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Things to Consider when Latisse won't work

When Latisse Won't Work

Latisse is an FDA approved and Health Canada approved treatment for improving eyelash length, thickness and darkness in patients with eyelash hypotrichosis (not enough eyelashes). Latisse contains the ingredient bimatoprost.

Clinical studies have shown that Latisse is very effective for many user. Many notice changes as early as 4 weeks and 50 % have changes by the second month.  By 16 weeks, 80 % will have an improvement.



Latisse Non-Responders: When Latisse just doesn't work



Latisse is effective for many individuals. However, about 1 out of every 5 users is not going to find that the medication worked all that well for them.  A large proportion of the patients I see in my office come to see me wanting to know why Latisse did not work as good as the advertising stated it should.  Let's review some of the reasons for poor results.



1. The patient is simply in the "20 % group."


Latisse does not help everyone. By 16 weeks, 80 % will be pleased with the money they spent. 20 % won't. I tell my patients that someone has to be in the "80 % group" and someone has to be in the "20 % group." Not everyone responds to Latisse.



2. The bottle does not contain bimatoprost and so it is not Latisse.


Latisse is available through physician's offices (and some drug stores), but there are many other ways of obtaining Latisse and products that claim to be Latisse. I encourage readers to simply enter phrases such as "buy Latisse online" in their Google search engine to see the array of possibilities. Most of these sites will ultimately lead to a box of Latisse (containing the true ingredient bimatoprost) showing up at the door.  But not all.  Patients need to keep in mind the possibility of counterfeit products. It's rare but most certainly does happen.



3. The method of application is wrong.


One needs to apply Latisse nightly to the lower eyelid margin of the upper eyelid with the brushes provided. I can't tell you how many variations of this simple sentence there actually are. Like any drug, it needs to be used according to instructions.



4. The individual has a medical condition of the hair follicle.


It comes as a surprise to many individuals that there are well over 100 reasons for eyelash loss. Not all lash loss is simply due to "aging" or a "tainted bottle of mascara" that was used in the past or improper use of a heated eyelash curler. These certainly can cause temporary or even permanent lash loss. Rather a variety of inflammatory and autoimmune conditions are associated with eyelash loss. 



Eyelash Loss: What else?
 

A careful review of one's story (called the medical history) and up close examination of the eyelashes is needed to determine the cause. One must also examine the eyebrow and scalp hair at the same time as there is no other way to confidently come to the diagnosis.



Causes of eyelash loss include


1. Inflammatory and Autoimmune Conditions. Inflammation of the hair follicle can cause it to fall out. Alopecia areata, frontal fibrosing alopecia, Scleroderma/ en coupe de sabre and lupus are all potential causes.  A variety of true dermatological conditions can also cause lash loss including various eczemas, seborrheic dermatitis and psoriasis. In such cases it is scratching and rubbing that often leads to lash loss.

2. Trichotillomania. 3-5 % of the world will purposefully pull out one or more of their hair follicles somewhere on the body during their lifetime. When repeated, the diagnosis of trichotillomania needs to be considered. Plucking of the lashes is quite common and may even be one sided. 

3. Endocrine disorders. Isolated eyelash loss is uncommon in patients presenting with endocrine disorders. However, one needs to consider thyroid, parathyroid and pituitary disorders.

4. Infections. Infections with fungus, bacteria, viruses all have the potential to cause lash loss. Isolated lash loss is uncommon but can be seen with conditions such as leprosy and syphilis. 

5. Drugs. There are many drugs now implicated in lash loss ranging from cancer drugs to antidepressants (escitalopram) to diabetes medications (sitagliptin and metformin) to methylphenidate. Other drugs include blood thinners, cholesterol meds, propranolol, valproic acid. Even cocaine vapour can cause lash loss.

6.  Infiltrative Conditions. Eyelashes can fall out when cells enter the hair loss that normally don't reside there. Lymphomas are a good example. Eyelash loss can also occur with a variety of local tumors including basal cell carcinoma, squamous cell carcinomas, sebaceous carcinomas and many others.

7.  Nutritional Issues. Poor diets and specific deficiencies can all cause lash loss. This ranges from severe illness with marasmus, to deficiencies of protein, zinc and iron.

8. Congenital and genetic conditions. Many many genetic syndromes are associated with less than normal eyelash density. Well over 50 conditions fall in this category from KID syndrome, Rothmund Thompson syndrome, Incontinentia Pigmenti, Keratosis follicularis spinulosa decalvans, Progeria, Bloom syndrome, Menke's syndrome, Monilethrix to Trichothiodystrophy. Many many others are on this list as well.



Conclusion


There are many causes of eyelash loss. Not every cause of eyelash loss responds to Latisse.

 


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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Eyebrow Hair Loss: What things do we need to consider?

Eyebrow loss: Knowing the cause allows one to plan the treatment

There are many causes of eyebrow hair loss and each has it's own treatment. Too often patients rush to treat their eyebrow loss without pausing to ask "What exactly is my diagnosis?" Here are a few common reasons for eyebrow loss and their treatment.

 

1. Age related eyebrow loss and overtweezing


If the eyebrow loss is due to age related changes or over plucking/tweezing the options inlcude

a. Minoxidil
b. Bimatoprost (Latisse)
c. Hair transplantation
d. Tattoos, and microblading


2. Eyebrow loss from alopecia areata


If eyebrow hair loss is due to the autoimmune disease alopecia areata, a majority of patients will also have evidence of aloepcia areata at other areas (scalp, eyelashes). Treatments for eyebrow loss due to alopecia areata include:

a. steroid injections   b. topical steroids c. minoxidil
d. bimatoprost
e. oral immunosuppressives (Prednisone, methotrexate, tofacitinib
f. Tattoos and microblading can also be used.  

 


3. Frontal fibrosing alopecia (FFA)


Frontal fibrosing alopecia of the eyebrows is certainly the most underdiagnosed cause of eyebrow hair loss in women who first notice eyebrow hair loss in their late 40s and early 50s. Hair transplants are ineffective in most, if not all patients with active disease. Treatment options for FFA of the eyebrow include:

a. steroid injections and topical steroids  b.topical non steroids (pimecrolimus cream)
c. oral finasteride
d. oral hydroxychloroquine, oral tetracyclines    
e. Tattoos and microblading can also be used.                                                                                   

 


4. Trichotillomania


Trichotillomania is common and 3-5 % of the world pull out their own eyebrows due to underlying psychological factors. For some, the pulling is temporary and for others is a chronic condition. Treatment of the underlying psychological factors (stress, depression, anxiety, obsessive compulsive disorder) can lead to improvement. Hair transplants are not an options if the patient is actively pulling his or her eyebrows



5. Other causes


Dozens of other causes of eyebrow loss are also possible including a variety of infectious, autoimmune and inflammatory conditions. Consultation with a dermatologist or hair transplant surgeon is recommended. I strongly advise consulting a dermatologist before proceeding to hair transplantation for women over 40 with new onset eyebrow hair loss after age 40.


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 and Scarring: Seborrheic Folliculitis

Can a seborrheic dermatitis lead to a scarring alopecia-like phenomenon?

 

In 2015, Australian researchers reported an interesting article in the Australasian Journal of Dermatology suggesting the possibility of a low grade folliculitis which ultimately leads to development of a scarring alopecia. They termed the condition "seborrheic folliculitis."

Here is one such example of a "seborrheic folliculitis" in a patient with androgenetic alopecia. Scarring is present and focal areas devoid of hair can be found on the scalp.

 

Reference

Pitney et al. Is seborrhoeic dermatitis associated with a diffuse, low-grade folliculitis and progressive cicatricial alopecia? . Australas J Dermatol. 2015


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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Frontal Fibrosing Alopecia: Do we Need a New Name for the Condition?

FFA.jpg

Frontal Fibrosing Alopecia: Do we Need a New Name

Frontal fibrosing alopecia is an uncommon hair loss condition that usually affects post menopausal women. The cause is not known. 

 

Frontal Fibrosing Alopecia: What does it mean?

At first glance, the name seems like a good one. Women with frontal fibrosing alopecia lose hair in the front of the scalp and it occurs with scarring (fibrosing process). The women in the photo on the right has typical frontal fibrosing alopecia. 

FRONTAL: Hair from the front of the scalp is lost

FIBROSING: Occurs with scarring (fibrosing process)

ALOPECIA: Simply a medical term for hair loss

Once the hair is lost, it's lost permanently. Only with hair transplant surgery can hair density in the front be improved. But surgery can only be done when the condition is quiet or else the newly transplantedn hairs are likely to die.  An ongoing research study in our office is seeking to understand when it's best to transplant women with frontal fibrosing alopecia.

But is this a good name for the condition?

FFA back.png

As time passes, we're learning more and more about frontal fibrosing alopecia. Many women not only lose hair in the front of the scalp (hairline), but also at the sides (above the ears) and at the back as well. The women in the photo shows a typical picture of hair loss occuring at the back. In addition, women with frontal fibrosing alopecia often lose eyebrows (in three quarters of patients) and often lose body hair as well ( in one quarter of patients).

Conclusion

The term frontal fibrosing alopecia has been with us for almost 20 years now. When hair specialists use the term, we know exactly what condition is being referred to. But the term has its limitations - and someday it might take on even a different name - one that encompasses the hair loss from the back and sides of the scalp,  body hair and eyebrows.



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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DPCP for Children and Adolescents: Is it Effective?

DPCP photo.png

DPCP for Children and Adolescents

Diphencyprone or “DPCP” is frequently prescribed for individuals with alopecia areata who develop more extensive amounts of hair loss or for individuals who aren’t improving with steroid injection treatments.  As shown in the photo to the right, DPCP is a liquid and is applied to the scalp weekly, usually in a dermatology clinic setting.  It causes a mild allergic reaction in the scalp skin, which in turn promotes hair regrowth in some individuals. In adults, DPCP treatment promotes hair regrowth in approximately 30-50 % of individuals. 

What about DPCP in Children & Adolescents?

We decided to examine this question. Prior to our study, the use of DPCP in children had not been thoroughly explored is whether DPCP is effective for children with alopecia areata. In fact, the use of DPCP in children has been the focus of only a 3-4 of research studies - and these studies were quite small.  One previous research study of 26 children indicated that DPCP helped with hair regrowth in 35% of patients. A second study of 12 patients indicated hair re-growth in 67% of patients.  

We recently published our research findings in the journal Archives of Dermatology. We looked back through the medical charts of 108 children who received DPCP at Sunnybrook Hospital in the past 10 years.    Children ranged in age from 4 months to 18 years. Most children had tried other treatments, such as steroids or minoxidil, prior to starting DPCP. However, none of those treatments were helpful and so DPCP was started.

Does DPCP have side effects in Children and Adolescents?

Overall, treatment with was safe, but minor side effects did occur in about one-half of patients. These included swelling, hives, small blisters and skin breadkdown and swollen lymph nodes.  About 13 % of patients stopped treatment after 2 months owing to a variety of factors, such as these side effecsts, difficulties commuting to the treatment center, and/or the disruption caused by weekly absences from school.

Was DPCP Beneficial ?

Overall, our research data showed that about one-third of children benefitted from DPCP treatment. 25 % of children had a partial improvement and 10 % had full regrowth.   

Conclusion

Our study is one of the largest research studies looking at whether DPCP is beneficial for children and adolescents with alopecia areata. It is a valuable study because it provides us helpful information that we can share with parents who bring their child to the DPCP clinic. Overall,  DPCP will help about 1 out of every 3 children who go through treatment.  However, only 1 out of every 10 children will experience full regrowth with treatment.  Right now, it’s not possible to predict which children will benefit from DPCP and who will not.  Certainly, more research is needed to understand how to make DPCP even more effective for children.

 References of Interest

1. Salsberg, J and Donovan, J. The Safety and Efficacy of Diphencyprone for the Treatment of Alopecia Areata in Children.  Archives of Dermatology 2012; 148: 1084-5.

2. Schuttelaar ML, Hamstra JJ, Plinck EP, et al. Alopecia areata in children: treatment with diphencyprone. Br J Dermatol. 1996;135(4):581-585.

3. Hull SM, Pepall L, Cunliffe WJ. Alopecia areata in children: response to treatment with diphencyprone. Br J Dermatol. 1991;125(2):164-168.

4. Mukherjee N, Burkhart CN, Morrell DS. Treatment of alopecia areata in children. Pediatr Ann. 2009;38(7):388-395.

 


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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Improving Eyebrow Growth: Does Bimatoprost (LATISSE®) Help?

 

Loss of eyebrows is common. A previous article reviewed a range of treatment strategies for eyebrow loss. These include topical medicines, like minoxidil and bimatoprost, as well as hair transplantation.

Bimatoprost is an interesting medication.  It is used for the treatment of glaucoma, an eye disease which leads to elevated eye pressures. Recently, it has found a new use – in the treatment of hair loss. The product is available by prescription under the name LUMIGAN® (used to treat glaucoma)  and LATISSE® (used to stimulate eyelash growth).  Both LUMIGAN® and LATISSE® contain the ingredient bimatoprost.

Chemically, bimatoprost is classified as prostaglandin analogue. Bimatoprost binds to prostaglandin receptors in the hair follicle and stimulates hair growth.  Several hair specialists including myself, have occasionally used this medication for patients with eyebrow loss. This is known as an “off-label” use as the drug is not formally approved for this use. Bimatoprost is formally approved for eyelash regrowth.

Doctors from Miami recently published an interesting report of two patients who achieved an improvement in their eyebrow density using bimatoprost solution.

Elias MJ et al. Bimatoprost ophthalmic solution 0.03 % for eyebrow growth. Dermatol Surg 2011; 37: 1057-59

Both patients used one 2.5 mL container each month and applied the medication nightly to each eyebrow. One patient, a 52 year old man had results after 16 weeks and the second patient, a 46 year old woman had results after 12 weeks. These two patients did not experience any side effects.

This is an exciting report and calls for more studies to be done to evaluate the use of bimatoprost (LATISSE®) in the treatment of eyebrow loss.

Reference

Elias MJ et al. Bimatoprost ophthalmic solution 0.03 % for eyebrow growth. Dermatol Surg 2011; 37: 1057-59.

 



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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Improving Eyebrow Density: Hair Transplantation vs Topical Medicines

dr donovan eyebrows.jpg

Eyebrow hair loss can be distressing for both men and women and an increasing number of patients are requesting appointments specifically for eyebrow hair loss. Why are eyebrows important and what can be done to improve their fullness?

The 250-500 eyebrow hairs have an important function. Eyebrows help frame the face and frame the eyes.  They draw attention to the eyes.  Talented make-up artists can even style the eyebrows to draw attention away from certain areas of the face. Subtle movements of the eyebrows can instantly reveal changes in emotion.

When I meet with patients with eyebrow hair loss, the most important aspect of the consultation is to reach the correct diagnosis.  In some situations, the diagnosis is easy. Over-zealous styling over many years can frequently lead to thinning of the eyebrows. In other situations, reaching the correct diagnosis of eyebrow hair loss requires a bit of detective work.  Many people are surprised to learn that there are over 30 causes of eyebrow hair loss. Reaching the correct diagnosis is especially important for those considering hair transplantation.   Individuals with certain autoimmune or medical conditions will not achieve improvement with hair transplantation.

Overall, treatment options to improve eyebrow density are improving.  For some individuals, hair transplantation is a great option and the procedure can be performed in 2-3 hours.  For others, treatments with topical medications such as minoxidil, bimatoprost (also called Latisse®) or corticosteroids can help improve eyebrow hair density.



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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