Hair Blogs

QUESTION OF HAIR BLOGS


Latisse and Benzalkonium Chloride

Can one be allergic?

Irritation happens from time to time in users of Latisse. It's not all that common but redness of the eyelid and even the eye can occur. Rarely a patient develops itching or rashes on the skin and asks "Could this be related?"

This is a complex question. Latisse contains bimatoprost as well as the preservative benzaalkonium chloride (BAC) at a concentration of 0.05 mg/mL. This preservative has been around since 1935. It is quite common in many products, especially those used around the eye. BAC is more likely to cause irritation than true allergy but certainly cases of allergic reactions can occur with BAC even serious ones. Studies at the Mayo clinic published in 2016 (see reference below) suggested that allergies to BAC might be increasing in the population. In fact, the allergen climbed up the list to now be one of their top 10 allergens they see in their clinic.

If a patient has a skin rash, it is far more likely that an allergy exists if the eyelids show some redness. If the eyelids look perfectly fine, it is much less common that the cause if the skin rash is related to Latisse use. But even without redness a systemic allergic response is still "possible". It's just much less likely. With these sorts of situations, I like to know the whole story (and see the rashes if they are present). I like to know if the patient uses products containing BAC in the past and if so, what types of reactions they had. It's a good idea to review the whole story with your physician. If it was only itching, one might (on the advice of the doctor) wait for the itching to go away completely and either try again or have a specialized physician test the product's allergic potential on the skin as a prick or patch test. However, if there was any runny nose, cough, chest tightness, wheezing, shortness of breath, dizziness, throat tightness, swollen tongue or eyelid swelling...one should should seek the advice of an allergist physician.

Overall, irritation from Latisse is much much more common than allergy. Nevertheless, if one is experiencing new or unusual type skin, mucosal or respiratory issues one must consider whether a true allergic response could be responsible

Reference

Wentworth, A et al. Benzalkonium Chloride: A Known Irritant and Novel Allergen. Dermatitis 2016.

 


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

Quieter Looking than LPP?

ffa vs lpp.png

Frontal fibrosing alopecia (FFA) is said to be a subtype of Classic Lichen planopilaris (LPP). The two conditions have many features in common but also have many differences.

LPP and FFA are nearly indintinguishable by scalp biopsy although biopsies from patients with FFA generally have less inflammation than biopsies from LPP. In addition, patients with FFA are frequently much more likely to be asymptomaric compared to patients with LPP. The scalp is less likely to be itchy, and less likle to be red. Patients with FFA at the sides of the scalp (around the ears), frequently have no scale (unlike LPP) and may or may not have much in the way of redness. Because FFA is often so “quiet”, this can frequently delay the diagnisis - sometimes by many years for affected patients.

This photo show typical feaures of FFA. A large number of single hair follicles are seen. Occassional hairs have white scale around them (perifollicular scale, see arrow) and several follicles have redness around them as well (perifollicular redness). Treatments for FFA and LPP are very similar but not identical. Finasteride for example is more effective in FFA than LPP.
 

Reference

Poblet et al. Frontal fibrosing alopecia versus lichen planopilaris: a clinicopathological study.
Int J Dermatol. 2006.


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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Folliculitis Decalvans in Darker Skin Types

Folliculitis Decalvans: Trichoscopy in Darker Skin Types

FD

Folliculitis decalvans is a type of scarring alopecia (scarring hair loss). It is rare. Men are more commonly affected than women.  Folliculitis decalvans in black men may take on a different appearance than patients with lighter colored skin. However, crusting, pustules and bleeding are frequently present. Tufting may be less common.

Dissecting cellulitis, tinea capitis, atypical bacterial and fungal infections and rare conditions like adult onset Langerhans cell histiocytosis can mimic folliculitis decalvans. A biopsy and culture should be done in atypical presentations.


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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Trichoscopy of DLE

DLE Features

Early DLE by dermoscopy shows follicular plugging, telangiectasias, pigmentation changes, scale.

due

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: Up close

Dermatoscopic (Trichoscopic) Features of Alopecia Areata

AA

Typical dermatoscopic findings in alopecia areata: 1) yellow dot 2) black dot 3) exclamation mark hair and 4) tapered hair. 


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 itching and burning: A closer look at Lyrica

A closer look at Lyrica

lyrica.png

Scalp dysesthesias are a group of conditions whereby affected patients have symptoms in the scalp such as burning and pain. Much to the surprise of the physician and even the patient- the scalp usually looks normal in this group of scalp conditions. I frequently perform a biopsy to ensure any other condition is not being missed.

It’s not clear how exactly these conditions develop. Some studies have suggested that disease in the upper spine (cervical spine) might play a role in some patients, but it’s not a mechanism that applies to everyone with scalp dysesthesia. Some patients have underlying depression and anxiety but again this is not relevant for everyone.

Most patients with scalp dysesthesia feel they have tried nearly every to stop their burning or pain. They have used topical steroids and various shampoos including a variety of anti-dandruff shampoos too. Nothing works.

A variety of options are available to treat scalp dysesthesias including oral and topical gabapentin, Lyrica (pregabalin), amitriptyline, capsaicin and topical ketamine, amitriptyline and lidocIne (TKAL). Lyrica is an anti-seizure medication which is also FDA approved for fibromyalgia, diabetic neuropathy and post herpetic neuralgia. It can benefit some patients with scalp dysesthesia and this is an off label use. It functions by reducing neurotransmitters in nerves such as substance P, glutamate and nortriptyline. When prescribed, I generally start slow with the dose even 50-75 mg a few times per week. 
More common side effects include dizziness and drowsiness. Less common side effects includes visual problems, tremor, fatigue, dry mouth, constipation, weight gain.


Reference

Women with scalp dysesthesia treated with pregabalin.
Sarifakioglu E, et al. Int J Dermatol. 2013.


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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Treatment of Androgenetic Alopecia During Pregnancy

Treating AGA in Pregnancy:

Most treatments for AGA are either not safe or not recommended during pregnancy. This includes minoxidil, anti androgens, various supplements, over the counter products and topical agents. The cardinal rule of treating any conditions during pregnancy or using any treatment during pregnancy is simple: ask a physician. 

 

Low Level Laser: Generally Safe for Most

 Low level laser treatments (LLLT) are the only safe treatments during pregnancy for women with AGA. This applies to most of the standard at home devices. Everything else needs stopping and some treatments need stopping well in advance. For some women, treatments during pregnancy are not necessary because it is possible due to hormonal surges during pregnancy stopping treatment may potentially not have a huge effect while pregnant and one can start many treatment again after giving birth. However, it should be noted that some women do experience hair loss during pregnancy as well.

 

WHICH HAIR LOSS MEDICATIONS ARE SAFE TO USE WHILE BREASTFEEDING?

Although I often ask my patients to discontinue most hair loss medications during pregnancy, the question frequently arises as to whether some medications can be restarted while moms are breastfeeding.  Breastfeeding has many benefits for babies.  For some drugs, the answer is yes. For others, the answer is no.

In 2001, the American Academy of Pediatrics published a helpful guide as to the safety of medications during breastfeeding. It's important to always check with your physician before starting any medication during breastfeeding. However, the following medications (used in hair loss) are felt to be safe for women who are breastfeeding.  For a full list of medications which are safe during breastfeeding, click here.

I generally do not recommend restarting treatments until month 1 after delivery if the baby is breastfed although many studies and reports show no harm in use if minoxidil and antiandrogens by women who are breastfeeding.

 


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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Telogen Effluvium: What are upright regrowing hairs (URH)?

URH in TE

urh

Telogen effluvium refers to a type of hair loss whereby the patient experiences increased daily shedding. Shedding typically occurs 2-3 months after a "trigger" such as weight loss, surgery, illness, low iron, crash diet, medication initiation or development of some internal illness.

Dermoscopy (shown here) does not have many specific findings in patients with telogen effluvium although many upright regrowing hairs (URH) may be seem along with hair follicles containing only a single hair follicle.  


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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Do Finasteride and Dutasteride increase the risk of muscle injury?

Is there a risk of myositis or myopathy?

MUSCLE INJURY.png

Finasteride and dutasteride are the two 5 alpha reductase inhibitors commonly used for treating androgenetic alopecia. Previous studies suggested an increase risk of muscle injury in some users of the drug. A new study examined the risk of muscle injury in 93 197 men ≥66 years of age who initiated a new prescription for finasteride or dutasteride, and they were matched to an equal number of men not prescribed a 5ARI.

Interestingly, the risk of myositis and myopathy was almost 2 times higher among users of finasteride or dutasteride (HR 1.63, 95% CI, 1.48-1.80, P < .01).

 

Conclusion


Finasteride and dutasteride can potentially cause muscle injury. The risk overall is quite low but any patient with concerns about muscle soreness, weakness, poor exercise ability should have their muscle enzymes tested.

 

Reference

Welk B et al. Risk of rhabdomyolysis from 5-α reductase inhibitors. Pharmacoepidemiol Drug Saf. 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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Lichen planopilaris: A classic example of scarring alopecia

LPP: A scarring (cicatricial) alopecia

LPP-trichoscopy

Hair loss is frequently divided into two big groups - "scarring" and "non-scarring."  The accompanying photo shows the typical 'dermatoscopic' appearance of lichen planopilaris (LPP), namely the absence of the hair follicle openings (pores), white scale around some hairs, appearance of many single hairs, and reduced overall density. 

Lichen planopilaris is an example of a scarring alopecia. The entities in this group generally are associated with permanent hair loss because the scarring alopecias are associated with death of hair follicle stem cells.

Treatment may help stop the disease but does not generally prompt new hair growth.

DOWNLOAD LPP HANDOUT


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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Hydroxychloroquine: 2 months to onset

How long does it take for hydroxychloroquine to start working?

plaqueil.png


Hydroxychloroquine (Plaquenil) is a notoriously slow acting drug. It is frequently used for treating scarring alopecia. It can take 2 months or more before the drug really starts to have an effect and actually help a patient using the drug. Because the drug is so delayed in its onset, I usually give it 4-6 months before judging if it is working ... and sometimes even longer. Clinical symptoms (itching and burning) are reduced first in those who respond followed by clinical signs (perifollicular erythema, perifollicular scale, scalp erythema). The reduction or slowing of hair loss is last.

Hydroxychloroquine is the slowest acting of all the typical oral immunomodulators such as doxycycline, methotrexate, mycophenolate and cyclosporine (cyclosporine tends to be the most rapid). For my patients I often tell them we are going to start the “timer” in 2 months. So if I see them in July, I tell them we will actually set your zero point or start of treatment in September. I tell the patient that for the next two months they can 'consider/imagine' that they are not really even on treatment from the perspective of their scalp. (Of course blood tests need to be done because the body knows from day 1 that the drug was taken.

I may even ask patients to come in at month 2 or 3 for repeat photos (or have them take at home) as a reminder that this time point is really the starting point.


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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What causes scalp pustules?

 

Scalp Pustules

PUSTULES.png

What causes scalp folliculitis? Folliculitis refers to a process whereby inflammation develops within the wall of a hair follicle. Individuals with folliculitis have redness around the hair follicles and may have pustules, papules and vesicles.

There are many ways to classify folliculitis but these processes are generally classified as infectious, non infectious and perifolliculitis. 
Bacteria, viruses and fungi and yeast can all cause various types of infectious folliculitis. They can cause temporary or permanent hair loss.

The list of non infectious causes is long. Certain medications like topical steroids or topical products like various hair care products can cause folliculitis. A variety of scarring alopecias are on the list of causes of scalp folliculitis including folliculitis decalvans, dissecting cellulitis, acne necrotica, and follicular mucinosis.

Perifolliculitis simply refers to inflammation that surrounds the hair follicles without penetrating through them. Lichen planopilaris is another scarring alopecia and a classic example but there are many others in this class including vitamin A deficiency and lithium toxicity.

A careful history and examination is needed for anyone with a suspected folliculitis. Swabs are essential if there are pustules and one should normally culture any pustules on the scalp. Viral swabs and scrapings for fungi may also be important depending on the situation. A scalp biopsy can sometimes be helpful and becomes mandatory if scarring is seen.


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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Permanent Chemotherapy Induced Alopecia

 

TCIA vs PCIA

PCIA.png

Every year well over 1/2 million patients undergo chemotherapy in the United States. About 65 % of these patients will lose hair as hair loss is a common side effect of chemotherapy. There are two main types of hair loss that occur in patients undergoing chemotherapy: TCIA AND PCIA

TCIA

The first type of hair loss that I would like to explain  is hair loss that happens within weeks of starting the chemotherapy and then lasts several months before growing back. This is known as temporary chemotherapy induced alopecia ("TCIA"). 

PCIA

The second type is uncommon and occurs when patients fail to regroth their hair back to the level it was before undergoing chemotherapy. If hair has not grown back after chemotherapy by the 6 month after chemotherapy, we call this permanent chemotherapy induced alopecia (PCIA).



PCIA in Breast Cancer Patients

A number of studies have highlighted the possibility of PCIA in women with breast cancer treated with various chemotherapeutic agents, especially drugs known as taxes (Docetaxel and paclitaxel are part of this group of drugs). The exact mechanisms by which they cause permanent hair loss are unclear although injury to the bulb as well as follicular stem cells are thought to be relevant. Adjuvant anti-estrogen hormonal therapy may be an important cofactor in many women with PCIA. A similar PCIA presentation has been reported in patients undergoing bone marrow transplantation. The scalp is predominantly affected in women with PCIA although a minority may have eyebrow, eyelash and body hair loss as well.

We don't really know yet how to best treat PCIA. However, the most common treatments described in the research literature are oral and topical minoxidil. Both seem to provide benefit to at least a proportion of patients. Other treatments are not known to provide benefit.


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: One of the many 'non-scarring' alopecias

Alopecia Areata is Non-scarring

AA-nonscarring

It's hard to believe that there are so many different reasons for hair loss. We see about a dozen causes commonly in the office each week but many more rarer entities exist.

Hair loss is frequently divided into two big groups - "scarring" and "non-scarring." Alopecia areata is an example of a non scarring alopecia. Clinically, when one looks at the scalp up close as in the accompanying dermatoscopic image, it can be seen that the hair follicle openings are present. If one were to biopsy the scalp in this condition, there would not be scar tissue present. 

The entities in this group of "non-scarring alopecias" theoretically have the potential to regrow although regrowth is more difficult for some of the non scarring alopecias compared to others. Common non scarring alopecias include alopecia areata, androgenetic alopecia, telogen effluvium, tinea, trichotillomania, and traction 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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An Up Close Look at AGA

AGA - Magnified

What does androgenetic alopecia (male balding and female thinning) look like up close and magnified?

AGA



This photo is a dermatoscopic image of early staged androgenetic alopecia. It shows a variation in the thickness of hairs that is typical of this type of hair loss. "Anisotrochosis" is a term that was introduced to the medical literature in 2007 to describe a simple phenomenon - namely the great diversity and variation in the thickness and thinness of hair follicles that is seen in individuals with genetic hair loss. This photo shows a large thick terminal hair (labelled “1”) as well as three progresively thinning hairs (labelled 2,3 and 4). In individials with androgenetic aloepcia, hairs get thinner and thinner over time. When more than 20 % of hairs are displaying this variation in size in an individual with hair loss, there is a good chance that genetic hair loss is present although the diagnosis may be possible to determine even with a 10 % variation in size using certain other strict criteria as well.

Over time, the thin “miniaturizing” hairs become thinner and thinner. Hair follicle 2 in the photo was once as thick as hair follicle 1. Hair follicle 3 in the photo was once as thick as hair follicle 2 and hair follicle 4 was once as thick as hair follicle 3. 
Treatments for androgenetic alopecia differ very slightly for men and women but include minoxidil, antiandrogens, laser, PrP, essential oils (rosemary), pumpkin seed oil, saw palmetto, ketoconazole shampoos, oral contraceptives (women), zinc. For women with AGA in the setting of PCOS resveratrol, and selenium can be considered. Hair transplants and scalp micropigmentation are treatments to also be considered.


Reference


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


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

Focal atrichia: What does it mean? 

Focal atrichia refers to small circular areas on the scalp that are devoid of hair. These areas are typically slightly larger than a pencil eraser. 

fa-in-aga


Focal atrichia is seen in both male and female androgenetic alopecia and more common in more advanced stages. They may contain a few tiny vellus hairs if one looks closely but eventually these tiny hairs disappear over time. Hair regrowth does not occur in these areas.

Studies by Olsen and Whiting (see references below) showed that focal atrichia was present in 44% of women with female pattern hair loss, including 67% of late onset vs 15% of early onset, compared to 3/146 (2%) of those with other hair disorders. Hu and colleagues showed that focal atrichia in men with balding was associated with more advanced stages.
 


Reference


Olsen EA, et al. Focal Atrichia: A Diagnostic Clue in Female Pattern Hair Loss. J Am Acad Dermatol. 2017.

Hu R, et al. Trichoscopic findings of androgenetic alopecia and their association with disease severity. 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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Focal atrichia with itching

Focal atrichia (+ itching)

fa-in-lpp

Focal areas of hair loss are common in advanced stages of androgenetic alopecia. However, other conditions can often mimic this so called 'focal atrichia'.

The photo shows a patient with lichen planopilaris (a scarring alopecia) who has focal areas of complete hair loss. The slight amount of redness along with the itching and tenderness in the area is an indication that another cause besides androgenetic alopecia might be present. A biopsy confirmed the diagnosis of lichen planopilaris (LPP).  

 

Further Reading

Focal atrichiaa: A worrisome sign 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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Acute Telogen Effluvium: Will my hair grow back or not?

Telogen Effluvium: Hair regrowth

I'm often asked if a patient with acute telogen effluvium will regrow their hair fully in 6-9 months. The answer is neither "yes" nor "no" but rather ... maybe. Hair often regrows very well if the specific "trigger" that caused the shedding in the first place can be identified AND treated properly and fully. These triggers include low iron, thyroid problems, stress, new drugs, diets, and various internal diseases as well.

te-regrowth

 

Telogen Effluvium: Is the the only diagnosis?

But one must always keep in mind that if another hair condition develops in the interim (such as androgenetic alopecia)... the regrowth might not be full and complete after a telogen effluvium. This is especially true in patients with androgenetic alopecia where a telogen effluvium often worsens the underlying androgenetic alopecia such that even when the telogen effluvium resolves the hair does not return to the original 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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Should I stop hair medications before a scalp biopsy?

Is it okay to be on treatment medications before a scalp biopsy?



I’m often asked if being on medications will make a difference to the 'accuracy' of a scalp biopsy for hair loss. After all, if one is looking for a certain finding (such as inflammation) and the drug is supposed to help remove that finding (such as inflammation)... wouldn’t being on the drug be a bad thing?

Overall, this tends to be a complex question and not as simple as one might think. In general though, it is preferable for a patient to NOT be on any type of anti-inflammatory treatment before his or her scalp biopsy.

In typical well-developed cases of scarring alopecia being on treatment will not affect the diagnosis but could affect the accuracy if determining the degree of inflammation in the skin and therefore the overall activity of the scarring alopecia.

In other words if the question is “is this a scarring alopecia? - being on treatment usually won’t alter that answer in a well developed case. However if the question is “is this scarring alopecia mildly active, moderately active or severely active?” - being on treatment could alter that interpretation.

The challenge comes with diagnosing early staged scarring alopecias. Here, we are talking about the subtle cases. Here we are talking about the cases that don’t look like scarring alopecia. Here we are talking about the cases whereby a patient has itching, burning, pain or shedding and everyone including the patient’s family, friends, neighbour, hairdresser and sometimes even physician is telling them they will be fine.

In these subtle cases, being in treatment is not a good idea.

The key finding in early LPP is inflammation centred in the upper follicle and inflammation causing death of keratinocytes in the hair follicle. Treatments such as topical steroids, steroid injection and oral immunomodulators (doxycycline, hydroxychloroquine, etc etc) can reduce this inflammation. But one needs to keep in mind that scarring alopecia is not only about inflammation - it’s about oil glands and scar tissue as well. Well-developed scarring alopecia shows disappearance of sebaceous glands which is not going to be affected by these immunosuppressive treatments. One must also consider the experience of the dermatopathologist reading the biopsy. It’s a huge huge deal. A very experienced dermatopathologist can sort through alot of these subtleties - an inexperienced dermatopatholigist sometimes can’t sort through these as easily.

I’m a big fan of analogies. If you consider for a moment your life as a plumber and being called to an old apartment building. The man renting the apartment thinks there is a leaky pipe in the roof because he has heard sounds of water dripping for days and days. He phoned the owner of the apartment who came in for 2 minutes carrying a box of bandages and tape and did something in the ceiling and now the dripping noise has stopped.

In cases of a tiny leak or early problems, this use of bandages and tape (ie the “treatment”) may be enough to stop the leak. After the tape is applied, it’s difficult now for the plumber really tell if there is a problem. The plumber can see the tape on the pipes when he looks up in the roof but it’s hard for him to say if there is really anything wrong. Maybe the tape was put there before? Phrased another way, the “treatment” done by the owner makes it challenging to know if anything is wrong with the pipe right now and whether the apartment is really under any sort of risk for flooding. When the plumber is asked “Is their a problem with the pipe or not?” ... the plumber is not sure. Treatments clearly make a difference to how we evaluate things in the case of early problems.

Now consider if you would a well developed leak. In a “well developed” pipe leak, there will be water everywhere! The floor may be stained with water stains. If the leak has gone on long enough, the room may smell and there may even be mold growing. Even if the pipe is fixed (ie treatment administered) it’s still very easy to tell there was a flood. Now when the plumber is asked “Is their a problem with the pipe or not?” he can say there was certainly a problem somewhere. The plumber is sure there is a plumbing problem and sure there was a leak. Treatment generally makes little to no difference to the final evaluation: Yes, there was a leak.

 

Summary


To summarize, it’s not ideal for a patient to use oral or topical treatments if one is trying to rule out a challenging case of early staged disease. If one tries to “fix” things before a biopsy is done .... it can be difficult to confidently determine if there was a problem. In well developed disease, it makes little difference. Overall, a patient using topical, injection or oral immunosuppressive treatment has the potential to have an altered interpretation of their biopsy... mainly a low risk of a “false negative” in cases of diagnosing early-staged disease. For most however, it’s only a “potential” (relatively small) risk.


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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Testosterone Injections for Women with Low T: Do they cause hair loss?

Treating Low T in Women: Is there a risk of hair loss?

In men, it’s clear that testosterone supplementation can cause hair loss in men with underlying or existing androgenetic hair loss. The reality for some is that we don’t know all the answers. However, a 2012 study looked at the effect of subcutaneous testosterone supplementation in 76 women with low testosterone who also had concerns about hair loss. 63 % of these women noted an improvement in their hair density with testosterone supplementation. Hair loss per se was not side effect. 93 % developed increased hair on the face as one of the side effects of the testosterone treatments.

low T

Low T in Women: Talking to your Physician

There are many symptoms of low testosterone in women. These include

Hot flushes
Insomnia
Depressed mood
Irritability
Fatigue
Memory Loss
Headaches
Vaginal dryness
Sexual problems

If testosterone levels are low, I encourage discussion with one's physician. For now, it seems that the risk for hair loss in most women with low testosterone is quite low. Whether adding anti androgens to block DHT is helpful for protecting hair is not know. We know antiandrogens seem to help men with hair loss who use anabolic type steroids.

 

Conclusion

This is an important study. It provides some guidance for symptomatic women with low testosterone who are considering testosterone supplementation. This study does not rule out the possibility of hair loss but certainly indicates that the risks for hair loss are low - most should actually experience an improvement. 

 

Reference

Glaser RL et al. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 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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