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QUESTION OF HAIR BLOGS


Smoking and Balding: Does smoking Impact Natural Balding?

Does smoking Impact Natural Balding?

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Genetic hair loss, also known as androgenetic alopecia, male pattern balding (men), female pattern hair loss (women), is controlled to a significant degree by inherited genes.

Nevertheless, there are several environmental risk factors that influence the speed and progression of androgenetic alopecia.

Smoking is among the most influential of these. In 2017, Fortes and colleagues showed that smokers at nearly 7 times more likely to have moderate to severe balding. The effect of smoking on balding was identified in several other studies as well.

Other risk factors including obesity seem to accelerate balding. A diet rich in fresh vegetables may protect against balding to some minor degree.

References

Fortes et al. The combination of overweight and smoking increases the severity of androgenetic alopecia.
Int J Dermatol. 2017.

Schou et al. Alcohol consumption, smoking and development of visible age-related signs: a prospective cohort study. J Epidemiol Community Health. 2017.

Fortes et al. Mediterranean diet: fresh herbs and fresh vegetables decrease the risk of Androgenetic Alopecia in males. Arch Dermatol Res. 2018.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Random opinions vs Real Science: Do they carry similar weight?

Principles of Scientific Inquiry Remain Most Important

Society must continue to protect the ability of a given individual to express his or her opinion. The opinion of another person, however, must never share the same spotlight with factual information that was obtained and validated using the principles of scientific inquiry. We must continue to protect the access of the world to accurate information.

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We can respect the view of a person who says that they believe the world is flat but we would never accept this view to permeate the classrooms and textbooks of our children.  Similarly we can respect the view of a person who says that they believe a certain treatment for hair loss will help. However, without proof, we must never accept this view to permeate the classrooms and textbooks of our health care providers and the magazines and media sources of the public. It is a dangerous and slippery slope when opinions of others shares similar influence as validated science.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Scalp Camouflaging Agents: A Closer Look at DermMatch

A Closer Look at DermMatch

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Scalp camouflage refers to a variety of methods to reduce the appearance of hair loss. Hair camouflaging agents include hair fibers, powder cakes, lotions, sprays, hair crayons, and scalp micropigmentation.

DermMatch is a so called “powder cake” and is applied to the scalp with an applicator. The popular product colors the scalp and also binds hairs. It is available in a variety of colors. DermMatch is safe to use and provides very effective camouflage for individuals with early staged hair loss.

Male and female patients with androgenetic alopecia, telogen effluvium, alopecia areata and even some localized scarring alopecias have found these products very helpful to reduce that appearance of hair loss.

Reference

Donovan J et al. A review of scalp camouflaging agents and prostheses for individuals with hair loss. Dermatol Online J. 2012.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Dengue Infections and Hair Loss: What is the mechanism of hair loss?

What is the mechanism of hair loss?

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Dengue fever is an illness caused by the Dengue virus which is spread from the mosquito. It has the potential to cause a very severe and even fatal illness. About 400 million infections occur per year making it a common infection.

Individuals infected with Dengue virus usually develop symptoms a few days to 2 weeks after being bitten. Symptoms are very similar to the common flu and include high fever, a very bad headache, pain behind the eyes, joint pain, muscle pain, vomitting, rashes and internal bleeding problems.

Hair loss is fairly common with dengue fever. Hair loss occurs usually a few months after the illness starts and lasts a few months for most. The hair loss from Dengue can be quite dramatic in some cases.  The hair shedding from Dengue eventually stops on its own. There is not a lot that can be done to help it ... other than for the individual to continue to get better.

Although the hair loss that occurs from Dengue is typically though to occur via a mechanism of “telogen effluvium” (hair shedding), new research from Taiwan suggests hair loss from Dengue might be more complex. Researchers showed that human hair follicle dermal papilla cells (HFDPCs) were susceptible to Dengue virus infection and this lead ultimately to inflammation and cell death in HFDPCs.

Further research is needed to understand the long term sequelae of Dengue virus infection and to confirm whether hair regrowth is the norm for all patients.

Reference

Wei KC et al. Dengue Virus Infects Primary Human Hair Follicle Dermal Papilla Cells. Front Cell Infect Microbiol. 2018.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Seborrheic Dermatitis: Do Dietary Preferences Play a Role?

Do Dietary Preferences Play a Role?

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Seborrheic dermatitis is a red scaly condition that affects multiple sites including the scalp. It is thought to be closely related to dandruff. Multiple factors contribute including Malassezia yeast. Other factors such as stress, ultraviolet radiation and several others factors too also play a role.

A recent study of 4,379 participants sought to examine the relationship between dietary factors and the development of seborrheic dermatitis. 636 of the participants (14.5%) had seborrheic dermatitis. Data analysis identified specific dietary patterns such as a 'Vegetable', 'Western', 'Fat-rich' and 'Fruit' dietary pattern.

Interestingly, a fruit-rich diet was associated with a 25 % reduction in the risk for seborrheic dermatitis. A Western type diet (high in red meat and processed food) was associated with a 47 % increased risk of seborrheic dermatitis but this dietary pattern seemed to have a link only for women.

The conclusion to the interesting study was that dietary choices likely do impact the development

of seborrheic dermatitis. A fruit-rich diet in particular may reduce the risk.


Reference


Sanders MGH et al. Association between diet and seborrheic dermatitis: a cross-sectional study.
J Invest Dermatol. 2018.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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On the Meaning and Significance of Hair

Everyone has a Different View on Hair

The way two people think about their hair or their hair loss is not only unlikely to be the same - it’s also practically impossible. Our cumulative experiences from birth to the present influence how we come to view many things in our lives, including our hair.

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Every part of the life journey matters. The way that a patient’s hair was brushed, washed or styled at age 3 influences, beyond any morsel of doubt, the way they think about their hair at age 23 or 63. The way the individual feels their hair looked like in the class photo from middle school affects how the high school student feels about their hair and ultimately how the same adult now thinks about his or her hair.

Comments and actions from family, friends, and teachers in childhood impact on how our emotions and thinking ultimately develop and influence exactly how we come to view our hair.

Our schooling, our jobs, our relationships, our hobbies - they all matter. What we choose to read, what we choose to watch and what we chose to listen to - it all matters to the meaning and significance each of us attaches to our hair. Every glance we have ever given our reflective self in the mirror, and every selfie we have ever taken further shapes these views.

Despite the world population of nearly 8 billion people, and countless generations of people in the past, there has yet to be two people who think about their hair or about their hair loss in a completely identical way.

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No two people have ever shared an identical life journey and no two people have ever yet come to think about their hair in an identical way.







Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Black Dots: Hair dye as an example

Hair dye as an example

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Magnified and dermatoscopic images of the scalp have an important role in making proper diagnoses. Black dots (as shown here) are a dermatosocpic sign that is encountered from time to time.

There are many causes of black dots that must be considered. Black dots are seen in alopecia areata, tinea capitis, traction alopecia and rarely some scarring alopecias too. Other causes are possible too and this list is not complete. Black dots generally represent hair follicles that have broken off at the level of the scalp. Black dots can also be caused by a variety of different “dyes” that dye the hair follicle opening and therefore do not actually represent broken hairs.

In this photo, the black dot represent recent use of hair dye that has colored the hair follicle opening or “pore.” Other types of dyes, such as anthralin used in alopecia areata treatment, also color the opening.



Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Lichen Planopilaris (LPP): Scalp Symptoms: none to severe

Scalp symptoms: none to severe

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Lichen planopilaris (LPP) is a scarring alopecia that has the potential to cause progressive and permanent hair loss.

Affected individuals typically first notice increased daily hair shedding and this is often accompanied by scalp symptoms such as itching, burning, tingling, tenderness or pain. Some patients, however, do not have symptoms.

This photo shows the scalp of a patient with LPP who has marked scalp symptoms. Repeated itching of the area has triggered skin excoriations and localized bleeding. This is one indication that the disease is active.

There are several treatments that can help slow it down or stop it but regrowth does not happen to a significant degree for most. Treatments include topical steroids, steroid injections and a range of oral medications such as doxycycline, hydroxychloroquine, methotrexate, mycophenolate, cyclosporine and low level laser. Options like low dose naltrexone, and tofacitinib may also be options.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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The Patient in the Room is an Expert

The Patient as Expert

The patient is an expert in his or her hair loss. Nobody really knows more about all the facts surrounding their hair loss than they do. Of course, the patient might not even know they are an expert, but they are an expert. The patient knows when their hair loss started, which parts of the scalp are more affected by the hair loss than others, which parts itch and what seems to help the hair to grow. The patient can explain more about the ins and outs of their hair loss than anyone.

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It’s true that the physician in the room is also an expert. He or she knows how to piece all the patient’s information together and what features on the patient’s examination or blood tests are relevant and which are not. The physician knows what the diagnosis is likely to be and what it simply can not be. But none of this is possible without the expertise of the patient.

I have come to realize that the patient’s story about his or her hair loss is actually more important than most give credit to. Of course, examining the scalp is important but in challenging diagnoses, it’s the patient’s story that often pushes the referral from a ‘long time mystery’ to an interesting or challenging diagnosis that finally gets solved. The patent’s story helps rule out hair loss conditions that simply don’t fit and rule in conditions that have not been thoroughly considered in the past.

The patient and physician both have expertise. However, nobody in the room will have more cumulative days and years of experience of experience with the hair issues in question than the patient in the room


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Biotin and False Test Results: Stopping Before Blood Tests is Essential

Stopping Before Blood Tests is Essential

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Many supplements contain biotin at levels well above the recommended daily intake of 30 micrograms. It is now recognized that high doses of biotin can interfere with some laboratory tests (specifically immunoassays using biotinylated antibodies). Many supplements contain 2 500, 5 000  or even 10 000 micrograms of biotin.

Both falsely low and falsely high results are possible in users of biotin supplements. The concern is that some patients might undergo unnecessary testing or start unnecessary medications after being told their blood test results are abnormal.

The issue is therefore potentially quite serious. In November 2017, the US Food and Drug Administration recently issued a safety communication regarding biotin interference with laboratory tests.

A recent report in the Journal of the Endocrine Society reported a patient with abnormal thyroid results, as well as elevated cortisol and testosterone. These abnormal results prompted the patient to undergo numerous consultations and radiographic and laboratory tests.

It was ultimately discovered in this patient that her abnormal results were due to the biotin supplement she was using. The patient was taking a biotin supplement at a dose of 5 000 micrograms per day regularly.  Once she stopped biotin, her lab parameters returned to normal although TSH tests (thyroid testing) did take more than 2 weeks before any normalization was seen.

This reports highlights the potential for patients using biotin to have false results. What is more concerning is the potential for such patients to undergo potentially invasive testing or start potentially harmful medications on account of these results.

Education as well as communication between health care teams, laboratorians, and patients is vital to ensure patients stop biotin well ahead of any testing.

Reference

Stieglitz HM, et al. Suspected Testosterone-Producing Tumor in a Patient Taking Biotin Supplements.
J Endocr Soc. 2018.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Androgenetic Alopecia: Variation in Hair Caliber (Anisotrichosis)

Variation in Hair Caliber (Anisotrichosis)

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Individuals with androgenetic alopecia (male balding and female pattern hair loss) may lose hair at different sites of the scalp (some front, some crown, some diffusely) but all show a variation in the caliber of hairs when the scalp is examined up close. That feature is known as “anisotrichosis.” This photo shows the scalp of a patient with androgenetic alopecia. Some hairs are thick (well above 60 micrometers) and a known as terminal hairs. The arrow on the right points to one fairly thick 77 micrometer hair.

Other hairs on the scalp are thin including many that are showing “miniaturization” or the progressive reduction in calibers. Hairs that are thin, small and less than 30 micrometers are traditionally called “vellus hairs.” One very thin 21 micrometer hair is shown in the photo.

The conversion of terminal hairs to vellus hairs is the hallmark of androgenetic alopecia.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Lichen planopilaris: Shedding, Itching, Burning, Tenderness

Shedding, Itching, Burning, Tenderness

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Lichen planopilaris (“LPP” for short) is a type of hair loss that is categorized as a type of so called scarring alopecia.

There is no single way that LPP first announces its presence. Some people have only scalp itching. Some have burning. Some have itching and burning along with a bruised-like tenderness in the scalp. Surprisingly, a small proportion of patients with LPP have no symptoms at all.

Many patients notice they are shedding more hairs on a daily basis than they once did.

Eventually, some patients develop an area of hair loss on the scalp that concerns them and brings them to the doctor.

In many cases the diagnosis can be determined by simply looking at the scalp but often a biopsy is performed to confirm the diagnosis. A biopsy shows the presence of both inflammation beneath the scalp (in a specfic pattern) as well as scar tissue (fibrosis). Treatments include topical steroids, topical calcineurin inhibitors, steroid injections, and a variety of oral medications (doxycycline, hydroxychloroquine, methotrexate, cyclosporine, mycophenolate, isotretinoin, low level laser, excimer laser, tofacitinib).


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Using Alcohol while taking Methotrexate: Is their a risk of liver injury?

Consuming Alcohol while on Methotrexate

Methotrexate is an immunosuppressive type pill that is used in the treatment of several autoimmune hair loss conditions including alopecia areata, lichen planopilaris, frontal fibrosing alopecia, and discoid lupus. A variety of side effects are possible with methotrexate including the risk of liver toxicity. 

 

Alcohol Use in Methotrexate Users

Both alcohol and methotrexate can irritate the liver.  On account of this, individuals using methotrexate need to have their liver enzymes monitored periodically. Traditionally, physicians have advised patients using methotrexate to limit their use of alcohol while using methotrexate.  New data suggests that while these concepts are correct, the use of limited amounts of alcohol by methotrexate users does not appear to increase the risk of liver injury.

The UK based authors studied the effects of alcohol consumption in rheumatoid arthritis patients using methotrexate. It's important to note that these were note hair loss patient and therefore the results need to be extrapolated. The researchers studies 11 839 patients over the years 1987 to 2016. They observed that there were 530 episodes of liver enzyme elevation (i.e. "transaminitis"). The authors found that methotrexate users who consumed less than 14 units of alcohol per week did not seem to have an increased risk of transaminitis. Patients who consumed between 15 and 21 units seemed to have some degree of liver injury and patients who consumed more than 21 units had a significantly increased risk of transaminitis.

 

Conclusion

This is an important study. Many patients with autoimmune hair loss conditions make decisions on use of methotrexate based on the potential side effects and the information they are presented about the necessity to limit alcohol consumption while using methotrexate. This study provides evidence that occasional use of methotrexate is likely to be safe from the perspective of liver injury and that keeping under 14 units is also likely to have a good liver safety profile.  14 units of alcohol would include 6 glasses of wine (13 %, 175 mL) or 6 pints of beer.

 

 

 

Reference

Humphreys J et al. Quantifying the hepatotoxicity risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Ann Rheum Dis. 2017 Sep;76(9):1509-1514.  


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Scalp Biopsies: Expert Interpretation Needed

Expert Interpretation Needed

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Scalp biopsies have multiple steps but all end with a pathologist sitting at his or her microscope looking at a slide like the one shown here.

A biopsy is important but not more important than the patient’s story (ie the “medical history”) and not more important than the actual clinical scalp examination. The biopsy is merely another tool to get information about the possible cause of the patient’s hair loss.

To perform a scalp biopsy properly, one must ensure a 4 mm punch size is used an taken from the right area of the scalp. The sample must be processed properly by the pathology laboratory and ideally should be assessed by a dermatopathologist who has a good amount of experience in scalp biopsies.

It is surprisingly for some to learn that biopsies are not the gold standard in diagnosing hair loss they are simply a tool. Incorrect interpretations are possible (false positives and false negatives)


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Late Onset Alopecia Areata: What are the Features?

Late Onset Alopecia Areata (LOAA)

Alopecia areata is an autoimmune disease that affects about 2 % of the world. About 50 % of patients who develop alopecia areata will develop their first episode of hair loss before age 20. The development of the first episode of alopecia areata after the age of 50 is uncommon.  Alopecia areata first occurring after age 50 is frequently referred to as late onset alopecia areaeta (LOAA).

 

What are the characteristics of patients who develop LOAA? 

In 2017, Lyakhovitsky and colleagues set out to determine the features of patients who develop LOAA. They performed a retrospective cohort study of patients visiting a tertiary centre over the 6 year period (January 2009 and April 2015).

Of 29 patients in their study who were found to have LOAA, 86.2% were female (female-to-male ratio, 6.2:1). There was a family history of alopecia areata in 17.2%, thyroid disease in 31%, atopic background in 6.9%, and 17/29 (58.6%) reported a significant stressful event. The most common disease pattern observed as the so called 'patchy' subtype. Interestingly the disease was mild in the majority of participants. Complete hair regrowth was observed in 82.8% of participants, and 37.9% relapsed.

 

Conclusion and Comments

This is a nice study which examines the characteristics of patients who develop their very first patch of alopecia after age 50. This group of patients appears have have less extensive disease, and frequently has complete hair regrowth. Affected patients are more likely to be  female than male.   

 

REFERENCE

Lyakhovitsky A, et al. Dermatology. 2017.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Mitochondria, Hair Loss and Hair Growth:

What are mitochondria and why do they matter?

If one thinks back to their earliest high school biology days, they'll likely remember learning about mitochondria. These are tiny 3 micrometer organelles that lie inside cells.  Mitochondria are essential components and play a key role in helping cell product energy. When one thinks of metabolism of muscle cells, liver cells, brain cells, one is really talking about mitochondria.  These are frequently referred to as the 'powerhouses' of the cell. 

 

A new study points to key role for mitochondria in hair loss

Most living (nucleated) cells have mitochondria, including many cells that make up the hair follicles. A new study from the University of Alabama at Birmingham nicely demonstrated just how important mitochondria are. When a mutation leading to mitochondrial dysfunction is induced in mice, the mouse develops visible hair loss in a matter of weeks. When the mitochondrial function is restored by turning off the gene responsible for mitochondrial dysfunction, the mouse regains thick fur, indistinguishable from a healthy mouse of the same age.

The researchers are interested to use this model to more thoroughly study mitochondrial function in a variety of states, including aging. Some treatments for hair loss are known to affect mitochondrial function - including low level laser therapy (LLLT).

Further research will elucidate if an how we can treat hair loss by affecting the function of these tiny organelles known as mitochondria.

 

REFERENCE

Bhupendra Singh, Trenton R. Schoeb, Prachi Bajpai, Andrzej Slominski, Keshav K. Singh. Reversing wrinkled skin and hair loss in mice by restoring mitochondrial functionCell Death & Disease, 2018; 9 (7) DOI: 10.1038/s41419-018-0765-9


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Lyme Disease and Hair Loss: What types of hair loss are possible?

What types of hair loss are possible?

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Lyme disease is an infectious disease caused by bacteria known as Borrelia. These bacteria are typically spread by ticks, such as the one I photographed here.  Most people develop a rash at the site of the tick bite (often shaped like a "bull's eye" as it spreads). Not everyone develops the rash. If untreated, patients with Lyme disease can develop neurological problems, heart problems and arthritis many years later. About 300,000 people in the United states are affected yearly by Lyme disease.

Lyme disease gets transmitted to humans when a specific tick known as the Ixodes tick bites the skin. What's unique about these ticks is that the tick must be attached to the skin for 36-48 hours before the bacteria can be spread. This means that if humans can identify the tick on their skin before the 36 hour mark (and remove it gently with tweezers), it may be possible to prevent the disease.

The frequency of hair loss in patient's with Lyme disease has not been carefully studied. Lyme disease may cause a diffuse hair loss similar to a telogen effluvium. One study from 1999 suggested that telogen effluvium occurred within three months after the outbreak of disease in 13 % of patients with Lyme meningitis and in 56 % of patients with encephalitis. Lyme disease has also been implicated in one subtype of scarring alopecia (Psuedopelade of Brocq) although this remains to be verified in repeat studies. Some researchers have suggested a role for Lyme Disease in patients with Morgellons Disease (a skin disease whereby patients identify fibers within the skin, under the skin or projecting from the skin). Overall, Lyme disease may cause hair loss. A history of a tick bite and spreading bull's eye rash can be helpful early clues in the diagnosis. Antibody tests are available for Lyme disease, but they are not useful in the early stage. They are more helpful in the diagnosis of later stages.  Testing is typically a two-stage process beginning first with a test known as an “ELISA” test. Patients who test positive with the ELISA test then undergo testing using a “Western Blot.”

Reference

Cimperman J, et al.
Wien Klin Wochenschr. 1999.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair, Feathers and Scales: How much do they have in common?

How much do they have in common?

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At first glance, it would seem like birds, mammals and reptiles are about as different as could be.

That’s of course until you speak with Dr Milinkovitch and his group in Switzerland about their landmark study in 2016. 
His data, which comes from studying specific reptile species points to the possibility that feathers and hair are in fact more closely related than ever imagined. Birds and mammals (including humans) are thought to share a common ancestor some 320 million years ago!

Scales in reptiles, feathers in birds and hair in mammals appear more closely related than once imagined.
 

Reference

Nicolas Di-Poï and Michel C. Milinkovitch. The anatomical placode in reptile scale morphogenesis indicates shared ancestry among skin appendages in amniotes. Science Advances  24 Jun 2016:Vol. 2, no. 6.
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Gummy Vitamin Use by Hair Loss Patients

Gummy Vitamins

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lI've noticed a fascinating trend in my hair clinic over the last decade: patients are increasingly consuming their multi vitamins by eating them in the form of 'gummies.' They love the taste and find them easy to take. Not a day goes by where a bottle of gummies does not emerge from a bag to be placed on my desk. 
The multivitamin industry is estimated to be a 7 billion dollar industry in the US alone; gummy multivitamins account for about 8 % of this industry. According to some estimates, there has been a 25 % increase in gummy sales in the past 3 years. Worldwide, gummy vitamin sales ares expected to increase from its present 2.7 billion dollar estimate to 4.2 billion by 2025. North Americans are chomping on the gummies at the highest rates with Europe in second place.

Gummy multivitamins are now produced in a variety of shapes and flavours. Gummy bears and gummy fruits are popular. For those who don't want the extra sugar that many gummy multivitamins contain, there are now sugar free versions.

My views on multivitamins are simple: if one is deficient in a particular vitamin or mineral, it makes sense to replenish it.  Getting vitamins through foods (i.e. fruits and vegetables) remains a far better option that through vitamins.  If this is not an option, or foods do not seem to restore levels, one can consider multivitamins.  Multivitamins may be particular important for certain subpopulations - including the elderly, alcoholics, patients undergoing bariatric surgery and women taking oral contraceptives. Many patients however require a different mix of vitamins and minerals and a one fits all approach may not work.

I am willing to admit that there may be some evidence that supplementation of certain compounds could be beneficial for some patients even if one is not deficient. Examples of this later category include amino acids like L-lysine and cysteine although more research is needed.  Overdosing on vitamins is common and could have negative effects on the body and hair.  High levels of vitamin A are well understood to cause hair loss.

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Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Diphencyprone for Alopecia Areata: Can one apply DPCP at home?

Can one apply DPCP at home?

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Diphencyprone (“DPCP”) is a unique treatment for alopecia areata that has been used for over 25 years.

What’s unique about DPCP is the fact that it causes an allergic reaction on the scalp which in turn alters the type of inflammation present in the skin and around hair follicles. By doing so, hair has the potential to grow because the immune system is no longer attacking it.

For years, DPCP treatments were exclusively done in highly specialized dermatology clinics. Fewer clinics are offering DPCP nowadways because of staffing issues (lots of nurses and physicians are needed!) and because many of the staff frequently becomes allergic themselves to the DPCP over time.

For many years, clinics have started offering patients the option of having the DPCP applied at home. Often a spouse, parent or friend will be trained to properly and safely apply the DPCP for the patient. This is frequently termed “outpatient” DPCP. Many clinics around the world, including ours have been supporting patients with “outpatient” DPCP for many years.

A recent study by Lee and colleagues showed that outpatient DPCP is just as safe as DPCP application in a dermatology clinic setting. This is great reassurance for the large numbers of patients who could potentially benefit from this much underused and often forgotten about treatment. DPCP can be safety applied at home provided patients and family members receive proper training on application techniques and safety principles.
 

Reference

Lee S et al. Home-based contact immunotherapy with diphenylcyclopropenone for alopecia areata is as effective and safe as clinic-based treatment in patients with stable disease: A retrospective study of 40 patients. J Am Acad Dermatol. 2018


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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