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QUESTION OF THE WEEK

Dr. Donovan's Articles

QUESTION OF HAIR BLOGS

Filtering by Category: Causes of Hair Loss


What are the types of alopecia areata?

Many Different Forms of Alopecia Areata

Alopecia areata is an autoimmune disease that causes hair loss. There are many different forms of the condition although most affected people experience ‘patchy’ alopecia areata whereby 1 or more patches develop on the scalp. When just a single patch develops, the term alopecia areata uniloculiaris is used. When 2 or more patches develop, we use the term alopecia areata multilocularis.

AA forms

Together, most patients with alopecia areata unilocularis and multilocularis are classifed as having mild disease which means that less than 25 % of hair has been lost from the scalp. Overall, about 30% of patients with alopecia area will experience moderate and severe forms and many will still experienced regrowth with treatment.

How common are mild moderate and severe forms of AA?

Out of every 100 patients who develop alopecia areata, about 2/3 will regrow hair back spontaneously by 1 year. About 40 % of these are individuals with alopecia areata unilocularis and 27 % are multilocularis. About 33 % of patients with alopecia areata will not experience spontaneous regrowth by the end of the first year. These include patients with alopecai totals (AT), alopecia universals (AU) and patients with relapsing alopecia areata (RR).

AA natural history



This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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What cancers metastasize to the scalp?

Lung cancer tops the list of cancers that metastasize to the scalp


Focal alopecia refers to hair loss in a single area of the scalp. Common causes of focal alopecia include alopecia areata, tine capitis, infections, trauma, trichotillomania. Cancer is another cause of focal alopecia - albeit an uncommon one.

Scalp metastases refer to cancer the started in another organ and then the cancer spread to other parts of the body, including the scalp. Less than 2 % of patients that are known to have metastatic cancer will experience scalp metastases.


What are the most common cancers that metastasize to the scalp?

Lung cancer is the most common cancer that is associated with scalp metastases. Of all metastases to the scalp, lung cancer is the most common at 24 % followed by colon (11 %), liver (8 %) and breast (8%). Kidney and ovary remain other causes on the list. In 30 % of cases, the exact origin can’t be precisely determined. There are many types of ‘lung cancer’ and it remains debated as to which of the types is really the most likely contributor to scalp metastases (adenocarcinoma, large cell, small cell, squamous).


What are the clues that an area of hair loss may actually represent a metastasis?

Scalp metastases can be challenging to diagnose in the early stages. Sometimes they aren't large and sometimes they get overlooked. They may appear as papule or nodules, or firm indurated plaques or ulcers or as an area closely mimicking alopecia areata. They may simply appear as an area that looks like an infection. In many cases, they are red from dilated blood vessels - and sometimes hemorrhagic from localized blood clots in the area.  “Alopecia neoplastica” is a term that refers to hair loss associated with destruction of hair follicles. It is accompanied by red, indurated skin with dilated blood vessels and sometimes ulceration. In most cases, alopecia neoplastica represents hematologenous spread (spread in the blood stream) of a breast cancer. In some cases of metastastic scalp lesions, the areas of involvement are associated with no symptoms which in turn adds to the delay in diagnosis. In fact, there can be a delay in diagnosis for many patients with some studies showing a delay in proper diagnosis of 4–10 months following the time they are first noticed.

The identification of a scalp metastasis can rarely be the very first indication that the patient has a cancer inside the body. This is not common and in most cases it is already known that the patient has a cancer somewhere in the body. Overall, a study by Lookingbill and colleagues of 7316 cancer patients found that 0.8 % of patients had a skin lesion that represented the presenting sign of the cancer inside the body.

Key Conclusions and Summary

Scalp metastases can be challenging to diagnose in the early stages and diagnosis of a scalp metastasis ALWAYS comes from a biopsy. One can never look at a skin lesion and know with 100 % certainty that it is a metastasis from a cancer somewhere in the body. One only reaches that conclusion after a biopsy is done.

It’s often a good idea for a doctor to consider performing scalp biopsy when a patient has a focal areas of hair loss that does not improve over time - especially in patients over 45 years of age. In situations where the diagnosis is completely clea…

It’s often a good idea for a doctor to consider performing scalp biopsy when a patient has a focal areas of hair loss that does not improve over time - especially in patients over 45 years of age. In situations where the diagnosis is completely clear simply by examining the scalp, a biopsy is not necessary.


In general, a biopsy should at least be considered in the following situations:

1) A patient with a history of CANCER AT ANYTIME IN THE PAST who presents with a solitary area of hair loss (i.e. affecting a single localized area of the scalp).

2) A patient with CURRENT CANCER DIAGNOSIS who presents with a solitary area of hair loss (affecting a single localized area of the scalp).

3) A patient over 45 years of age who presents with a solitary LOCALIZED, RED PATCH OF HAIR LOSS ON THE SCALP that has persisted for 3 or more months.


Most patients with previous cancer diagnoses or who are dealing with cancer at the present time do not have a scalp metastasis as the reason for their hair problems when they present to the hair doctor’s office. However, it must always be on the doctor’s radar - especially when the patient has a solitary patch of hair loss (a single spot).

Persistent solitary patches of hair loss, especially when red, are extremely important to consider biopsying in anyone over 45.


Reference

Chiu CS, Lin CY, Kuo TT, et al: Malignant cutaneous tumors of the scalp: a study of demographic characteristics and histologic distributions of 398 Taiwanese patients. J Am Acad Dermatol. 56:448–452. 2007.

Frey L, Vetter-Kauczok C, Gesierich A, Bröcker EB and Ugurel S: Cutaneous metastases as the first clinical sign of metastatic gastric carcinoma. J Dtsch Dermatol Ges. 7:893–895. 2009

Kim HJ, Min HG and Lee ES: Alopecia neoplastica in a patient with gastric carcinoma. Br J Dermatol. 141:1122–1124. 1999.  

Lifshitz OH, Berlin JM, Taylor JS and Bergfeld WF: Metastatic gastric adenocarcinoma presenting as an enlarging plaque on the scalp. Cutis. 76:194–196. 2005

Lookingbill D.P., N. Spangler, F.M. SextonSkin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J. Am. Acad. Dermatol., 22 (1) (1990), pp. 19-26


 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Hair loss in the Frontal Hairline.

Cause of Frontal Hairline Loss

I enjoyed giving a lecture yesterday to our brilliant University of British Columbia dermatology resident physicians. We discussed the common and uncommon scarring and non-scarring hair loss conditions that affect the frontal hairline of males and females.

frontal hairline

 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Managing Hair Loss During and After Pregnancy: Facts vs False Reassurance

Hair Loss During and After Pregnancy

Individuals with hair loss often ask what steps they should be taking to best help their hair during pregnancy and what steps they should take after delivery.

I have written on certain aspects of this topic before. Please consider reviewing my past articles on Hair Loss, Pregnancy & Breastfeeding:

July 23, 2019 - Stopping Medications in Pregnancy

May 6, 2018 - Pregnancy and Female Pattern Hair Loss

Mar 1, 2017 The Safety of Hair Loss medications in Pregnancy

May 19, 2012 - Which medications are safe during breastfeeding?

For many women who ask this question and are currently pregnant, I often say that there are two ways to help the hair while pregnant. The first is make sure that the individuals does not truly have any deficiencies by getting some basic blood tests if the individual or her doctor are worried about some type of deficiency. The second way to potentially help the hair is to consider reviewing the benefits of low level laser therapy (LLLT). Besides correcting a vitamin deficiency, administration of low level laser treatments is really the only treatment that can be safely used during pregnancy.

For women who were using minoxidil before pregnancy but needed to stop during the pregnancy, I strongly encourage them to see an expert to determine when minoxidil might best be restarted after delivery. Both the American Academy of Pediatrics and the American Academy of Dermatology have stated that Rogaine is reasonably safe for breastfeeding women (yes, despite the fact that all warning labels say otherwise). I can’t emphasize enough the importance of speaking to the dermatologist about this. in my opinion, we need to let years and years of medical research and years of observation help guide how we make tough decisions not simply outdated warning labels that protect companies from legal ramifications. These decisions are of course taken on a case by case basis.

False resurgence has no place in the management of any type of hair loss - and this is particularly true in managing hair loss around the time of pregnancy. It would be wonderful if I could reassure women that hair always grows back “fully” after delivery (i.e. to the same density as before pregnancy) - but this is not accurate. For most women who shed hair post partum, the shedding eventually slows down around month 6-9 post partum and shedding returns to normal and hair regrowth happens. However, hair density does not always grow back as full as it was before pregnancy if a woman has the genes for genetic hair loss instructing the hairs what to do.  For many women it does - but not all. This is far more than my professional medical opinion - it’s fact. For this reason, I encourage patients to have a solid treatment plan in place.

False reassurance that hair “always” grows back and not to worry leaves many women confused and disappointed. I sometimes advise a conservative approach and sometimes an aggressive approach to treatment after delivery. It all depends on the stage of the patient’s androgenetic alopecia, her current age and health and her family history of hair loss and other conditions. We don’t yet have tests available to set the known genes for genetic hair loss - so this is not part of the evaluation. The decision on what to use during pregnancy is easy as only laser is safe (and supplementing any deficiencies that are uncovered in the blood tests).  


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Is Androgenetic Alopecia (AGA) Caused Only by the Effects of DHT ?

Despite the Myth, Androgenetic Alopecia is Not Simply a Story of DHT

Androgenetic alopecia is a type of hair loss that affects men and women. In males, this condition is also referred to as male balding or male pattern hair loss and eventually affects some 80 to 90 % of males. In females, the condition is referred to as female pattern hair loss or simply hair thinning and affects 40% of women by age 50. The purpose of this article is to deal with some misconceptions, wrong information, errors and myths that many people have about the role of DHT in the balding process. DHT is certainly important - but other factors must be considered too.

The Evolution of the DHT Theory of Male Balding

Some of the earliest observations about the role of hormones in male balding happened in the time of Aristotle back in 300 BC. Aristotle showed that castrated males (eunuchs) did not develop balding. JB Hamilton in 1942 did additional pioneering work to understand male balding. He showed that male hormones are relevant to the balding process. Specifically, he confirmed observations by Aristotle and others that males that were castrated before puberty did not go on to develop balding. Hamilton took this further and showed that if testosterone was given back to castrated males, the males proceeded to develop male balding. This showed that male balding was an “androgen-dependent” process.

Hamilton

Further key work in understanding male balding was done in the 1970s and ultimately published in the New England Journal of Medicine. These were studies that showed that male pseudohermaphrodite living in the Dominican Republic with a genetic deficiency known as 5 alpha reductase deficiency did not produce dihydrotestosterone (DHT) and did not develop male balding. These findings lead ultimately to the rational development of drugs such as finasteride and dutasteride which block 5 alpha reductase and lower DHT levels.

story of MPB

The Story of Male Pattern Balding has a DHT Chapter but Don't Forget to Read the Others

From 300 BC to the 1990’s, the story of male balding seemed pretty clear. Male hormones, particularly the infamous DHT, seemed to be what male balding was all about. Blocking DHT was what treatments were all about.

Many people incorrectly assume that male balding is just a DHT story. Many people incorrectly assume that this DHT chapter is the only chapter they need to read when trying to understand male balding. While it’s true that DHT has a whole lot to do with male balding - the correct way to state it is “male balding is due in part to the effects DHT on hair follicles that are genetically sensitive to this hormone.”


DHT not the only chapter in the balding story

DHT not the only chapter in the balding story. One only need to consider a few other treatments that are used for balding to very quickly realize that male balding must be much more complex than just a DHT story. Minoxidil (Rogaine), for example, has nothing to do with DHT - and yet it helps some people with male balding. Granted I agree that finasteride and dutasteride are much much better treatments than minoxidil - but if DHT was the only thing we need to think about when it comes to treating male balding then minoxidil would not be expected to have any sort of benefit. Well, it does. Low level laser therapy also has nothing to do with DHT hormone levels - and yet it helps some males with their male balding. Platelet rich plasma (PRP) also has very little to do with DHT- and yet it helps some males with their male balding.

Drug Companies are Investing Large Sums with the Knowledge that Male Balding is Far Far More than A Simply DHT Story.

At least 12 pharmaceutical companies are investing millions upon millions of dollars with the clear understanding that DHT is not the only chapter in the balding storybook. These companies are hoping to the first to market with brand new types of drugs - again drugs that have nothing really to do with DHT. A brief summary of the drugs is below.

companies in race



If Male AGA is Far More than A Simply DHT Story, Female AGA is Far Far Far More than A DHT Story

If you have now come to realize that male balding is a bit more complex than simply a story about DHT, I’d like to point out that female androgenetic alopecia (i.e. female pattern hair loss) is even more complex. If you think for even a moment that you’re going to apply the same DHT story that you used in males to explain balding to the mechanisms operating in females with androgenetic alopecia, you’re going to come up short in terms of your ability to explain hair thinning in women.

Androgenetic alopecia in females is a far more complex story - and we still don’t know all of the mechanisms that govern how hairs thin in women. Of course, there is some aspects of the DHT story that relevant to female thinning. But finasteride and spironolactone and anti-androgens are far less consistently helpful in females than in males. Other treatments such as minoxidil and laser may be far more helpful in some women than in males. In other words, there are likely several different mechanisms that are contributory to androgenetic alopecia in females besides simply a DHT story. As further information for reflection to readers who still doubt this information, one must consider that some women with a genetic condition that completely makes them insensitive to the effects of androgens (called androgen insensitivity syndrome) can still develop androgenetic alopecia. Even women with low testosterone and low DHT levels can develop androgenetic alopecia. There are even some androgen deficient women who do not develop any balding whatsoever when you give them back supplemental androgens through various means of testosterone replacement therapy.

Conclusion

Is androgenetic alopecia simply due to the sensitivity of hair follicles to DHT? Well, it’s a good story, but it’s only part of the story. The DHT chapter is an important chapter to read in the story of male balding and female thinning, but be sure to read the remaining chapters of the story book. The DHT story is not the only story - and many pharmaceutical companies are banking on this concept.





This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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The Course of Treating Lichen Planopilaris: What do we hope for?

A Closer Look at the Typical Course of Treating Lichen Planopilaris

Lichen planopilaris is a scarring alopecia. Treatments are largely focused on reducing inflammation in hopes that by doing so the disease can be stopped. 


In the present day, there are many aspects of LPP that are difficult to predict. We know to some degree which treatments are better than others. We know the proportion of patients that are expected to benefit from a certain type of treatment and the proportion of patients who are not expected to benefit. However, we do not know if a given patient will require several trials of medications before finding one that ‘works’ to suppress the disease and whether a given patient will need 1, 2 3 or more treatments to suppress the disease completely (and therefore stop it). In addition, we do not know how long the patient will need to use their treatments before the disease completely stops. It ranges from a year or two to many decades.

When all goes well, LPP disease activity eventually settles down with use of one or more medications. Disease flares and micro flares can still happen even when patents are on the right treatment plan. Some patients, but not all, finally enter a sta…

When all goes well, LPP disease activity eventually settles down with use of one or more medications. Disease flares and micro flares can still happen even when patents are on the right treatment plan. Some patients, but not all, finally enter a state where their disease is completely quiet. When the disease stays quiet and mediations can be stopped, we call the condition “burnt out.”


Flares and MIcroflares in LPP

Even when a patient’s disease achieves a fairly inactive state, flares and microflares may still happen from time to time.  These refer to sudden increases in the activity of the disease. Patients who are experiencing flares may become more itchy, or notice more daily hair shedding. Stress, heat, can humidity can cause such microflares and sometimes these sorts of flares occur for no apparent reason at all.Some patients, but not all, finally enter a state where their disease is completely quiet. When the disease stays quiet and mediations can be stopped, we call the condition “burnt out.” 

 Although no patient is really ‘typical’ when it comes to LPP, a standard treatment protocol is summarized in this graph above.


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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What Combination Locks Teach us About Managing Hair Loss

Getting all the Numbers Right Opens the Lock

There are many ways people can physically lock up their personal belongings. Key locks and combination locks are popular ways of securing one’s belongings. With a key lock, one simply needs to have the right key and the lock can be unlocked. With a combination lock, one needs the right digits and enter them in the right order.

Combination Locks and Hair Loss

Combination locks remind me a lot about how we treat hair loss. Nobody ever expects to be able to open a three digit combination lock if only remember 1 or 2 of the required combination numbers can be remembered. Unless they can all be entered, the lock is simply not going to open.

Every day, I see patients with hair loss who tell me they their treatments just aren’t working. For example, they might have lichen planopilaris and tell me their topical steroids aren’t working. They might have androgenetic alopecia and tell me their minoxidil is not working. They might have alopecia areata and tell me their steroid injections aren’t working. In many cases, the patient is absolutely right - the current treatments just aren’t the right treatments and we need to change them. Sometimes, however, the treatments are actually just fine, it’s just we have not addressed the other hair loss conditions that are present. The patient and his or her physician was expecting success but several other hair loss conditions are present and have not been addressed. We can’t successfully open the lock unless we enter all the numbers and we can’t successfully treat hair loss unless all the conditions that are present are treated.

Consider the 46 year old female patient with lichen planopilaris who is using topical steroids (clobetasol). She feels the hair shedding is a bit better but she’s still losing hair and it’s still quite itchy. What I soon realize is that the patient also has seborrheic dermatitis and has low vitamin D, and low zinc. I also suspect an allergic contact dermatitis from a shampoo ingredient. After examining the patient, I recommended that she continue the topical steroids, supplement with oral vitamin D and oral zinc, add a low allergen anti dandruff shampoo (such as Free and Clear Antidandruff) and avoid her regular shampoo until patch testing is arranged by a dermatologist. Within a few weeks the patient finds her scalp feels better and looks better and hair shedding is reduced further. She’s glad she does not need stronger immunosuppressants for her particular case… and so am I.

Conclusion

With many hair loss treatments, we often expect the treatments to work. But too often we forget to ask ourselves if any other conditions are present. Many patients are surprised to leave the office with 2, 3 or 4 hair and scalp diagnoses but they should not be really too surprised. We can’t open a four number combination lock by entering just 1 number. Similarly, we can’t successfully and completely treat a scalp disorder whereby four conditions are contributing if we are just trying to deal with only one of the conditions.


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Hair Loss in Women: Irregular periods = Blood tests

Irregular periods = Blood tests

irregulr periods.png

When speaking with patients about their hair loss, there are many pieces of information that a patient may share that should trigger the clinician to look deeper into the particular issue.

Irregular menstrual cycles in women are one such example especially when they occur in females age 16 to 43. Of course, there are many reasons for irregular periods and some of these reasons may have nothing to do with hair loss.

However, a variety of medical issues associated with hair loss may cause irregular periods. These include polycystic ovarian syndrome, congenital adrenal hyperplasia, hyperprolactinemia, Cushings, adrenal and ovarian tumors and cysts, stress, excessive dieting, thyroid disease.

The evaluation of women with irregular periods is best done on a case by case basis after review of all the facts. Blood tests shown here are frequently helpful especially in the third to fifth day of the menstrual cycle and especially in the morning. Patients with abnormalities may sometimes undergo further testing or referral, depending on the suspected cause.


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Stopping Birth Control: Will My Hair Come Back?

Will My Hair Come Back?

Stopping birth control can be associated with hair shedding. For many individuals the shedding occurs with 4-8 weeks after stopping birth control and eventually shedding returns to normal within 9-12 months and hair density returns to normal as well.

One of the most misunderstood topics when it comes to hair loss and birth control, is the array of considerations when hair density and shedding do not return to normal as one would anticipate. 
Situation “A” and “B” are common when birth control is stopped. In “A”, there is an initial shed followed by a cessation of shedding at month 7-10 and hair density returns to normal by month 12. In situation “B” there is no real perceived increased in shedding at all and the patient notices no real change in her hair at all. These situations typically occur in a patient with no underlying androgenetic alopecia and no strong predisposition to it as well.

Situation “C” and “D” are different. In situation “C” the patient starts out with good hair density but notices at 9-12 month later that her hair density has not returned and is a bit thinner. In situation “D” the patient notices the hair density is quite a bit thinner. In these two situations, the patient often has an underlying predisposition to androgenetic hair loss. In “C” there may have not been any degree of androgenetic hair loss to begin with but the shedding has accelerated the arrival of the patient’s genetic hair loss. In situation “D” there was some genetic hair loss to begin with but it was so mild it was unnoticed by the patient. The birth control pill in this situation was often helping as a treatment to stop the balding process even though the patient was not using it for this reason. By stopping the birth control pill, a helpful treatment actually gets stopped without the patient knowing and the patient’s hair loss is accelerated to a greater degree than in “C”

Patients and physicians should be aware of the array of different possibilities that exist when birth control is stopped.


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Hair loss in Kidney Transplant Patients

Hair loss is among the top distressing symptoms

Nearly 30,000 kidney transplants are performed every year in North America. Patients receiving kidney transplants require lifelong immunosuppressive medications to help them avoid graft rejection and loss of the transplanted kidney.  The symptoms that patients experience after their transplant have the potential to affect quality of life. These include excess hair loss on the scalp, hair growth on the face (hirsutism), gingival hyperplasia, weight gain, cushingoid facies, hand tremors, and skin disorders. These are consistently among the most bothersome to patients and may have serious psychosocial implications.

Several studies have examined factors affecting quality of life in patients receiving kidney transplants. Hair loss In a recent study of 231 kidney transplant patients, high blood pressure, tiredness and hair loss were the three most distressing symptoms in both men and women. For women, hair loss was the most distressing symptoms.  A 2010 study in adolescents showed that hair loss was among the most distressing of the symptoms in adolescent kidney transplant patients.  


Conclusion

Hair loss can occur for a variety of reasons in patients with organ transplants. This study, as well as others, indicate that patients experiencing side effects are most likely to be non adherent to various aspects of their immunosuppressive treatment recommendations. This can result in more serious complications, such as acute rejection, graft loss, rehospitalization, and even mortality. Strategies for minimizing side effects of immunosuppressive therapy and improving medication adherence are key to the long-term management of kidney transplant recipients. It is important to properly diagnose and treat hair loss in organ transplant patients to limit the effects on quality of life. 

 

Reference

Teng S, et al. Symptom Experience Associated With Immunosuppressive Medications in Chinese Kidney Transplant Recipients.  J Nurs Scholarsh. 2015.

Dobbels F, et al. Health-related quality of life, treatment adherence, symptom experience and depression in adolescent renal transplant patients. Pediatr Transplant. 2010.

 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Scalp Psoriasis: Many Variations

Many Variations

scalp-psoriasis-many.png

Dermoscopy of Scalp psoriasis. There are many variations in how scalp psoriasis appear. It can be red to pink and scaly white to scaly silver. Psoriasis needs to be differentiated from a range of inflammatory conditions such as seborrheic dermatitis, dandruff, scarring alopecia and various infectious causes.


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Telogen Hairs: Lack of pigment at root

Lack of pigment at root

no pigment.png

Telogen hairs are hairs that are ready to be shed from the scalp. At any time, most individuals have 9-12 % of hairs in telogen phase on the scalp.

Telogen hairs have a characteristic appearance once shed from the scalp. They look like clubs and are therefore called "club hairs". They also lack pigment at the very bottom of the hair follicle. This is due to the cessation of pigment production by the hair follicle at the end of its growing phase (called anagen).


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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From Dark to White to Dark Again: What causes transient colour changes?

Short term Hair Colour Changes

They greying of hair is common. By age 50, about 50 % of people have at least half of their hairs appearing grey/white. This type of hair colour change is permanent - and the only way most people can achieve a darker colour is through the dyeing of hair. 

A different scenario exists with individuals noticing that their hair has turned white only to notice that it turns back to the original colour again within months of noticing it.  There are a variety of causes of this phenomenon, especially when it occurs in one area compared to if it occurs all over the scalp. The most important conditions to consider in transient hair greying/whitening are the autoimmune conditions alopecia areata and vitiligo. Other issues to consider include thyroid abnormalities, pituitary problems, and deficiency of vitamin B 12.   Deficiencies of iron, calcium and vitamin D as well as pregnancy and systemic illnesses need to be considered by are uncommon causes. 

 

 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Preventing Androgenetic Alopecia: Is it possible?

Preventing AGA in Men and Women

I'm often asked if one can prevent genetic hair loss. The typical scenario is a patient whose parent or sibling is bald or balding and wants to know if they can reduce their chances of developing a similar pattern of hair loss. Can one prevent balding outright? In the present day, that answer is no. However, there are things that can be done to reduce the magnitude and speed of progression of the hair loss.

Genetic Hair Loss is strongly ... genetic. It's the genes inside the hair follicles that influence how the hair loss will or will not unfold. We'll take a look at factors that can affect genetic hair loss to a slight degree in a moment, but first let's turn our attention to studies of identical twins. 

Studies of identical twins are very important in answering questions like "does what I eat affect my rate of balding?" or ,,,, "does being stressed affect how fast I bald?"

Identical twins carry the same genetic profile. By studying the appearance of identical twins at various points throughout their lives, we can get a better sense of how important factors like genetics and the environment actually are. If genes are the "key factor" in how balding progresses then, identical twins should look ‘identical’ in terms of their hair density at various points in their lives. In contrast, if environmental factors like smoking, drinking, stress, weight loss and ultraviolet radiation are important, identical twins might not have the same hair density because their environment is different. 

 

The 1992 Hayakawa Study


Interesting research studies in 1992 showed that genetics is by far the most important factor and the environment only has a minor role. 92 % of identical twins were found to have "no significant" differences in their hair density at later points in their lives. However,  8% of identical twins had a slight difference. Interestingly, no twin had a striking difference! In other words, there was never a situation where one identical twin was bald and another had full hair. These studies support the notion that one’s genetics is by far the most important factor in the balding process - but there is a slight role for how outside 'environmental factors' shape genetic hair loss.

 

Limiting Genetic Hair Loss: Optimizing Environmental Factors  

The Hayakawa studies taught us that there is a bit of room to optimize how fast genetic hair loss occurs. Overall, these factors have a minor role but still have some role. These factors include the following.

 

1) Be a non smoker.

It's clear that smoking can influence genetic hair loss by speeding up how fast it progresses. An important study examing the relationship between smoking and hair loss was a 2007 study by the Taiwanese group of Dr. Su and Dr Chen.  These researchers examined 740 patients between the ages of 40 and 91 over a 2 month period.  They found that smokers generally had worse androgenetic alopecia compared to non-smokers. In fact, smokers had nearly a two-fold increased risk of having moderate or severe genetic hair loss compared to non-smokers. In addition, the early development of male balding was more likely in smokers. The exact reasons is not clear but it has been proposed that smoking is damaging to the tiny blood vessels and the there are toxic substances in cigarette smoke that damage the cells in the hair follicles. It's also possible that smoking causes inflammation which speeds up the process of genetic hair loss. 

 

2) Keep a healthy weight. 

It does appear that obesity increases one's risk of developing worsening androgenetic alopecia. A 2011 study looked at the risk factors for male balding in policeman in Taiwan. Interestingly, young male policemen who were obese had much higher rates of male balding than thinner policemen. In 2014, researchers from Taiwan explored whether there was a relationship between obesity the severity of male balding. They studied 142 men (average at 31 years) with male balding who were not using hair loss medications.   The study showed that men with more severe  hair loss tended to be more overweight than men with less severe hair loss.  In fact, men who were overweight or obese had an approximately 3.5 fold greater risk for severe hair loss than men with more normal weights. In addition, young overweight or obese men had a nearly 5 fold increased risk of severe hair loss. The exact reasons are unclear. However, obesity leads to altered metabolism, insulin resistance and worsening inflammation that could affect balding. 

 

3) Limit anabolic steroid use.

Anabolic steroids can worsen genetic hair loss in those that are predisposed. These steroids increase the pool of androgens that all act to facilitate miniaturization.

 

4) Reduce ultraviolet radiation to the scalp.

An interesting study from researchers in Taiwan offers further clues that sunlight just 'might' contribute in some way to male balding.  The researchers compared balding patterns in 758 policemen  and 740 men in the general polulation.  Interestingly, policemen aged 40 to 59 had a two fold increased risk of having male balding. In addition, there was a statistically significant association between male balding and sunlight exposure. More research is needed understand if and how ultraviolet radiation affects the process of male balding. Reference

 

Conclusion

It's not always possible to prevent genetic hair loss. However, it may be possible to reduce the speed of its progression by limiting hair shedding and limiting toxic (i.e. smoking, obesity, UV radiation) and hormonal effects (i.e. anabolic steroids) on the hair follicle.

 

Reference

Hayakawa K, et al. Intrapair differences of physical aging and longevity in identical twins. Acta Genet Med Gemellol (Roma). 1992.

Su LH and Chen T H-H. Association of Androgenetic Alopecia with Smoking and Its Prevalance Among Asian Men. Archives of Dermatology 2007 143; 1401-1406.

Mosley JG and Gibbs AC. Premature grey hair and hair loss among smokers: a new opportunity for heatlh education? British Medical Journal 1996; 313: 1616.

Severi G et al Androgenetic alopecia in men 40-69 years: prevalence and risk factors.British Journal of Dermatology 2003; 149: 1207-1213

Chao-Chun Y et al. Higher body mass index is associated with greater severity of alopecia in men with male-pattern androgenetic alopecia in Taiwan: A cross-sectional study.  J Am Acad Dermatol 2014; 70; 297-302.

Su LH et al. Androgenetic alopecia in policemen: higher prevalence and different risk factors relative to the general population (KCIS no. 23). Arch Dermatol Res. 2011 Dec;303(10):753-61

 

 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Morgellons Disease: The Basics

Morgellons Disease

Morgellons

Morgellons disease (MD) is skin and scalp condition that is becoming better and better recognized. However, its cause and classification still remains open to debate.  It's important for hair specialists to recognize this condition and to understand options for patients.  Patients with Morgellons disease frequently lack insight, and are reluctant to be referred to psychiatrists regardless of the underlying psychopathology present. It's important for dermatologists and hair specialists to understand the options for managing Morgellon's disease. 

 

What are the features of Morgellons Disease?

The key features of MD is the presence of skin lesions with filaments that lie under, are embedded in, or project from skin. These filaments can be many colors including white, black, or brightly coloured. The typical patient with MD has concerns that fibers of glass/other material are coming out of the skin. They may resemble cotton. Many patients (up to 25 %) self-diagnose themselves through reading on the internet.  A vast majority of patients believe there are specific precipitating factors that explain the fibers. Patients may have burning, itching, stinging of the skin and sensations of something crawling. They may have fatigue, difficulty concentrating and difficulties with sleep.

How common is Morgellons Disease?

It's not clear how common the condition really is. Pearson and colleagues suggested rates as high as 3-4 people out of every 100,000 population. 

 

What is the cause of MD?

The exact cause of MD remains a mystery. Some sources, continue to describe this as a purely psychiatric disease having overlap with Delusions of Parasitosis. 

Recent research has suggested that MD patients display a variety of clinical manifestations that closely resemble symptoms of Lyme disease (LD). These symptoms include joint pain, nerve damage and fatigue.  In one study,  98% of patients with MD subjects had positive Lyme disease serology and/or a diagnosis of tick borne disease. IN comparison, only 6% of LD patients in an Australian study were found to have MD.

The spirochetes identified as Borrelia spp. are thought to be alive and viable in tissue from patients from Morgellon's Disease. These spirochetes are difficulty to culture in a laboratory so PCR amplification is often used to identify Borrelia.  

The exact relationship between Lyme disease and Morgellon's Disease is still open to debate. Not all experts agree with the link. A much quoted CDC study by Pearson and colleagues. did not find an infectious cause or any good proof of an environmental link in a study of 115 patients 

 

Psychiatric Disease in Patients with MD

The central debate in the Morgellons medical literature (i.e. the medical journals) is whether MD is a psychiatric disease or a infectious disease (perhaps due to Borellia) with psychiatric manifestations.  It's clear from many studies that mental illness can develop in patients affected by tick-borne disease. These include depression, mania, delusions, bipolar disorder, paranoia, schizophrenia,  sensory hallucinations, major depression, and mania. Infection by spirochetes can affect how neutrons function. 

The vast majority of patients with Morgellons disease have psychiatric disease as well. In one study by Harvey and colleagues, 23 of 25 Morgellons patients had psychiatric diagnoses including attention deficit, bipolar disorder, obsessive-compulsive disorder, and schizophrenia. The fact that MD patients may show neuropsychiatric symptoms is what makes this field so challenging. It makes the diagnosis challenging.  It also makes it difficult to distinguish from a  delusional disorder. 

 

Animal Models of MD

Animal models of MD have arisen which provide some understanding of how human MD may come about. There is similarity between MD and an animal disease known as bovine digital dermatitis (BDD). Similar to MD, this particular animal disease is associated with ulcerative lesions exhibiting keratin projections and is an acknowledged spirochetal infection (just like human Lyme disease.  In this animal model, it was confirmed that there is a bona fide causal relationship between spirochetal infection and filament formation infection with pure cultured tremens lead to the clinical disease.

 

What are the fibers in Moregellon's Disease?

The fibers seen in patients with MD are often mistaken by patients and physicians to be textile fibers. However, this is not correct in most cases- the fibers are composed of keratin and collagen. They are produced by epithelial cells. They come from the patient themselves because the base of these filaments are nucleated.  A proportion of these fibers may actually be types of hairs.

 

Classification of Moregellons Disease

Middelveen and colleagues recently proposed a clinical classification system that reflects the duration and location of MD lesions:

Early localized Morgellons Disease. This is a form of MD with lesions/fibers present for less than three months and localized to ONLY ONE area of the body (head, trunk, extremities).

Early disseminated Morgellons Disease. This is a form of MD with lesions/fibers present for less than three months and involving MORE THAN ONE area of the body (head, trunk, extremities).

Late localized Morgellons Disease. This is a form of MD with lesions/fibers present for more than six months and localized to ONLY ONE area of the body (head, trunk, extremities).

Late disseminated Morgellons Disease. This is a form of MD with lesions/fibers present for more than six months and involving MORE THAN ONE area of the body (head, trunk, extremities).

 

Treatment of MD

Since the cause of MD can't be uniformly agreed upon and since the  clinical classification of MD has not been universally accepted, it is not difficult to understand why optimal treatment strategies are still open to some amount of debate.  Some view this as entirely a psychiatric disease and so much of the medical literature focuses on use of psychiatric medications. 

A few principles do seem relevant:

1. Treat it early. Morgellons Disease should be treated as early as possible to improve the ultimate outcome that a patient will achieve. 

2. Consider treatments that address Spirochetes. Although still controversial, treatment should be aimed at the Borrelia if there is evidence by serology or other studies. In such cases, treatment may involve prolonged antibiotic and/or anti-parasitic therapy.

3. Consider psychiatric medications. Psychiatric medications, particularly the antipsychotics are helpful in Morgellon's Disease patients with psychiatric symptoms. However, use of these medications as stand along treatments without addressing the tick infection often leads to incomplete clinical responses.  Psychiatric medications that have best been studies in MD include pimozide, rispidadone, olanzapine and trifluoperazine.

4. Offer support. Patients affected by Morgellons disease often feel isolated and stigmatized.  There are few resources in the medical community for patients affected by Morgellons disease. 

 

 

Conclusion and Final Thoughts

Morgellons is a fascinating condition that is still poorly understood. Some experts take a position that Morgellons Disease is a real somatic condition and yet some take the stance that it's a delusion disorder.  It's not all that easy to diagnose properly and the whole entity itself is surrounded with controversy. The literature on Morgellons is filled with a great deal of controversy. Many patients with Morgellon's have psychiatric disease and separating whether psychiatric disease is due to Lyme disease and Morgellons Disease and what component is due to pre-existing psychiatric disease is challenging.  Furthermore, countless numbers of patients I see have been given diagnoses of Lyme disease by various clinics - even using methods that are not generally agreed upon. There is still controversy as to what 'really' constitutes Lyme disease. 

Despite these controversies, I strongly believe that we need to be thinking about Lyme disease, syphilis and similar spirochetes in all patients who present to clinic with sensations of creepy crawlers, concerns about parasites, chronic itch and report of fibers emerging from their skin. If we don't think about spirochete type infections and infestations, we'll repeatedly miss this condition and the entire field of MD will remain shrouded with controversy and mystery.  It's likely that many patients with true Delusions of Parasitosis will present with a Morgellons-like presentation but the reverse needs to be considered as well.  The fact that a patient has psychiatric disease (including delusions), is not proof they don't have a Morgellon-like presentation. Moreover, the fact that a given patient responds to anti-psychotics is also not proof they have a Morgellon-like presentation. 

We certainly need to open the dialogue in this are of medicine rather than close it. For every study that suggests there is no link between infections and Morgellon's there is a study that suggests there could be. For every study that suggests the fibers that patients find are man made external fibers, there are studies that suggest these are keratin and collagen fibers from the skin itself. The true story of Morgellons will unfold as years go by. For now, patients affected by Morgellons disease need support.

 

Reference

Harvey WT, Bransfield RC, Mercer DE, Wright AJ, Ricchi RM, Leitao MM. Morgellons disease, illuminating an undefined illness: a case series. J Med Case Rep. 2009;3:8243. [PMC free article][PubMed]

Kellett CE. Sir Thomas Browne and the disease called Morgellons. Ann Med Hist, n.s., VII. 1935;7:467–479.

Mayne PJ. Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort. Int J Gen Med. 2015;8:15–26. [PMC free article] [PubMed]

Middelveen MJ, et al. History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol. 2018.

Middelveen MJ, Bandoski C, Burke J, et al. Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients. BMC Dermatol. 2015;15:1. [PMC free article] [PubMed]

Middelveen MJ, Stricker RB. Filament formation associated with spirochetal infection: a comparative approach to Morgellons disease. Clin Cosmet Investig Dermatol. 2011;4:167–177. [PMC free article][PubMed]

Mohandas P, et al. Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes. J Dermatolog Treat. 2018.

Pearson ML, Selby JV, Katz KA, Cantrell V, Braden CR, Parise ME, et al. Clinical, epidemiologic, histopathologic and molecular features of an unexplained dermopathy. PLoS One. 2012;7:e29908.[PMC free article] [PubMed]

Savely VR, Stricker RB. Morgellons disease: analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology. Clin Cosmet Investig Dermatol. 2010;3:67–78.[PMC free article] [PubMed]

Savely G, Leitao MM. Skin lesions and crawling sensation: disease or delusion? Adv Nurse Pract. 2005;13(5):16–17. [PubMed]

Savely VR, Leitao MM, Stricker RB. The mystery of Morgellons disease: infection or delusion? Am J Clin Dermatol. 2006;7(1):1–5. [PubMed]

Savely VR, Stricker RB. Morgellons disease: the mystery unfolds. Expert Rev Dermatol. 2007;2(5):585–591.

 

 

 

 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Pumpkins, Squash and Hair Loss: A bitter tale

A Bitter Tale

bitter tale.png

Pumpkins and squash, together with zucchini and some gourds are members of the cucurbita family (formally Cucurbitaceae). A new interesting report suggests that “cucurbit poisoning” is something all hair loss physicians need to know a thing or two about. Fortunately, it’s not common and provided we never eat “bitter” pumpkin or squash we’ll all be fine and can continue to enjoy these foods.

Dr Assouly (Paris) reported two women who developed severe illness and hair loss after eating members of this cucurbit family. The first patient developed nausea, vomiting and diarrhea within hours of eating some “bitter tasting” pumpkin soup. Although her stomach issues quickly cleared up, one week later she developed hair loss. Her family (who also ate the soup) also got sick but didn’t lose hair - presumably because they ate less pumpkin soup.

The second patient also developed severe vomiting within 1 hour of eating “bitter tasting” squash. Three weeks later she developed hair loss.

This case is interesting as the type of hair loss found to be present was best in keeping with a true “anagen effluvium” - similar to what one might experience after chemotherapy. Numerous broken hairs and hair breakage characterized the loss. The toxic compound in this case is known as “cucurbitacin” and this is what gave these otherwise delicious foods the bitter taste. It’s thought to be rare that squash and pumpkins would have high levels of these toxins. However, cross pollination with wild growing cucurbita can cause occasional ones to have high cucurbitacin and a bitter taste. One should never eat squash and pumpkin that tastes bitter. Fortunately, both patients experienced regrowth of their hair.

Reference

Assouly P et al. Hair Loss Associated With Cucurbit Poisoning. JAMA Dermatol. 2018
 


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Why is my scalp so tender?

Considerations when the scalp feels bruised and tender

There are many reasons why a scalp can feel tender or bruised. One needs a careful evaluation by a dermatologist if this symptom persists. Below the common causes of a tender scalp are reviewed. This list is by no means exhaustive but provides a useful overview.

 

1) Seborrheic dermatitis.

Seborrheic dermatitis (SD) is an inflammatory condition of the scalp that affects up to 5 % -10 % of adults. Males are more commonly affected than females. SD occurs on body sites where the skin is oily such as the scalp, eyebrows, sides of nose, eyelids and chest. Individuals with SD of the scalp develop red, flaky skin that is often itchy. It’s not uncommon for the scalp to be tender as well. Tenderness is SD frequently becomes more of an issue the longer and longer it has been since the individual last shampooed their hair. The scales in SD can be yellow, white or grey colored and are often described as being "greasy." This differs from scalp psoriasis where the scales are often silver and powdery (see below). 

 

2) Psoriasis

Psoriasis is complex immunological disease which can affect not only the skin, but also affects the nails and joints. Scalp psoriasis occurs in about 50 % of patients with skin psoriasis and is very often the first site involved. Patients have scalp redness, flaking and scaling. Patients may also have bothersome itching and not uncommonly the scalp is tender. Tenderness in scalp psoriasis may accompany areas of scalp bleeding. Although the redness and flaking often cause embarrassment, scalp psoriasis does not usually cause hair loss. 

 

3) Scarring alopecias

Scalp tenderness may be a sign of scarring alopecia. Scarring hair loss conditions or "cicatricial alopecias” are a group of hair loss conditions which lead to permanent hair loss. These conditions may frequently be associated with redness of the scalp as well as scalp itching, burning and/or pain. Tenderness and a bruise-like feeling are not uncommon. These feelings may not be present all the time but rather may come and go. Occasionally it may even hurt to move the hair or the patient may feel as though their hair has been kept in a tight ponytail despite wearing it down. The scarring alopecias include conditions with names such as lichen planopilaris, folliculitis decalvans, lupus and several others. 

 

4) Other inflammatory diseases

A wide variety of other inflammatory scalp conditions, including dermatomyositis, morphea, scleroderma and scalp rosacea can be associated with scalp redness. A scalp biopsy can help differentiate these entities.

 

5) "Red Scalp Syndrome"

'Red scalp syndrome" is a condition which occurs in individuals who have persistent scalp redness that is not explainable by any other condition. The condition was first described by Drs Thestrup and Hjorth Patients with the Red Scalp Syndrome may have itching and burning but typically do not have scaling or flaking. Occasionally tenderness can be a predominant feature.

 

6) Irritation

Many products that are applied to the scalp or hair can cause irritation. This is often due to an irritant contact dermatitis that the product elicits. Such products include many cosmetic products, including gel, mousse, hair spray and hair dyes. Some treatments for hair loss can also be associated with irritation, itching and tenderness, including minoxidil and other topical products containing irritants such propylene glycol.

 

7) Allergy

Shampoos, hair dyes and even some cosmetic products can cause allergic reactions in the scalp. Although some individuals with allergy have itching in the scalp, many have only slight tenderness. In such cases, a rash may be present on the neck, ears or back where the product came into contact with the skin. The five most common allergens in shampoos include fragrance, cocamidopropyl betaine, MCI/MI, formaldehyde releasers and propylene glycol.

 

 

8) Infection

Infections are a possible causes of a tender scalp. Bacterial, viral and fungal infections may cause redness and pain in the scalp. Determining the specific cause may come from a careful history and scalp examination and sometimes submission of a swab or piece of scalp tissue to the microbiology laboratory. 

Bacteria, such as staphylococci, may cause infections of the scalp. Bacteria may also cause infection of the hair follicle, which is a condition called " bacterial folliculitis." A variety of viral infections cause scalp redness and pain. Chicken pox and shingles are two such examples. Scalp ringworm or “tinea capitis” refers to infection of the scalp by certain types of fungi. Scalp redness, tenderness and scaling may be seen in these cases.

 

9) Alopecia areata

Alopecia areata is an autoimmune condition affecting about 2 % of the population. It is not typically a cause of scalp tenderness. However, scalp tenderness is occasionally reported by patients. A specific form of alopecia areata known as cephalagic alopecia areata is associated with pain. It is hypothesized that factors secreted from nerves play a role in the pain.

 

10) Scalp Injury and Trauma

Patients with scalp injuries, either due to previous accidents or surgeries, may have persistent scalp tenderness. Burns from fire, chemicals or radiation can cause temporary or persistent tenderness in the scalp. 

 

11) Sun damage

Patients with extensive sun damage, from years of sun expose, may frequently have scalp tenderness.

 

12) Cancers

A variety of pre cancers and cancers of the skin, including non melanoma and melanoma skin cancers, can cause tenderness in localized areas of the scalp. A biopsy may be obtained to reach the precise diagnosis.

 

13) Headaches

Headaches, especially tension headaches, can be a cause of scalp pain and tenderness. For some individuals, stress, anxiety and depression can cause or worsen the tenderness on account of making muscles tense.

 

14) Temporal arteritis

Temporal arteritis is a potentially worrisome cause of scalp pain amd tenderness. Temporal arteritis is a condition in which the temporal artery becomes inflamed and quite tender to touch. Patients with temporal arteritis may develop jaw pain, headaches, and visual disturbances. Most affected individuals are older adults. 

 

Conclusion

There are many causes of scalp tenderness. Fortunately, the cause of the tenderness can usually be diagnosed from a thorough examination of the scalp. In complex or challenging situations, a scalp biopsy should be performed to confirm the diagnosis.


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Seborrheic Dermatitis Risk Factors: Altitude and UV Radiation

Altitude and UV Radiation

Seborrheic dermatitis is a common condition that can affect the scalp (where it causes an itchy, red and greasy scalp) but can also affect the eyebrows, face, chest as well as other areas too. A yeast known as Malassezia has an important role. 
There are many factors that are known to increase one’s risk of developing seborrheic dermatitis. For example, stress, age, heat, humidity, depression, Parkinson’s disease, head injury, neurological disease, HIV and UV radiation all increase the risk of SD. Other risks include acne, lighter skin, higher body fat content.

It’s clear that immunosuppression can affect SD. This is especially true in patients with HIV/AIDS. But we also see the effect of immunosuppression with ultraviolet radiation which is also a form of immunosuppression. Studies have shown that some individuals experience flares with intense UV radiation exposure.

High altitude may be a risk factor for seborrheic dermatitis.

High altitude may be a risk factor for seborrheic dermatitis.


An interesting study conducted in 2000 looked at the risk of SD in 283 mountain guides from 3 different counties who have a high occupational exposure to UV radiation. 16.3% mountain guides when examined clinically were found to have SD and these rates were similar across the 3 countries. This number is higher than the 3-5 % rate of SD in the general population. These studies suggested that UV-induced immunosuppression due to occupational sun exposure as a pathogenetic factor in SD. 

Reference

Moehrle M, et al. High prevalence of seborrhoeic dermatitis on the face and scalp in mountain guides.
Dermatology. 2000


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Bacteria and SLE: Does bacteria have a role in Lupus?

Does bacteria have a role in Lupus?

SLE;bacteria.png

For the past decade, bacteria have increasingly been proposed to play a role in the autoimmune disease known as lupus. Specifically, research has shown that biofilms containing bacteria are potential triggers of this serious disease. 
A new fascinating study raises the possibility that bacteria that are commonly found on humans could trigger some of the auto-antibodies found in patients with with systemic lupus erythematosus (SLE).
About 50% of patients with SLE have anti-Ro antibodies, including anti-Ro60 antibodies. These are among the most common antinuclear antibodies that can be seen even before the disease develops. These auto-antibodies are also “pathogenic” meaning the directly cause disease.

In a new study, a research team from Yale collected microbiome samples from 8 SLE patients who were positive for anti-Ro60 autoantibodies. Controls include five SLE patients who were anti-Ro60-negative, and seven healthy controls. The researchers then took samples from the mouth, sternum, and stool. They found that commensal bacteria containing orthologs to Ro60 were found commonly in all of the patient groups.

In addition, the study investigators showed that CD4 memory T-cell clones from SLE patients that were specific to Ro60 autoantigen were stimulated by Ro60-containing bacteria. Further studies in mice showed that injection of bacteria could trigger a “lupus-like” disease. The conclusion from their study was that commensal bacterial have the potential to initiate and trigger lupus. More research is needed int his important area. This data is important and adds to a large body of research already present that infections could potentially trigger lupus. 

REFERENCE

Commensal orthologs of the human autoantigen Ro60 as triggers of autoimmunity in lupus.
Greiling TM, et al. Sci Transl Med. 2018


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Taxotere induced alopecia

Hair loss from Taxanes


There are two types of hair loss from taxotere and the taxanes in general. The first is a temporary one and requires time as the hair will grow back on it’s own. This is known as temporary chemotherapy induced alopecia ("TCIA"). Low level laser and minoxidil have evidence of speeding things along. The second is a type of permanent hair loss that has been described with certain taxotere dosing regimens. If hair has not grown back after chemotherapy by the 6 month after chemotherapy, we call this permanent chemotherapy induced alopecia (PCIA) and it is sometimes also called Chemotherapy Induced Permanent Alopecia (CIPAL).  The ideal treatment plan has yet to be determined. Topical and oral minoxidil do have some evidence of being helpful. There is no evidence for PRP treatments. Hormone blocking pills, which are frequently used to treat hair loss,  are generally contraindicated (not allowed) in patients with cancers treated with taxotere.

 

References

1. https://donovanmedical.com/hair-blog/pcia

2. Sibaud V, et al. Dermatological adverse events with taxane chemotherapy. Eur J Dermatol. 2016


This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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