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QUESTION OF THE WEEK

Dr. Donovan's Articles

QUESTION OF HAIR BLOGS

Scalp Biopsies

Where Should the Sample Come From?

Scalp biopsies are very helpful in situations where the diagnosis is not clear. A 4 mm punch is the minimum size and the specimen should always be obtained from a region on the scalp that has the highest chance of showing diagnostic features under the microscope.

The use of dermoscopy (trichoscopy) greatly increases the chance that a biopsy will lead the clinician to the correct diagnosis. The blue dot in the picture shows an area that was selected for a biopsy.

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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The New Normal: Well Understood for those Living with Chronic Conditions

The New Normal: 

It was several years ago that I first heard the term "the new normal." I remember the day and where I was standing. I remember the patient. I really don't know why the day stands out so vividly among days that have so many other memories. But it does.

It was a busy clinic day. I was running a bit behind. There were a few too many patients added to my clinic list before I was to leave for a meeting abroad. A patient was describing her symptoms, and the way she was feeling and dealing with hair loss and how the world around her was equally responding to her changes and feelings.

 

"It's the new normal, Dr. Donovan."

 

The New Normal

The term "new normal" has many meanings. Those living with a chronic health conditions understand what is meant by the "new normal." There is no good definition but it refers to a resetting of some kind of internal mechanism to deal with new changes in how one looks or feels after experiencing a change in his or her health. At least that's my definition.

New Normal and Hair Loss

The new normal is often talked about in the context of patients living with cancer, heart disease or other chronic internal illness. But it equally applies to many with hair loss.  

Significant hair loss, especially if it occurs suddenly causes severe emotional distress for many patients.  For some whose hair loss is likely to be of a more permanent nature, an entirely new means of coping sets in. Such patients often tell me that they find their "new normal." To say that they accept their hair loss is not accurate for all patients. To say that they learn to deal with it is also not accurate for all patients. But they will tell me it's their new normal.

Some of my patients with alopecia totalis, alopecia unversalis and some forms of advanced scarring alopecias will tell me that over time they find their new normal slowly. For some, the new normal is explaining their hair condition to family. For others it'stalking about hair with their friends, hairdressers or even complete strangers.  

For some with scarring alopecias, or hair loss from systemic illnesses like lupus, the new normal relates not only to the emotions and feelings that come with hair loss but actual physical symptoms. This might be the chronic itching or chronic fatigue they experience that comes and goes even when on the very best of medications.   

 

"It becomes the new normal, Dr. Donovan."

 

Conclusion

The "new normal" refers to something different for every one of my patients who use the term.  I have learned over the years that it does not necessarily mean that the patient is doing fine or coping well with a new emotional or physical change in the body. It simply means their internal mechanism for dealing with chronic life changing event has been reset.  

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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How can one identify a telogen hair?

Hairs that are shed from the scalp are known as telogen hairs. These hairs lack pigment at the very end and do not have a root sheath around the ends either. Telogen hairs are known as "club hairs."

I always encourage my patients to bring in hairs they shed if they are worried about the type of hair they are seeing. 99.9 % of the time the hairs they see are telogen hairs. About 30-70 telogen hairs are released from the scalp each day. In some hair loss conditions (such as telogen effluvium), an increased number of telogen hairs are released every day

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Answering Hair Loss Questions

3000 on Realself.com

I enjoy educating others about hair loss. I'm always willing to provide some facts, educational information and scientific backing to clarify one or more issues. Some patients ask questions on our website, some on Instagram account, some on Twitter and Facebook. People have really good questions about the diagnosis and treatment of an array of hair issues. Many times, I simply need to know more information from the patient and see the patient myself (to examine the scalp up close) in order to provide an answer. But often questions from the public that are of a more general nature can be addressed fully through these various online sources and social media sites.

I was informed that that I had answered 3,000 questions from patients on the website Realself.com. I have participated in this particular website for several years now, helping to answer questions from patients who have real concerns and real worries. It's hard to believe it's been 3,000 questions!

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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