Hair Blogs


2nd FDA Cleared Cold Cap

Preventing Chemotherapy Hair Loss

Hair loss during chemotherapy has a major impact on quality of life. Some patients rate hair loss as one of the most negative aspects of their chemotherapy. Scalp cooling with various cold caps has emerged as a means to reduce the chances of hair loss during chemotherapy. In December 2015 the Dignicap was FDA cleared and now this month the Paxman cooling system received FDA clearance.

In the Dignicap study, 67 of 101 women in the study who used the DigniCap Scalp Cooling System (66.3%) lost less than half of their hair, when followed for a month after the last chemotherapy cycle. In comparison, all women who did not receive scalp cooling lost more than half of their hair. The most common chemotherapy regimen was docetaxel/cyclophosphamide for 4-6 cycles.

In the Paxman trial, patients receiving scalp cooling wore the device for 30 minutes before their chemotherapy treatment, for the duration of their treatment, and for 90 minutes following treatment. These women had stage 1 or 2 breast cancer and were receiving a broader range of chemotherapies. Out of the 95 patients who used the Paxman device, 48 (50.5 percent) lost less than 50 % of their hair (meaning no wig or scarf was needed, compared to 0 (0 percent) in the no cooling group. 
Conclusion: Scalp cooling is a highly effective method to reduce hair loss associated with certain types of chemotherapy. I thank Richard Paxman for sharing with me a photo of the newly FDA cleared device.

Reference
Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial.
Randomized controlled trial
Nangia J, et al. JAMA. 2017.


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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Rogaine

I posted an answer to new question on Realself.com

Rogaine


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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Dialated Blood Vessels and Scalp pain

Trichodynia refers to hair pain. There are many potential causes of trichodynia. A study by Willimann and Trueb (in 2002) showed that dilated blood vessels seen in the scalp were strongly associated with trichodynia.

Reference
Willimann B, et al. Hair pain (trichodynia): frequency and relationship to hair loss and patient gender. Dermatology. 2002


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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Scino 5

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

Scino 5


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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Scalp Psoriasis

Options for Thick Scale

Psoriasis is an inflammatory condition that increases the rate that skin cells grow. Thick scale is commonly seen and in some cases is challenging to remove.

The use of salicylic acid shampoos, tar shampoos, and combinations of both are frequently a good first step. Application of steroid oils overnight with use of a shower cap also softens scales. Steroid shampoos and steroid injections may be needed along with oral medications or biologic agents for those with extremely thick scale.
 


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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SCALP DYSESTHESIAS: Misunderstood, Misdiagnosed, and Poorly Managed

SCALP DYSESTHESIAS: 

It comes as a surprise that some patients have a scalp that hurts, burns, stings or itches - even when it looks perfectly fine.  Many of these patients have what are called 'scalp dyesthesias.' These conditions are often misdiagnosed.  

Scalp dysesthesia was first presented in the world medical literature by Hoss and Segal in 1998 as a  a syndrome characterized by itching, burning, stinging, or pain of the scalp - when other physical findings in the scalp are lacking.  In their original case series description of 11 patients - 7 had symptoms which were worsened by stress, 5 patients had at least 1 known psychiatric disorder (depressive type symptoms, anxiety, somatization). Interestingly,  9 patients had symptom improvement with low-dose antidepressant treatment.

 

In 2013, Thornberry and colleagues from the University of Pittsburg examined the medical records or 15 women with scalp dysesthesia. 14 of these women had cervical spine disease. This included problems in the C5-C6 region of the cervical spine, anterolisthesis, osteophytic spurring, lordosis, kyphosis, and nerve root impingement. Treatment with gabapentin (topical or oral) had been recommended. 4 of the 7 patients that they had long term data on noted improvement in symptoms when taking gabapentin. 

 

COMMENT

The scalp dysesthesias remain an area of dermatology that is poorly researched and poorly understood. We are moving towards an understanding that these are complex disorders with multiple reasons for their cause. Yes, some patients with scalp dysthesisas do have underlying depression and anxiety that is contributing to their symptoms, but not all such patients. In a similar light, disease in the cervical spine may contribute to a subset of patients with scalp dysestheias - but the actual proportion is unknown. We have a lot more to learn about these conditions, both in terms of cause and treatment. 

 

REFERENCE

Hoss and Segal. Scalp dysesthesia. Arch Dermatol. 1998 Mar;134(3):327-30.

Thornsberry and English. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol. 2013 Feb;149(2):200-3.

 

 


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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Anisotrichosis in Female AGA

Variation in Follicular Caliber

Variation in size of follicles is typical of androgenetic alopecia (hereditary thinning). This has been termed "anisotrichosis." In this picture of a female patient with androgenetic hair loss, it can be seen that some hairs are thick and some are much thinner. The decrease in caliber is due in part to a decease in the size of the dermal papilla (a part of the hair follicle).

Reference
Sewell L et al Anisotrichosis: A novel term to describe pattern alopecia. J Am Acad Dermatol 2007; 56: 856. 


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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Dry Shampoos

Dry shampoos are becoming increasingly popular. These products, whether they are powders or sprays help absorb oils and keep the hair fresh. Many people with hair loss love these products as they limit the amount of shampooing they feel they need - and therefore limit the emotional burden of seeing excess hair in the shower and drain. One of the risks of dry shampooing and the "no poo" (no shampoo) movement in general is the development of the red itchy flaky scalp condition known as seborrheic dermatitis (shown here). Patients with seborrheic dermatitis require anti yeast agents to control their scalp inflammation. These are typically available in shampoo form and require the patient to 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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