Will Spiro work?
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This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
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.
I posted an answer to a new question on Realself.com
Hair transplants and minoxidil for scarring alopecia: Does it help?
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
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).
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.
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
I posted an answer to a new question on Realself.com
Amphetamines are a group of drugs that stimulate the central nervous system. They have been used since the 1920s. Amphetamines are used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy and obesity. At higher doses, amphetamines are also drugs that are frequently abused.
Most amphetamines are prescription based and include drugs such as:
1. Dextroamphetamine
2. Levoamphetamine
3. Lisdexamfetamine
4. Methamphetamine
5. Adderall and Adderall XR
6. Dexedrine
7. ProCentra
8. Ritalin
9. Concerta
10. Dextrostat
11. Vyvanse
12. Focalin
13. Strattera
14. Zenzedi
15. Evekeo
Hair loss is a possible side effect of amphetamines. It does not happen to everyone but a proportion are affected. Hair loss typically occurs 4-7 weeks after starting. Daily shedding increases from well under 70 to above 100. Hair loss occurs all over the scalp rather than in any given area. Hair loss from amphetamines can also occur on the body hair.
Hair loss can be from the drug itself or the caloric and nutritional deficiencies that come from the appetite suppressing effect of these drugs.
It is important for anyone with suspected amphetamine induced hair loss to see a physician. The first step is to determine if the timing of the hair loss and the type of hair loss pattern fit with a diagnosis of amphetamine induced hair loss. On some occasions, the hair loss and amphetamine use is simply a coincidence. If the amphetamine use is thought to be contributory, it is important to determine if the patient has a telogen effluvium from the actual drug, or from a nutritional deficiency that the drug has brought about or from another cause such as androgenetic alopecia. Blood tests are necessary for anyone with amphetamine induced hair loss to look for underlying nutritional deficiencies. Sometimes a hair collection or biopsy is also performed.
In many fields of medicine, the pathology report provides the final answer as to a patient's diagnosis. We're most familiar with this for example with cancer diagnoses. It comes as a surprise for many patients that scalp biopsy reports are sometimes not so definitive.
A great example is the diagnosis of early androgenetic alopecia (AGA and early lichen planopilaris (LPP). Sometimes it is pretty clear cut - but not always. Sometimes a diagnosis of LPP is made and the patient really has AGA. Sometimes (although much less commonly) a diagnosis of AGA is made and the patient really has LPP.
Lichen planopilaris (LPP) is a scarring alopecia that typically starts with scalp symptoms such as itching and burning. Sometimes the scalp is quite tender in areas. Shedding is often present as well. LPP affects similar areas to androgenetic alopecia (female pattern thinning) so it is a close mimicker. In the early stages, some scalp redness may be present and inflammation may be seen around the hairs clinically.
Androgenetic alopecia (AGA) also starts with shedding. There can be a hint of itching/tingling but not too often. Usually the front of the scalp is more affected by hair loss than the back.
A biopsy can be very helpful provided it is read by an experienced dermatopathologist. Traditionally we have thought of AGA as "non inflammatory" and "non scarring" so one might not think that inflammation and scarring should be present on the biopsy. We know now that's not completely true. Inflammatory infiltrates are present in AGA in the upper hair follicle and so is loose perifollicular fibrosis. In LPP biopsies, inflammation is also present in the upper hair follicle but it specifically appears to be attacking the hair follicle outer root sheath. (We call this "lichenoid" change). To differentiate AGA and LPP one needs to direct their attention to this specific change in the actual hair follicle. When this specific immune attack is seen, one needs to consider LPP over AGA. Also the amount of perifollicular fibrosis is usually greater as LPP advances. LPP may have other changes in the skin as well that help differentiate it from AGA.
So by biopsy, androgenetic alopecia and LPP can be confused as both can have inflammation (perifollicular inflammation in the isthmus) and both can have scarring (perifollicular fibrosis). An experienced dermatopathologist can sort this out.
One needs to take into account the patient's entire story. If a physician just biopsies every patient that comes into the office, I can guarantee one will make a whole lot more diagnoses of LPP than truly are present. I'm a big believer in this - even though LPP is under diagnosed in the world! But by listening to the patient's entire story, and examining the scalp and reviewing what the biopsy shows (not just the final read out on the bottom line), one can usually get a fairly good sense. However in rare cases - time is the best judge as a missed case of LPP will likely declare itself over time.
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