of women with androgenetic alopecia. In contrast, men rarely have a diffuse pattern of hair loss.
The reason the diffuse pattern is important to identify is that hairs taken from a thinning area from the back of the scalp and transplanted into the front will thin out over time, making the hair transplant unsuccessful.
If the female patient does not have thinning in the back of the scalp and the physician predicts she will never have thinning in the back of the scalp.... then the patient may be a good candidate for hair restoration (provided point 2 and point 3 below are met).
Hair loss in women is far more complex than for men and many men have two (and even three) reasons for their hair loss. Women with only one reason for the hair loss do better with hair restoration procedures. If there is a component of telogen effluvium or cicatricial alopecia, these individuals usually do not have good results with hair transplant procedures.
The recipient area (are to be transplanted) needs to be of a certain density to effectively accommodate new grafts. In the early stages of thinning, the patient appreciates their is a reduction in density in the area, but has not experienced sufficient hair loss to make a hair transplant a good option. In many of these cases, attempts to do a hair transplant can sometimes lead to worsening of hair loss, or no change in density. Of course, the transplant can also be a success sometimes - but decisions to proceed with surgery come with a risk.
Approximately 30,000 women undergo hair transplants every year in the world. Many have success but many do not. Overall, it is important to understand that not all women are good candidates for surgery. An experienced hair physician can help a patient understand her chances of getting an improvement with surgery before undergoing the procedure. If the patient has diffuse thinning, multiple types of hair loss and the hair loss is in too early of a stage ... one may not achieve expected results.
Sulphur-containing amino acids (cystine, cysteine) are essential components for the health of normal hair. Cystine is used in the treatment of many forms of hair loss. Vitamin B6 (pyridoxine) plays an important role in the development and maintenance of the skin and it is useful in reducing hair loss. Cystine is needed for proper Vitamin B6 utilization in the body. Vitamin B6 also speeds up how Cystine gets incorporated into the body.
D'Agostini and colleagues performed some very fascinating studies looking at the B6/cystine pair. In a 2007 study they showed that vitamin B6 and cystine prevented smoke induced hair loss in mice.
They demonstrated a study in 2013 that the combined oral administration at high dosages of L-cystine and vitamin B6 prevented hair loss from doxorubicin chemotherapy in mice.
Conclusion: There may be a role of cystine and B complex vitamins including vitamin B5 and B6 in human hair health. It seems that we may be entering a new era in understanding how to use supplements. Even when cystine dietary intake is good, there may be benefits in supplementation - especially in those with excessive shedding. Cystine use in sheep (to make more wool) has been studied since the early 1930s. These early studies showed that increasing cystine delivery to sheep helped these sheep produce more wool. It is important to check with your physician for how much of any supplement to take and for how long. 20 mg L-cystine and 100 mg B6 are often appropriate for short periods. Whether and how the supplement n-acetyl cystine (NAC) - a precursor of cystine- can be used in place of cystine remains to be determined.
D'Agostini F, et al. Chemoprevention of smoke-induced alopecia in mice by oral administration of L-cystine and vitamin B6. J Dermatol Sci. 2007.
D'Agostini F, et al.Chemoprevention of doxorubicin-induced alopecia in mice by dietary administration of L-cystine and vitamin B6. Arch Dermatol Res. 2013.
Does long distance travelling trigger hair loss? Well, usually not. The one exception would be travel from low daylight to hight daylight environments (a traditional "winter break" to a sunny destination). A mild increase in daily shedding is noticed several weeks later.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an authoritative guide to the diagnosis of mental disorders. It is used by health care professionals throughout the world. The DSM contains detailed criteria for diagnosing mental disorders, including descriptions and symptoms.
Every few years the DSM undergoes revisions. The purpose of such revisions is to make the diagnostic criteria more reliable and to further enhance the communication between physicians regarding mental disorders.
Trichtillomania (TTM) is a hair pulling disorder whereby affected individuals pull out their own hair. 3-4 % of the world experiences trichotillomania at some point in their lives making it a common disorder. In 2013, the DSM underwent a revision from the previous DSM - IV TR to the DSM 5. And with these revisions, the new manual had proposed new criteria for TTM.
The earlier DSM IV TR criteria for TTM included the following:
A. Recurrent pulling out of one's hair resulting in noticeable hair loss.
B. An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.
C. Pleasure, gratification, or relief when pulling out the hair.
D. The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition).
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association
With the revisions of the DSM 5 in 2013, criteria B and C above were removed. There is no longer a requirement for diagnosed individuals to show urges to pull and subsequent relief after pulling. These criteria showed the lowest relatedness to the underlying TTM construct. The new criteria are:
Recurrent pulling out of one’s hair, resulting in hair loss
Repeated attempts to decrease or stop the hair-pulling behavior
The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
The hair pulling or hair loss cannot be attributed to another medical condition (eg, a dermatologic condition)
The hair pulling cannot be better explained by the symptoms of another mental disorder (eg, attempts to improve a perceived defect or flaw in appearance, such as may be observed in body dysmorphic disorder)
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Washington, DC: American Psychiatric Association; 2013. 251-4.
DPCP is a topical treatment used for patients with alopecia areata. After an initial application dose of 2%, patients (or their family member, spouse, etc) apply the medication at home on a weekly basis - provided they have received appropriate training from our office. Training is very important as DPCP can cause serious rashes and blisters to other parts of the body if not properly applied. Nitrile gloves are recommended by the individual applying DPCP to limit his/her exposure. We prefer this over latex or vinyl gloves.
It's clear that JAK inhibitors like tofacitinib and ruxolitinib help alopecia areata, a specific autoimmune disease affecting 2 % of the world. But what about genetic hair loss - is there any evidence these drugs help this condition?
The answer is 'maybe'. Studies by Columbia University researcher Angela Christiano has shown the JAK inhibitors provide a very strong signal to get hairs growing. It remains to be seen if these signals are sufficient to help androgenetic alopecia (male and female genetic hair loss). In Sept 2015, Aclaris bought the rights to further study JAK inhibitors. This is interesting and may point to some benefits we have yet to fully understand.
Oral JAK inhibitors don't appear to help AGA that much, as patents with alopecia areata and genetic hair loss can improve their alopecia areata - but not their androgenetic alopecia. Nevertheless, topical products may act differently and studies in this area are needed.
Harel et al. Pharmacologic inhibition of JAK-STAT signaling promotes hair growth. Science Advances 2015