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Filtering by Category: Genetics of hair loss


What cells play key roles in hair growth?

What cells play key roles in hair growth?.png

If you've ever gone deep into the basement of a large building, factory or even a house, you will likely be amazed at how complex the machinery, wires, circuits that all work together are to make the building function optimally.

As far as the hair follicle goes, it takes a considerable amount of coordination by many cell types to finally produce a normal hair fiber. The dermal papilla (or "DP") has an important role in making it all happen.

The DP is found at the base of the hair follicle. It is made up of a group of very specialized cells known as fibroblasts.

The DP is an important control centre for the hair follicle. It tells another collection of cells known as the "hair matrix" exactly what to do in order to make a hair fiber.

The more cells the DP contains and the more active it is .... the bigger and wider the hair follicle that will be produced. 

The DP has the remarkable potential to form brand new hairs when transplanted into other areas of the skin. DP are therefore said to be "trichogenic" (hair forming). One day, it could theoretically be possible to take a patient's skin and increase the number of DP cells they have and inject them back into their scalp. This could lead to an endless supply of hairs.


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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Capturing the very earliest changes of Genetic Hair Loss

Recognizing genetic hair loss in the earliest stages

Genetic hair loss is common. By age 50, about 60 % of men and 35 % of women will develop genetic hair loss.  Hair loss typically starts in certain areas of the scalp - such as the temples and crown in men and central scalp in women.

 

 

Alteration in follicular counts may precede miniaturization 

Miniaturization refers to the progressive reduction in hair follicle diameter during the course of genetic hair loss. In other words, hair follicles get skinnier and skinnier over time. This is a very typical feature of genetic hair loss. One other feature that is frequently seen is the alteration of hair follicle counts. Rather than hair follicles appearing in bundles of two hairs or three hairs, they are frequently seen as single isolated hairs. 

The photo above nicely illustrates this concept. Both photos were taken from the same patient. The photo on the left shows hair follicles grouped together in groups of two three and even four hairs. This area of the scalp is unaffected by genetic hair changes. The photo on the right shows very typical genetic hair loss. Hair follicles are still similar in size (thickness), but what is seen is mostly single hairs - the groupings of two and three hair bundles are no longer present. This is very typical of the earliest features of genetic hair loss. 

 


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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Dutasteride and Finasteride: New data suggests no Link with breast cancer in men

Dutasteride and Finasteride: Do they cause breast cancer?

Finasteride (Propecia) and dutasteride (Avodart) are prescribed for the treatment of male pattern baldness. Many of my male hair transplant patients receive finasteride or dutasteride in order to help reduce the progression of balding in existing hairs.  

Finasteride and dustasteride belong to a group of drugs called "5 alpha reductase inhibitors." They block the enzyme 5 alpha reductase and decrease the levels of the potent androgen hormone DHT (dihidrotestosterone). In addition to reducing DHT, the drugs increase the levels of estrogen slightly which has raised questions from physician and researchers around the world as to whether these drugs increase the risk of breast cancer in men.

US researchers set out to examine the relationship between the use of 5 alpha reductase inhibitors and male breast cancer. They studied men using the higher 5 mg dose of finasteride used in prostate enlargement (rather than the 1 mg dose used in hair loss) and the 0.5 mg dose of dutasteride.  They looked at the use of these drugs in 339 men with breast cancer and 6,780 men without breast cancer.

What were the findings and conclusions from the study?

The authors did not find an association between using 5 alpha reductase inhibitors and the development of breast cancer in men. Overall, the authors concluded that the "development of breast cancer should not influence the prescribing of 5 alpha reductase inhibitor therapy."

 

Reference

Bird ST et al. Male breast cancer and 5 alpha reductase inhibitors finasteride and dustasteride. J Urology; 190:1811-4


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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Is your hairline 'maturing' or a 'balding'?

Is your hairline 'maturing' or a 'balding'?

It’s a little known fact among many men that the frontal hairline actually changes shape between the ages of 17 and 27 – even if that man doesn’t proceed to develop genetic balding. We refer to this normal change as ‘maturation’ of the hairline and we say that the man noticing these changes has a ‘maturing’ hairline. Eventually the hairline stops ‘maturing’ and we say that the man has a ‘mature’ hairline.  Not all men’s hairlines proceed through this normal process of ‘maturation’ but most do.

The concept of a maturing hairline is extremely important to know about so that medical treatment or surgical treatment is not recommended to patients who don’t require it. For example, a 23 year old man who notices his hairline thinning out slightly in the area just above his eyebrows may not have genetic hair loss - but rather a ‘maturing’ hairline. He doesn’t need to begin any sort of treatment whatsoever. Several studies have shown that men with maturing hairlines don’t necessarily go on to develop balding. These are two completely separate processes!

Hairline maturation diagram

The following diagram helps to explain the process by which the hairline matures and how it differs from genetic hair loss. The hairline of a boy or early adolescent is relatively flat and we refer to this as a ‘juvenile” hairline.  Between age 17 and 27, many men (but not all) start to notice that the hairline directly above the middle section of the eyebrow starts to undergo thinning (maturing).   

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In fact, if you wrinkle your forehead, you’ll see a series of lines that run side to side. The highest forehead wrinkle often marks a spot where the ‘juvenile’ hairline was once located. A ‘mature’ hairline is usually about 1-1.5 cm above this. In true genetic balding (male pattern hair loss), the hairline may recede beyond this 1.5 cm point and undergo even more significant recession in temple area. 

Why is this concept important?

Understanding the concept of hairline maturation is especially important when it comes to designing natural looking hairlines during a hair transplant.  Attempting to lower a ‘maturing’ hairline is a young man is usually not a good idea. Many young men want a more ‘juvenile’ hairline when they first meet for a hair transplant consultation.  However, by proceeding down that route,  the young man runs the risk of having his new hairline take on an unnatural looking appearance when compared to other males as he approaches his 30s, 40s and 50s.

Other References of Interest

Rassman WR, Pak JP and Kim J. Phenotype of normal hairline maturation. Facial Plast Surg Clin North Am 2013; 21: 317-23

 

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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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How many hair transplants can a patient have?

Hair transplants: how many can a patient have?

The number of hair follicles available to move from the back of the scalp (the 'donor area') to the front or top of the scalp (the 'recipient area') is limited.  Someday, hair research may allow us to expand the number of hairs available, but for now there is a limited number. The number of grafts available to move depends on a number of factors, espeically how bald a person is destined to become.  It is generally estimated that between 4,000-10,000 follicular units are available in men. Men who are destined to have advanced balding patterns have less hair available to move than men destined to have minimal balding.

New study from Mount Sinai

A new research study by Dr Walter Unger and colleagues from the Department of Dermatology at Mount Sinai School of Medicine set out to refine these estimates even further. A group of 39 hair transplant surgeons were asked to estimate the number of 'permanent' follicular units available for surgery in a hypothetical 30 year old man destined to develop advanced balding (i.e. Hamilton Norwood Scale V or VI)

What were the results of the survey?

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Respondents indicated that men destined to have Hamilton Norwood Stage V balding had between 5,000 - 8,000 follicular units available for surgery and men destined to have Hamilton Norwood Stage VI balding had between 4,000 - 6,600 follicular units available for hair transplant surgery.Man with 4000 follicular units max in lifetime

Why are these results important?

This study reminds hair transplant surgeons (and patients) that there are a finite number of follicular units available for surgery. A middle aged man destined to have advanced balding in his  lifetime has two (and maybe three) surgeries maximum in their lifetime.   It is exteremely important to discuss with patients how grafts will be placed so that the appearance of bald areas of the scalp can be minimized throughout life.

Source

Unger WP, Unger RH, Wesley CK. Estimating the number of lifetime follicular units: A survey and comments of experienced hair tranpslant surgeons. Dermatol Surg 2013;


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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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INCREASED RISK OF HEART DISEASE IN MEN WITH HAIR LOSS

Do balding men have an increased risk for heart disease?

male balding crown (androgenetic alopecia, male).jpg

Several studies in the past have examined the relationship between balding and heart disease.   In a study published in this month's British Medical Journal, researchers from Japan carefully examined all of the research studies to date focusing on the relationship between hair loss and heart disease.

 

Balding and heart disease: what did the new research find?

The researchers looked at studies involving 36,690 balding men and found that men with hair loss in the top of the scalp or ‘vertex’, had an increased risk of heart disease.  Interestingly, men with more severe balding had a greater risk of heart disease compared to men with lesser degrees of balding in the vertex.  Men with hair loss in the front of the scalp did not demonstrate an increased risk of heart disease.  

The exact reasons why balding men have increased heart disease risk is not clear but may be related to common mechanisms that lead to heart disease and hair loss including high blood pressure, smoking, high cholesterol, insulin resistance and increased inflammation in blood vessels.

These findings are important for the approximately 4 million Canadian men and 40 million American men affected with male balding.

SOURCE:   Yamada et al. Male pattern baldness and its association with coronary heart disease: a meta-analysis. BMJ Open; 2013; e002537.

 

 


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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Is there a Link Between Sun Exposure and Hair Loss?

Sun Exposure and Hair Loss: Is there a Link?

This new video highlights the current evidence of the relationship between sun exposure and hair loss.

I hope you enjoy it!

- Dr Jeff Donovan

 References of Interest

Gatherwright J et al. The contribution of endogenous and exogenous factors to female alopecia: a study of identical twins. Plast Reconstr Surg 2012 130; 1219-26.

Su LH and Chen.  Androgenetic alopecia in policemen: higher prevalence and different risk factors relative to the general population. Arch Dermatol Res. 2011 Dec;303: 753-61


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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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Is there an increased risk of prostate cancer in balding men?

male balding crown (androgenetic alopecia, male).jpg

The risk of prostate cancer in balding men

About 50 percent of men will be affected by male pattern balding throughout their lifetime. The medical term for male balding is "androgenetic alopecia."

Which men will developing balding and which will not? Well there are still some things we need to learn about balding. But in general, male balding is influenced by genetics, hormones and occurs with advancing age. Prostate cancer is one of the most common cancer in men. It  too is influenced by genetics, hormones and occurs with advancing age.

 

Is their any link between the male balding and prostate cancer?

Well, researchers at the Cleveland Clinic in Cleveland, Ohio recently set out to look at this question. They looked at all the high quality studies published so far which have examined the risk of prostate cancer in balding men.

In total, the researchers looked at the development of prostate cancer in 8994 patients - 4078 with prostate cancer and 4916 healthy men.

What did the researchers find?

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When all of the studies were pooled together an interesting finding was confirmed - and that is that men with hair loss in the top of the scalp  or “vertex” have a small but significant increased risk of prostate cancer. It's important to note that the increased risk was quite small - but nevertheless the data pointed to an increased risk. The authors indicated that further studies in the future are needed to confirm these interesting findings.

SOURCE: Amoretti A, Laydner H and Bergfeld W. Androgenetic alopecia and risk of prostate cancer: A systematic review and meta-analysis. J Am Acad Dermatol 10.1016/j.jaad2012.11.034)


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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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Alopecia Areata : Is it Genetic ?

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Alopecia Areata  : Is it Genetic ?

I'm often asked if alopecia areata is "genetic." It's sometimes hard to believe that alopecia areata is so strongly tied to genetics when only 10-20 % of patients have a family history of the condition. But dozens of high quality research studies back up the statement: alopecia areata is "genetic."

 

Alopecia Areata is a Multifactorial Genetic Trait

There is not just one gene that is involved with the developing of alopecia areata- there are many. For this reason, alopecia areata is said to be a multifactorial genetic trait.  If one of your first degree relatives is affected by alopecia areata, you have a ten fold increased risk of developing alopecai areata.  But the inheritance patterns are complex- even if one identical twin develops alopecia areata - the other twin has only a 55 % chance of developing alopecia areata.

AA genetics.jpg

We're learning more and more every day about the complex genetics of alopecia areata. We've come to learn that alopecia areata is likely much more closely related to type 1 diabetes and rheumatoid arthritis than we ever imagined. The exact genes and segment of genes that increase one's risk of developing the condition are slowly being worked out.

Right now alopecia is 'genetic' but is influenced to some extent by the environment too. That's why one twin develops aloepecia and the other twin does not. The exact environmental factors that contribute to alopecia areata are still being worked out as well.



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 Loss in Women: Often More than a Single Cause!

Hair Loss in Women: Often More than a Single Cause!

Hair loss among women is common. Although it's natural to think there is a single cause of an individual's hair loss, women often have more than one reason for their reduced hair density or 'hair thinning.'

Example: Consider the 32 year old woman who came into see me for her first appointment. She told me that she had been using minoxidil topical lotion for a 8 months now for a presumed diagnosis of:

Presumed diagnosis:

1. Female Pattern Hair Loss (also known as androgenetic alopecia).

However, she felt her hair was not getting better. She had some annoying scalp itching from time to time and wondered if she should stop the mionxidil as she was told the lotion could sometimes cause itching.

Is this the correct diagnosis? What should she do to stop her itching?

Join me as we pursue the necessary "detective work" to come up with the correct diagnosis for this woman and ultimately help her hair improve. First, lets take a look at her scalp up close:

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Is this normal? Is it abnormal? Well, let's compare this photo to a relatively normal appearing scalp from a similarly aged woman in my practice with good hair density and extremely healthy hair. You'll note that all the hairs are fairly similar size (calibre) and the scalp itself is not red and their is no scaling or flaking:

nrlscalp.png

Now that we know what is normal, let's return to the 32 year old woman with hair loss. Many things can be seen by examing this woman's scalp. First this woman has many 'thick' hairs. The light blue arrows show the thick hairs (also called terminal hairs).

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However, this woman also has many thinner hairs with greatly reduced calibre (skinnier hairs). These thinner hairs are known as "miniaturized hairs" and the green arrows below point to several miniaturized hairs. Miniaturization is frequently seen in individuals who have a diagnosis of "androgenetic alopecia" (also called female balding or female pattern hair loss):

Slide1miniaturization.jpg

So I know this woman has androgenetic alopecia as one of her diagnoses.  But the other thing that is noted is that she not only has many skinnier hairs, but she also has a significantly reduced number of hairs.  You can see that the hair density that is seen in the top of the picture is very different than in the bottom of the picture  - the blue stars show the "missing hairs." So we know that she has lost a lot of hair.  

Slide1emptytracts.jpg

By gently pulling on several of her hairs, I discover that many of these remaining hairs come out pretty easily. This is called a "positive pull test" and this test is a sign this woman may have excessive shedding ( a phenomenon called telogen effluvium). In fact, the orange arrows point to many of these telogen hairs - which are farily easy to spot in this photo because telogen hairs become much lighter in color as they are about to shed from the scalp. So we are gaining some good evidence that this woman has an abnormal shedding problem:

Slide1telogenhairs.jpg

As I described in a previous  video, there are many causes of exessive or abnomal shedding. The include low iron levels, thyroid problems, crash diets and a variety of medications. Basic blood tests performed in this patient showed she had very low iron levels. Further details also revealed she had multiple cycles of crash dieting in the past one year. These are certainly two potentially important causes for her shedding.

Further examination of her scalp showed that there is redness in the scalp and some scale. The red arrows in the photo below point to this scale:

Slide1.JPG

There are many causes of scale but this woman scale and the redness in her scalp is typical of a condition called seborrheic dermatitis. Scalp "dandruff" and seborrheic dermatitis are two closely related processes and are caused by a common yeast called Malasezzia. Seborrheic dermatitis is very common and causes scalp itching and redness and excess flaking. Often patients notice that their scalp feels better if they wash their hair more often as this helps reduce the annoying itch they sometimes experience. Seborrheic dermatitis may cause itching but doesn't typically cause hair loss. Additional questions showed that this woman had scalp itching long before she started using the topical minoxidil therapy - so her itching may be coming from her seborrheic dermatitis rather than the minoxidil ! However, both are possible.

So at this point, it appears this woman does in fact have female pattern hair loss, but she also has three other diagnoses:

1. Female pattern hair loss (also known as androgenetic alopecia).

2. Telogen effluvium (exess hair shedding) - from low iron levels

3. Telogen effluvium (exess hair shedding) - from crash dieting

4. Seborrheic dermatitis

But is this ALL she has?

For this patient, further questioning revealed that the cause of her low iron was very likely from heavy and sometimes irregular menstrual periods. She could go several months without a period. Additional blood work and an ultrasound of this woman's ovaries showed that she in fact had a condition known as polycystic ovarian syndrome or "PCOS."  Women with PCOS have altered hormone levels which can cause hair thinning.  The altered hormone levels are produced by the ovaries. Early diagnosis of this condition is extremely important as women with PCOS have a higher chance of developing diabetes, high blood pressure, infertility and high cholesterol.  She was referred to an endrocinologist for further evaluation of her PCOS.

Final diagnoses for this woman: 

1. Female pattern hair loss - with Polycystic Ovarian Syndrome

2. Telogen effluvium (exess hair shedding) - from low iron levels

3. Telogen effluvium (exess hair shedding) - from crash dieting

4. Seborrheic dermatitis

How was this woman ultimately treated?

This woman was continued on her topical minoxidil therapy as it was concluded this was NOT a cause of her particular symptom of itching.  On account of her diagnosis of PCOS, she was advised to start on a birth control pill to regulate her periods. Oral Spironolactone medication was also started to help her androgenetic alopecia. Iron pills were prescribed to help the low iron levels and blood work was performed every 5 months to ensure the iron levels were rising properly. The woman's diet was stabilized to ensure that no further crash dieting would occur. The seborrheic dermatitis was treated with an anti fungal shampoo and this helped stop her itching. An improvement in hair density was noted in 6 months.

Conclusion

Diagnosing hair loss in woman often requires a bit more detective work than hair loss in men. Hormonal issues, and hair shedding conditions are more common in women than men. One should never assume that a patient has a single diagnosis for their hair loss -- all causes need to be explored. This can only come with a very detailed history about the patients hair loss, past health, diet, medications, family history and a very detailed examination of the scalp.



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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A New Era in the Treatment of Androgenetic Alopecia: Focus on the "Prostaglandin Pathway"

The "Prostaglandin" Pathway

Recently, we've been hearing a lot about a group of hair growth drugs that affect "prostaglandins".  Several recent blogs of mine have discussed the role of prostaglandin F2a analogues in stimulating eyelash growth (click here for article).  A few months ago a major buzz was created in the hair world when Dr. Cotsarelis at the University of Pennsylvania showed that blocking the prostaglandin D2 pathway might be relevant to the treatment of androgenetic alopecia (click here for article).

New Study Highlights Role of Prostaglandin Analogues

Latanoprost is a prostaglandin F2alpha drug that is often used in treating glaucoma (an eye disease characterized by elevated eye pressures). Recently the drug has been shown to be useful in stimulating eyelash growth. 

In yet another study, researchers from Germany examined the use of the drug latanoprost 0.1% in the treatment of men with androgenetic alopecia (male balding). 16 men participated in the study.  All men had early staged androgenetic alopecia  Men applied one drop (50 microliters) of latanoprost solution to one small area of the scalp daily and one drop of the placebo drug (mock drug) daily for 24 weeks. 

 

What were the results?

Overall about 50% of men benefitted from the drug.  Patients who did end up benefitting from the drug showed evidence of improved growth by 16 weeks. The drug was well tolerated with the most common adverse effect being scalp redness. Interestingly, the patients who developed scalp redness also experienced hair growth.  How exactly these two are related remains to be clarified.

 

Comment

These results are exciting and highlights the importance of this prostaglandin pathway.  We will certainly be hearing a whole lot more about the pathway in the years ahead. Its important to note that all participants in the study were men, so we don't know if the results are generalizable to women.  Furthermore, all men in the study had early stage androgenetic alopecia so we dont know if the drug will have benefit for men with more advanced stages of balding.

 

Reference

Blume- Peytavi et al. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24 week topical treatment by latanoprost 0.1 % on hair growth and pigmentation in healthy volunteers with androgenetic alopecia.  Journal od the Amaerican Academy of Dermatology 2012; 66:794-800.

 


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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Finasteride Use by Young Men: Not only for Baldness in the Crown !

male balding crown (androgenetic alopecia, male).jpg

Finasteride Use by Young Men

For years, we've largely assumed that finasteride helps men with hair loss in the crown, but does little for men with hair loss in the front of the scalp or the temples.

A new study by US researchers has nicely shown that finasteride 1 mg daily can help young men with male pattern balding regardless of where on the scalp the man has hair thinning.

The researchers studied men 18 to 60 years of age for a period of two years. Four areas of the scalp were examined: (1) vertex (crown), (2) the mid-scalp, (3) the frontal hair line and (4) the temples.

What were the results of the study?

The study showed that young men benefitted from taking finasteride - regardless of where there hair thinning occured. Young men (age 18-40) with hair loss in front, temples, mid-scalp or crown all had benefit from taking finasteride. However, the same was not true of men age 41-60. Men in this slightly older group benefitted most if their hair loss was in the crown and the mid-scalp.

Reference

Olsen EA et al. Global photographic assessment of men aged 18 to 60 with male pattern hair loss receiving finasteride 1 mg or placebo.  J Am Acad Dermatol 2012; 67: 379-86. (click for abstract)

 


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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Dr. Donovan on Discovery Channel's Daily Planet

Back in 2010, I was interviewed by Ziya Tong, the co-host of the Discovery Channel's Daily Planet show.   Our topic was hair (and fur!). I've posted a link to the Daily Planet segment below. Enjoy!

Watch video

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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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February is Heart Health Month: What does your hair tell about your heart?

 

Heart disease is one of the leading causes of death in Canada and the United States. In fact, about one out of every three deaths is due to heart disease and stroke. February is designated heart health month - a great time for us all to think about risk factors for heart disease and all the things we candue to reduce our risk of heart disease. It’s also a great time to discuss the relationship between male and female balding and heart disease.

About 50 % of men and 30 % of women will develop genetic balding by age 50. The medical term for genetic balding is “androgenetic alopecia”. In men, androgenetic alopecia causes hair loss in the front, temples and the crown and may even involve the entire frontal scalp. In women, androgenetic hair loss causes hair loss in the centre of the scalp. 

Is there a link between balding and heart disease?

The answer is yes. Several large research studies have confirmed an association between androgenetic hair loss and heart disease.  It seems that men who develop early balding have a higher risk to develop coronary artery disease.  This may be especially true in younger men who develop rapid balding.   New research is showing that the same relationship is true for women.

This doesn’t mean that hair loss causes heart disease or heart disease causes hair loss. Rather it tells us that the two are linked somehow through a similar process: men and women who develop early hair thinning also tend to have a higher chance to get heart disease.

Why is this information important?

The research is important for a number of reasons. If you are young and have androgenetic alopecia, do what you can to minimize your risk factors for heart disease.

If you are young and have androgenetic alopecia, do what you can to minimize your risk factors for heart disease. Eat well, excercise, get your blood pressure checked to make sure you don't have high blood pressure (hypertension).  Ask your physician about checking cholesterol and blood sugar levels. If you smoke, get help to stop.

I often encourage young men and women with early balding to get tested for all the heart disease risk factors. This involves getting a blood pressure measurement, checking cholesterol and fat levels, checking for diabetes or pre-diabetes and making sure that these individuals are getting enough exercise.  Although I encourage all smokers to stop smoking (as smoking negatively impacts hair), I advise those with early balding to quit smoking and smoking is a top risk factor for heart disease.

Happy Heart Month!

 

References

Lotufo, PA Chae CU, Ajani UA, Hennekens CH, et al. Male pattern baldness and coronary heart disease: the Physicians Health Study. Arch Intern Med 2000; 160 (2): 165 - 71.

Lesko SM, Rosenberg L, Shapiro S. A case-control study of baldness in relation to myocardial infarction in men. J Am Med Assoc 1993; 269: 998 - 1003.

Trevisan M, Farinaro E , Krogh V, et al. Baldness and coronary heart disease risk factors. J Clin Epidemiol 1993; 46 (10): 1213-8.

Cotton SG, Nixon JM, Carpenter RG, et al. Factors discriminating men with coronary heart disease from healthy controls. Br Heart J 1972; 34: 458-64.

Ford ES, Freedman DS, Byers T. Baldness and ischemic heart disease in a national sample of men. Am J Epidemiol 1996; 143 (7): 651 - 7.

Herrera CR, DAgostino RB, Gerstman BB,et al. Baldness and coronary heart disease rates in men from the Framingham Study. AM J Epidemiol 1995; 142(8): 828 - 33.

Persson B, Johansson BW. The Kockum study: twenty two - year follow - up coronary heart disease in a population in the south of Sweden. Acta Med Scand 1984; 216(5): 485-93.

 

 



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 Lessons from Rapunzel

 

We all know the story of Rapunzel, the 1812 Grimms Brother fairy tale of the beautiful young woman trapped in a tower. Using her long hair, she pulls the witch up into the tower whenever the witch calls out:

"Rapunzel, Rapunzel let down your hair so I can climb the golden stair"

A few weeks ago, I found myself writing about Rapunzel's hair, an unusual event in my day to day activities.  But the story of Rapunzel has a few important lessons for anyone interested in learning more about the magic of hair.

1. Hair is remarkably strong. The Grimms brothers were correct in creating this fictional character who could help pull up another human being with her own hair.  Our hair is incredibly strong. In fact, a single hair fiber has about the same tensile strength as a copper wire of the same caliber. If a hair is stretched very slowly it will support about 70 grams. Of course, if a hair is tugged quickly it will break. Hair is so strong that Rapunzel could have supported 50 people climbing up her hair - at once!

2. Blondes have more hair. Rapunzel had blond hair.  Although most people don't know it, blondes have more hair than those with brown hair. Those with red hair have the least.  The more hair you have the more weight you can support, so it's no wonder Rapunzel was created a blonde. 

3. Most people can not grow hair as long as Rapunzel. The maximum length our hair will grow is determined by the length of the growing phase (also called the anagen phase). For most humans, the anagen phase of scalp hair varies from 2 to 6 years. Because hair grows about 15cm per year, most people can only grown hair down to their mid back and rarely to their waist. It is only a rare person who is able to grow hair down to their feet (or beyond). At my last check, the world record for the longest hair belongs to Xie Quiping in China. Her hair length was once measured at 6.627 m (18 ft 5.54 inches). It is not true that Xie's hair grows fast rather her anagen growth phase is very, very long.

 



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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Finasteride: Does it Increase the Risk of Breast Cancer in Men?

 

Health Canada issued a news release August 4, 2011 advising doctors and the public of the possibility of breast cancer in men using the oral medication finasteride. Finasteride at 1 mg is used approved for the treatment of hereditary hair loss in men and is marketed under the name Propecia. Finasteride at a 5 mg dose is used for the treatment of enlarged prostate in men and is marketed under the name Proscar. Although the drug is sometimes prescribed off-label to treat women with androgenetic alopecia, it is not FDA approved for women.

Reports of a possible association between finasteride and male breast cancer are not new.  The possibility of this association was raised over 10 years ago.  There are now at least 50 previous reports in the medical literature about men who developed breast cancer while taking finasteride at the 5 mg dose. There are at least 3 reports in the literature of men who developed breast cancer taking the 1 mg dose. 

Overall, breast cancer in men is rare. 99 % of breast cancers are diagnosed in women and 1 % are diagnosed in men.  Each year about 2000 new cases of male breast cancer are diagnosed in the United States and 200 cases are diagnosed in Canada. 

The public needs to be aware that these studies do not prove that finasteride causes breast cancer in men. This relationship is not known at the present time and more research is needed.  However, it remains a possibility.    The Health Canada report states:

Based on the currently available evidence, it is not known with certainty whether finasteride can cause breast cancer, nor can this possibility be ruled out at this point in time.

All men starting finasteride should be aware of the possibility that reports of breast cancer have rarely occurred in men taking finasteride.  The risks in women are unknown at the present time. Health Canada has advised individuals who take finasteride to report changes in their breasts to their doctors. These changes would include:

  • Enlargement of the breasts
  • Lumps in the breasts
  • Tenderness or pain in the breasts
  • Discharge from the breasts

 The Health Canada report is found in the following link:

Finasteride (Propecia, Proscar): Potential rare risk of breast cancer in men

 


 


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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Miniaturization: The Clue to the Early Diagnosis of Androgenetic Alopecia

Miniauturization Follicles.jpg

One of the most common causes of hair thinning is androgenetic alopecia.  Men with androgenetic alopecia may notice hair loss at the top of the scalp as well progressive receding in the temples. Women with androgenetic alopecia notice thinning in the middle of the scalp.  The central hair part may become wider over time.  As hair thinning occurs the scalp becomes progressively more visible.   

I treat androgenetic alopecia with either 1) topical medications such minoxidil, 2) oral hormone blocking medications or 3) with hair transplantation. For some patients, I may recommend all three treatments. I encourage patients to consider using medical treatments in the early stages in order help maintain or improve the present hair density and prevent further loss over time.

Patients considering treatment for the very early stages of androgenetic alopecia often ask how I can absolutely sure they have androgenetic alopecia. Some of the doctors I teach ask the same question. How do you tell androgenetic alopecia is present if the patient does not actually have hair loss yet?What are the clues to the early diagnosis of androgenetic alopecia?

Androgenetic alopecia can be diagnosed based on the pattern of hair loss and by observing a process known as hair follicle “miniaturization.” When I lecture about androgenetic alopecia, I refer to miniaturization as the process by which hair follicles get skinnier over time.   It takes time for doctors to learn to identify hair follicle miniaturization, but I teach the following analogy to help others master this skill. 

Pretend that hair follicles are like tree trunks in the forest.  This analogy is kept in mind as the scalp is examined. If the size of the tree trunks is all the same – the patient does not have androgenetic alopecia.  If some of the tree trunks are fat and some of the tree trunks are skinny, the phenomenon of miniaturization is being observed. This is shown in the picture above. The most likely cause, by far, is androgenetic alopecia.

There are rarely other conditions that can be associated with miniaturized hairs besides androgenetic alopecia.  But this analogy is extremely important.  Many patients with concerns about hair loss end up receiving a diagnosis of androgenetic alopecia.  If there is no miniaturization, the diagnosis is wrong, and there is another reason for hair loss.



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 Inheritance of Androgenetic Alopecia: Father’s Father ... Mother’s Father ... or Father’s Mother?

family tree.jpg

Androgenetic alopecia is common in the general population. In fact, the condition is often called “common balding”.  Approximately 50-60 % of men and 30-40 % of women will develop androgenetic alopecia by the age of 50.  

When I meet with patients, I generally ask about the hair characteristics of his or her mother and father.  I try to get a sense of his or her parent’s hair density and the age at which the parents started losing hair.   Although men and women with androgenetic alopecia often have a family history of androgenetic alopecia, it’s not absolutely necessary for the diagnosis.   In fact, a family history is least likely to be found in women diagnosed with androgenetic alopecia.  This is because the inheritance of androgenetic alopecia is much more complicated in women than in men.

There are many myths when it comes to hair loss and patients are often surprised to hear me say that the chance to inherit hair loss comes from both sides of the family tree.  Upon hearing this I commonly hear patients reply:

I thought hair loss came from the mother’s father?

or ... I thought hair loss came from the father’s mother?

or ... I thought hair loss came from the father’s father?

The main message is that hair loss is inherited from both mother and father and their respective sides of the family tree.  It’s possible for children to have high hair densities in adulthood even if dad has androgenetic alopecia.  Furthermore, it’s possible (albeit uncommon) for children to have significant androgenetic alopecia when dad or mom have minimal hair loss in adulthood.



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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