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Scarring Alopecia

Distortion of Normal Follicular Architecture 

Scarring alopecias are a group of hair loss conditions that give permanent hair loss. Common types of scarring alopecia are:

  • Lichen planopilaris (LPP)
  • Frontal fibrosing alopecia (FFA),
  • Pseudopelade (PPB),
  • Folliculitis decalvans (FD) and
  • Central centrifugal cicatricial alopecia (CCCA) 

The various types of scarring alopecia look different, however many share some common features. Lymphocytic scarring alopecias is one group of scarring alopecias that share in common the destruction of the normal hair follicle bundles of hair. The cause of this destruction are immune cells known as lymphocytes. LPP, FFA, CCCA and PPB belong to this group of "lymphocytic" scarring alopecias.

Normally hair follicles are grouped together in bundles of 1, 2 and 3 haired units. In the lymphocytic scarring alopecias, these bundles of 2 and 3 haired follicles disappear and what is left is a large number of single haired follicles.


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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Vitamin D and Hair loss: Is replacing a low vitamin D going to help?

Vitamin D is important but not the whole story (unfortunately)

Vitamin D clearly has a role in normal hair growth. But does supplementing vitamin D (in those with low levels) cause it to come back? No. I have never ever witnessed convincing evidence of such a direct link. It is absolutely true that low vitamin D is associated with some types of hair loss. This includes AGA (in some studies only) and alopecia areata.

 

Vitamin D supplementation does not promote hair growth for most

I do not believe that supplementing vitamin D alone will promote hair growth for the vast majority of people with the story you have just shared. Do I believe supplementing D is a good idea when levels are low? Yes. It has other health benefits and may help various hair growth treatments work better. That too has yet to be proven.

I appreciate this is a tough concept and doesn't always make a great deal of sense at first. If low vitamin D has a role in hair growth and my levels are low... it would only make sense that supplementing would help! Not quite.

 

A simple analogy

I often use a simple analogy. We all know that an engine is essential for a car to work. If you don't have an engine, you are not going to get too far. But consider the car that you see on an abandoned lot. It has problems with the engine sure. But there are problems with numerous aspects in the car. Replacing the engine is not going to allow you to drive the car off that car lot. No matter how many engines you put in that car or how well engineered that engine is. Other things need to be addressed as well.

No one can argue that vitamin D is not important for hair. Babies who can't make vitamin D or who have problems with the Vitamin D receptor or signaling - have hair loss. So clearly it's important just like an engine in the car is important.

But giving back vitaminD to adults with hair loss or giving back a new engine to a car on an abandoned lot does not solve the main issue.

I always supplement vitamin D when low (and I would recommend fixing an engine on a car that does not work) but it is far too big of a jump to conclude that that alone is sufficient to grow hair (or get that car running again to drive off the lot).


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 for AA

I posted an answer to a new question on Realself.com

Treatment for AA


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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Nail Rubbbing

I posted an answer to a new question on Realself.com

Nail Rubbing


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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Microneedling for treating AGA

Where Are We Now?

Scalp Micro-needling" is a technique whereby a controlled injury is created in the scalp. Skin injury (at least in some situations) can stimulate the production of growth factors and inflammatory cytokines that promote skin healing and possibly hair growth.

A "dermaroller" (shown in the photo) is one such device to cause controlled injury. A dermaroller consists of teeth of different lengths that are attached to a wheel. Dermarollers of 0.5 mm, 1 mm, 1.5 mm are common. These are "rolled" back and forth across the skin to create redness.

A 2013 study of 100 patients supports benefit of dermarolling. The study set out to determine in patients who use topical minoxidil (Rogaine, etc) could achieve even further benefit by dermarolling.

In the study, half the patients received daily minoxidil and the other half of the patients received weekly dermarolling sessions (using a 1.5 mm dermaroller) in addition to minoxidil treatment.

Results showed that patients using a dermaroller achieved greater benefits than those using minoxidil alone. Specifically, 82 % of patients receiving dermarolling felt they achieved greater than a 50 % benefit in their hair compared to just 4.5 % receiving minoxidil alone. Physicians rated the improvements similarly. 

Hair counts (at an up close level) were increased in the dermarolling group compared to the minoxidil alone group (91.4 vs 22.2 respectively).

Conclusion: These studies support the potential benefit of dermarolling - especially to increase the efficacy of minoxidil. More studies need to be done to verify or refute these results as well as to determine the optimal parameters for dermarolling. These include comparisons of daily vs weekly vs monthly treatment and comparisons of 0.5 mm needles, 1 mm or 1.5 mm needles. Studies are also needed to determine if any proportion of patient actually worsen with dermarolling.

Reference
A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study.

Dhurat R, et al. Int J Trichology. 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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Hair loss

I posted an answer to a new question on Realself.com

Hair Loss


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

Hair Loss at the Side of the Scalp

What are the causes of hair loss at the side of the scalp?

There are many potential causes of hair loss in women. Women presenting with hair loss typically have a greater array of potential diagnoses than men presenting with hair loss.

It is important to understand the causes of hair loss at specific spots on the scalp. Hair loss in the front of the scalp has a list of top causes. The same is true with hair loss at the back, sides and top of the scalp.

So what are the most common causes of hair loss at the side of the scalp (the area just above the ears)?

The top 5 causes of hair loss at the side of the scalp include:

1. Female genetic hair loss
Women with genetic hair loss usually have thinning in the centre of the scalp. The hair strands become finer. Unlike men (where thinning rarely extends to the sides), thinning in women can often become diffuse.


2. Scarring Alopecia (Frontal fibrosing alopecia, Lichen planopilaris and others)
Autoimmune conditions like frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) cause permanent hair loss. FFA causes hair loss at the front of the scalp and typically this extends around to the sides and even the back of the scalp. This photo shows typical FFA- if you look close there is redness around the hair follicles, which is a feature not present in the other diagnoses listed here.


3. Alopecia areata
Alopecia areata is an autoimmune condition that affects 2 % of women. Unlike many of the other causes listed here has a propensity to affect younger ages. Hair regrowth is possible for many patients with treatment and even spontaneously.


4. Telogen effluvium
Telogen effluvium refers to hair shedding. Some causes of this are low iron, thyroid problems, crash diets, stress and medications. Hair loss occurs "diffusely" meaning all over - and the side of the scalp can be affected.


5. Traction alopecia
Traction alopecia is hair loss from tight pulling of hair. Braids, weaves, cornrows, ponytails, hair extensions all have the potential to cause traction. Hair loss at the sides is common with extensions and weaves.


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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Cholesterol Pills for AA

Anti-Cholesterol & Anti- Inflammatory

Alopecia areata is considered autoimmune in nature. Medications that lower or modify the effects of the immune system are traditionally used to treat alopecia areata. 

A study done in 2015 suggested that  medications that reduce cholesterol might help too. In addition to the ability of these drugs to lower cholesterol, they also reduce inflammation. The ‘statins’ are medications used to treat high cholesterol. It is estimated that about 3 millions Canadians and 30 millions Americans use statins to control their cholesterol. Ezetimibe is a second type of cholesterol lowering medication and works by blocking the absorption of cholesterol.

In the 2015 study, 19 patients with advanced alopecia areata were treated with two cholesterol medications – simvastatin and ezetimibe for 24 weeks. Remarkably, after 24 weeks, 14 of 19 patients (nearly 75% of patients) were found to regrow hair at least to some extent. The majority of those who continued the drug after the study period maintained their hair and most of patients who stopped the drug lost their hair again.

This is an interesting study, opening the doors to even larger studies of the use of these cholesterol lowering drugs in the treatment of alopecia areata. I think large studies are important as our own small studies haven't shown the same degree of promise. These drugs are well known in the population as cholesterol lowering drugs and so we have many years of experience with these drugs. Although side effects such as muscle pains, muscle damage, diarrhea, irritation of the liver, and a rise in blood sugars can occur with these medications, although they are relatively infrequent. 


Reference
Study: Lattouf C and colleagues. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad 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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