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Dissecting Cellulitis (DSC)

This is another example of healed sinus tract. This will likely give a permanent scar in the area.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Minoxidil for Telogen Effluvium: Do I need to use it forever?

Telogen effluvium (TE) is a hair shedding condition. Individuals with telogen effluvium experience increased daily shedding than they may have normally experienced. Rather than losing 50-100 hairs per day, affected individuals lose well over 100 hairs and some lose upwards of 400-1000.  The main causes of TE are low iron levels, thyroid problems, stress, crash diets, illness within the body (Systemic illness), medications. These are all 'triggers' for TE

Is minoxidil a treatment for TE?

Before addressing whether minoxidil is a trigger for TE or not, let's look at the primary treatment for TE. TE is best treated by addressing the trigger for TE. If low iron is the cause of the TE, the iron must be replaced. That is the primary treatment. If hypothyroidism (low thyroid hormone levels) is the primary cause of a TE, the affected patient needs thyroid replacement as their primary treatment. 

Minoxidil is not the first choice for TE, but certainly can be a choice in those individuals for which the diagnosis can't be found. For 50 % of individuals with TE, we can't find the cause of the TE.  For some people, despite the blood tests, and review of their history, a clear 'trigger' can't be identified.  Minoxidil can help the hair cycles return to normal and facilitate the establishment of more normal shedding patterns.  Minoxidil helps some people with such unknown shedding but not all.

Is the use of minoxidil life long for TE?

Minoxidil is well known for being a 'lifelong' treatment for patients with androgenetic alopecia (male and female pattern hair loss). If someone with androgenetic alopecia uses minoxidil and gets a benefit and then decides to stop the treatment, they will lose all the benefits they gained by using the treatment. Their use is lifelong. For patients with androgenetic alopecia, minoxidil can not be stopped. 

These same rules do not apply to all patients with TE. In many cases minoxidil can be tapered and then stopped as hair follicles regain normal cycling patterns.  If an individual decides to use minoxidil to treat their TE from their crash diet, the minoxidil can be tapered and stopped once a normal diet resumes.  The use in these situations is not lifelong.

Conclusion

For patients with a true TE, minoxidil use is typically not life long. After the trigger for the shedding is fixed, shedding will often return to normal and minoxidil can be stopped


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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Pulled out hair

I posted an answer to a new question on Realself.com

Pulled out 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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Will Spiro work?

I posted an answer to a new question on Realself.com

Will Spiro work?


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Is this AA?

I posted an answer to a new question on Realself.com

Is this AA?


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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Biotin

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Biotin


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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Dandruff Shampoo

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Dandruff Shampoo


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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Dissecting Cellulitis (DSC)-Healed Sinus Tracts

Dissecting Cellulitis (DSC), is a rare scarring hair loss condition that is characterized by deep inflammation and leads to the formation of draining sinus tracts (especially tunnels that allow pus and inflammation to escape). The diagnosis of DSC in advanced stages is easy as these openings (sinus tracts) can be seen all over the scalp. In early stages, up close exam and use of a dermatoscope can prove extremely helpful.

Early DSC is characterized on dermoscopy by large yellow dots, thin vellus hairs within the area, broken hairs and healing (covered) or open sinus tracts. This picture shows a sinus tract at an earlier stage than the picutre yesterday (panel 4 in our 5 day series). There is inflammation in the skin which gives a red color.


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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Bald spots

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Bald spots


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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MPB

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MPB


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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Oily Skin

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Oily Skin


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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Dissecting Celluliti(DSC)

Healed Sinus Tracts

We will continue our week's theme of Dissecting cellulitis (DSC), a rare scarring hair loss condition. It is characterized by deep inflammation and leads to the formation of draining sinus tracts (especially tunnels that allow pus and inflammation to escape). The diagnosis of DSC in advanced stages is easy as these openings (sinus tracts) can be seen all over the scalp. In early stages, up close exam and use of a dermatoscope can prove to be extremely helpful.

As seen yesterday, early DSC is characterized on dermoscopy by large yellow dots, thin vellus hairs within the area, broken hairs and healing (covered) or open sinus tracts. This picture shows a healed sinus tract (arrow).


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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Dissecting cellulitis (DSC)

Dissecting cellulitis (DSC) is a rare scarring hair loss condition. It is characterized by deep inflammation and leads to the formation of draining sinus tracts (especially tunnels that allow pus and inflammation to escape - see number 1 and 4 in the picture). The diagnosis of DSC in advanced stages is easy as these openings (sinus tracts) can be seen all over the scalp. In the early stages an up close exam and use of a dermatoscope can prove extremely helpful.

Early DSC is characterized on dermoscopy by large yellow dots, thin vellus hairs within the area, broken hairs and healing (covered) or open sinus tracts. The early stages of the nodule can mimic alopecia areata (see top right, number 3 and 5). A swiss cheese like appearance is common as scarring progresses (number 2). Biopsies of DSC often show deep inflammation but in more advanced cases show inflammation higher up in the skin which can easily be mistaken for another scarring alopecia known as "folliculitis decalvans." Therefore, it is not uncommon for patients to be referred with a diagnosis of biopsy "proven" folliculitis decalvans only to need to explain to them after examining their scalp that what they actually have is DSC.


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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