Focal trichina is a term which refers to a specific observation seen on the scalp of patients with androgenetic alopecia. Those with focal atrichia have small circular areas devoid of hair.
This is a feature of advanced male balding (androgenetic alopecia) and also female pattern androgenetic alopecia. The finding is very important to recognize. Focal atrichia occurring in patients under 30 is worrisome for me as it is associated with a higher risk for progression to more extensive balding.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Telogen effluvium refers to a hair loss condition associated with excessive daily shedding.
The actual amount of increased shedding experienced by the patient can vary. For some, shedding is only slightly increased. For others, shedding can be massive.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
"Black dots" represent hair follicles broken off at the level of the skin surface. Black dots are also referred to as cadaverized hairs.
Black dots correlate with disease activity in alopecia areata and are a negative prognostic factor.
Black dots are seen in other conditions besides alopecia areata, including dissecting cellulitis, trichotillomania, tinea capitis and chemotherapy induced alopecia.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Bimatoprost (Latisse) is a popular product for growing longer lashes. Users of the product are likely very familiar with the fact that the drug was originally used for glaucoma to lower eye pressures.
The actual drug stimulates pigmentation in the iris because of the ability of bimatoprost to increase in pigment granulates in melanocytes. This side effect is mostly observed when individuals put the bimatoprost drops right into the eyes (as is done for those using the medication for glaucoma).
Pigmentation of the iris is not typically observed with those used bimatoprost for the eyelids or eyebrows. However, pigmentation of the surrounding skin can be observed.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Lichen planopilaris (LPP) can affect any area of the body that has hair. When it affects the scalp, it's often red, itchy and scaly/flaky.
When LPP affects the legs, arms facial hair, eyebrows and eyelashes, it's often completely asymptomatic and the patient simply notices hair has disappeared. Occasionally, a bit of redness is seen in the area too as seen in this photo of the beard area in a man with lichen planopilaris of the facial hair.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Is my hair breaking off? Or is it new growth? How can I tell?
Short small hairs can be confusing. So many times when short hairs are seen a conclusion is made that these hairs are short on account of breaking off.
New growth is pointy
In many situations, a careful and magnified view of the hairs will reveal that they are actually newly regrown hairs rather than broken hairs. Newly regrown hairs can be readily identified by their "pointed" ends. Broken hairs on the other hand have blunt often jagged ends.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
In 2012, I created the term Alopeciology as a new word in the hair loss lexicon. "Alopecia" refers to "hair loss" and the root 'ology' refers to the "study of" or "science of". To me, Alopeciology was a great term to describe the study of all things hair.
Patients, doctors, and family members all study alopeciology in one form or another. In the grand view, the (yet unwritten) imagined textbook of "Alopeciology" has many chapters - including those that describe what it's like to have and live with alopecia. Those chapters are mainly read by patients and families - but need to be read more often by doctors and heath care providers. The textbook also has chapters on the diagnosis and treatment of hair loss and the science behind hair loss conditions. These chapters are read mainly by doctors and health care providers - but more needs to be done in the world to do a better job to convey this information to patients.
We are all students of Alopeciology.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
What is a scalp biopsy? Which hairs should be taken ?
A scalp biopsy is a 15-20 minute procedure that helps the dermatologist obtain a small piece of tissue for analysis. The sample is processed in a history laboratory into thin sections and mounted on glass slides for review by a pathologist under the microscope. A scalp biopsy is not required for most patients with hair loss. When the diagnosis is uncertain, it can be very helpful.
First, an area of the scalp containing hair follicles should always be included in a biopsy. A scalp biopsy specimen from a completely bald area is not helpful!
Second, the hair follicles obtained should be taken from an area showing the specific abnormalities thought to be in keeping with the hair loss condition in question. If no such features are present, hair follicles might be obtained from an area of the scalp where the hairs are easily extractable (positive pull test), or from an area having the most symptoms (itching, burning or pain).
The key point is that obtained a scalp biopsy from a random area on the scalp does not usually yield useful information.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Normal daily shedding is often quoted as "anything less than 100 hairs per day" but that has never been carefully studied and documented. The reality is that there is quite a range of "normal" and somewhere closer to 50-60 is probably closer to what most people experience (or at least can collect).
Of course, there is a wide variation on what is considered normal shedding.
It is incredibly challenging (and incredibly emotional) to have to count daily shedding each day. There are many methods (brushing, shampooing, collecting) to try to measure daily loss. They are helpful and I often use a variety of such methods, but they each have their limitations.
Even those with a clear "telogen effluvium" (increased shedding) sometimes return with 45 hairs collected in a particular day (rather than the magic number 100). Are they shedding excessively? Absolutely. Are they able to measure it properly and capture what is happening? No.
A key principle of shedding is if one is certain they used to lose 30 and now lose 65 hairs per day - this is likely abnormal and warrants further consideration.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Can alopecia areata develop at the site of a hair transplant?
Alopecia areata affects 2 % of the world. It is an autoimmune hair loss condition whereby the immune system targets the hair follicle causing it to fall out. Alopecia areata can develop anywhere on the scalp - and anywhere on the body where there is hair such as eyebrows, lashes, etc.
In previous published reports, alopecia has been documented to occur at the site of a hair transplant. However, proving there is a direct link between the two is challenging. Alopecia areata usually develops in most people without trauma or injury.
Is a link plausible for some?
It is certainly not impossible that some sort of a more direct link could exist between alopecia and injury. I have many patients with autoimmune type reactions in the donor area following hair transplantation - including alopecia areata and lichen planopilaris. It's just really difficult to prove a direct association.
This photo show "black dots" and vellus hairs that are typical of the scalp in patients with alopecia areata. The photo also shows the scar from a previous hair transplant done using follicular unit strip surgery (FUSS).
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Musculoskeletal concerns among hair transplant surgeons have not been the focus of significant study. Injuries are talked about among colleagues but numbers have not been collected.
To explore the frequency, exact nature and extent of possible injuries, a questionnaire which was e-mailed to 100 surgeons practicing in the hair transplant field more than 5 years. 38 surgeons completed the study, and most who did were males between 50-69 years of age. 50 % reported musculoskeletal issues during or after the procedure, including both pain and fatigue. The reported frequency of pain and fatigue was higher for FUE than FUT (strip) procedures and lasted longer during FUE than strip procedures.
Two thirds of surgeons indicated that they had moderate/severe pain during FUE procedures, compared to one third of surgeons during strip excision procedures. Seventy-five (75%) percent of surgeons indicated they had moderate/severe pain immediately after FUE procedures compared to 29% of surgeons immediately after strip excision procedures. Moreover, one-third of hair restoration surgeons had pain, fatigue or discomfort lasting more than 12 hours after a procedure.
Only 30 % of surgeons used any type of ergonomic support such as an ergonomic chair.
REFERENCE
Williams K et al. Ergonomics in hair restoration surgeons. J Cosmet Dermatol 2016; 15: 66-
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Is a scalp biopsy always needed to determine the cause of an individual's hair loss?
The answer of course is no. A biopsy is only needed if the diagnosis is uncertain. In tough hair loss cases, I often like my patients to go a few days without shampooing the scalp. This allows the highest chance of some of the key features of the "suspected" condition to be present on the scalp (and not washed away by a recent shampooing).
Where does one biopsy?
I always biopsy an area which has the most features of the particular hair loss condition I suspect. For scarring alopecias, I often try to biopsy areas that cause the patient's scalp to be itchy, have burning or areas that cause pain.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
TE is a from of hair loss whereby the affected individual experiences higher than normal levels of hair shedding day to day. For example, instead of losing 40, 50 or 90 hairs in a given day (i.e. what is considered normal shedding) individuals experiencing telogen effluvium lose well in excess of 100 hairs on any given day.
Triggers of TE
Telogen effluvium occurs when some "trigger" causes hair follicles to leave the growing phase of the hair cycle and enter the resting phase. So, what exactly are the triggers that "send" a hair follicle out of the actively cycling (growing) phase and into the undesired shedding phase? I teach health professionals the easy to remember memory cue "SEND"
There are quite a few causes of a red, itchy and bleeding scalp. Anyone with such a trio best see a dermatologist to guide them.
Common conditions
Conditions such as psoriasis and seborrheic dermatitis are common in the population and must be placed at the top of the list of possibilities. Other causes include folliculitis decalvans and other scarring alopecias, infections, bites, infestations, allergy and irritation.
Pinpoint bleeding in this photo tells me right away that the patient I am examining may be quite itchy. As it turned out, they were!
I often prescribe a topical steroid to help reduce itching.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Recognizing new growth is critically important to understanding hair cycles and how a patient is responding to treatment. New hairs are short and have pointed ends.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
I buy watermelon after watermelon 🍉during the Summertime. Based on "Dr Google", watermelon consumption seems pretty good for hair too👍. But I don't buy it 👎.
"Dr Google" is a phrase that my own patients taught me. The term refers to the vast amount of medical information that can be easily obtained from the internet.
The world loves Dr Google.🏅❤️ I love Dr Google. ❤️ I am frequently looking to see just what Dr Google thinks about countless numbers of topics in hair loss.
Does consuming watermelon help stop hair loss?🍉 Does drinking a lot of water 💦help my hair? Is waking up early in the morning 🕓good for hair? Can the odour 👃of a new car 🚗 result in hair loss?
No matter what question you raise, Dr Google has probably written something on it. However, it does not mean that "something" is correct.
Watermelons and Hair : No evidence
Let's return to the subject of watermelons and hair loss 🍉. Those who write about the benefits of watermelon for hair loss claim that watermelon is loaded with the amino acid citrulline which gets converted in the human body to another amino acid called arginine. Arginine is a vasodilator and proponent of its benefits for hair claim this helps increase blood flow to the scalp which in turn is good for helping hair loss.
The claim that watermelon is good for hair loss has no evidence. Vasodilation itself does not help as a treatment for hair loss. Increasing blood flow as a means of treating hair loss is a myth. Massaging the scalp and standing on one's head upside down - and eating watermelon 🍉 does not help treat hair loss.
The myths prevail.
Does watermelon 🍉 help as a treatment for hair loss? I don't buy it. However, I'm still sticking with Dr Google🏅 and I'm still sticking with watermelon. Stay cool this summer 😎⛱
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
