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Valproate and Hair Loss: Does valproate cause hair loss through an androgen mediated mechanism?

There are many different types of drugs used as mood stabilizers is women with bipolar disorder. Many of these drugs can cause hair loss, albeit with different mechanisms. Common medications used in treating bipolar disorder include lithium, valproate, lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine.

 

Vaproate and Hyperandrogenism

There is increasing evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS). To study this further, researchers studied three hundred women 18 to 45 years old with bipolar disorder. A comparison was made between the incidence of hyperandrogenism (including hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other types of anticonvulsants drugs (like lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. 

 

What were the results?

It was interesting that among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate compared to just 2 (1.4%) of 144 women on nonvalproate anticonvulsants or lithium. This translated into a nearly 8 fold risk of these hyperandrogenism and menstrual cycle changes with valproate. Oligomenorrhea happened within 12 months with valproic acid users.

 

Conclusion

Once needs to be aware of a possible PCOS like clinical phenomenon and for hair specialists - the development of hyperandrogenism and accelerated AGA in women using valproate for bipolar disorder. More studies are needed to confirm these findings.

Reference

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

Joffe H, et al. Biol Psychiatry. 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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Oral Immunosuppressants for Lichen planopilaris: should I increase my dose?

Dosing oral immunosuppressants for Lichen planopilaris (LPP)

There are many different immunosuppressants and immune modulators that can be used for treating lichen planopilaris. Examples include doxycycline, hydroxychloroquine, methotrexate, mycophenolate, cyclosporine.  I'm often asked what dose a patient should be using? 

 

What dose should a patient be using? 

When it comes to immunosuppressant medications, I always try to keep patients on the lowest possible dose that controls their disease. Generally I start at fairly standard doses of immunosuppressants and observe what happens to the patient's hair loss. For example, this might be 200 or 400 mg of hydroxychloroquine (Plaquenil) daily, 15-20 mg of methotrexate weekly, 150-300 mg of cyclosporine, 500-1000 mg of mycophenolate mofetil, 100 mg of doxycycline. If the disease is vastly improved after a few months, we may consider going down on the dose or staying at the same dose for a few more months. If the disease is getting worse, we might consider going up on the dose is their is room to go up or changing the immunosuppressant altogether. 

 


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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Can minoxidil change hair texture?

Minoxidil is FDA approved for the treatment of androgenetic alopecia in men and women. The medication has several mechanisms of action including affecting potassium channels inside cells.

The main side effects are headaches, dizziness, heart palpitations, hair shedding and excessive hair growth. Another "side effect" that is not often discussed is the change in hair texture that some users notice. Such changes are varied but include mentions of hair becoming curlier, coarser, more wavy, drier, and straw-like. Sometimes this is attributable to the propylene glycol in the minoxidil lotion formulation but some of these changes also occur with minoxidil foam (which lacks propylene glycol). One needs to be aware of the possibility of hair texture changes when using minoxidil.
 


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 is meant by a "clinical diagnosis?"

What is meant by a "clinical diagnosis?"

The diagnosis of most types of hair loss is achieved through what is termed a "clinical diagnosis".  Many individuals incorrectly believe that the diagnosis "shows up" in a blood test or in a hair sample sent off for fancy mineral analysis. That's not how a hair specialist achieves the diagnosis of a person's hair loss.

A "clinical" diagnosis means that a patient needs to have the scalp carefully examined in the CLINIC by a CLINICIAN and the CLINICIAN needs to listen to the patients entire story (sometimes called the CLINICAL history) of his or her hair loss. Laboratory values are not required in making the diagnosis but might be helpful in making other diagnoses.

 

Examples

Consider the 32 year old man who has hair loss in the crown. He is concerned that the diagnosis he was given of male balding might not be correct because his lab tests are normal and his testosterone levels and DHT levels in particular are normal. One needs to remember that the diagnosis of androgenetic alopecia is a "clinical diagnosis" and so if the CLINICIAN in the CLINIC seen miniaturization of hairs in the area of hair loss there is a good chance what we are dealing with is androgenetic alopecia.

I could give countless other examples. Many types of hair loss are diagnosed through clinical diagnosis. Lab tests might still be helpful in the work up but they are not needed to make the diagnosis. 

Consider the 23 year old female with hair loss whose labs for ferritin, thyroid (TSH) and hemoglobin come back normal. What type of hair loss does she have?  Without the opportunity for me to review the clinical history and examine the scalp clinically, I would only be guessing.

 

Conclusion

Most hair loss diagnoses are made through a clinical diagnosis.


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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Can drugs accelerate androgenetic alopecia (AGA)?

Medications can potentially accelerate androgenetic alopecia. Common examples are anabolic steroids, the use of testosterone injections and topical androgen gels (commonly used for men with "low testosterone"), androgenic progestins in birth control pills, danazol as well as many other medications.

This individual whose scalp is shown in the picture has been using anabolic steroids for body building and has experienced rapid hair loss mainly due to a conversion of his large terminal hairs (some labelled by green dot) to thinner miniaturized hairs (labelled by yellow dot). Treatment of drug accelerated AGA involves either stopping the androgen or blocking the effects of the androgen on the hair follicle using 5 alpha reductase inhibitors... or both. Less specific treatments like minoxidil may provide some benefit. Many individuals can improve with this plan but full regrowth is unlikely.


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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Where to proceed?

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

Where to proceed?


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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Normal daily shedding of hair: Does it occur equally?

Does normal hair shedding occur in an even distribution?

I'm often asked if hair shedding under normal circumstances occurs equally all over the scalp. In other words, if a person's daily shedding is 60 hairs, do 30 come from the front and 30 from the back?

 

Normal hair shedding

Normal hair shedding does occur equally. Hairs on the scalp grow independent of each other and so shedding occurs independent of other hairs too. If 60 hairs is a person's rate of daily shedding, then 30 would come from the front half and 30 from the back. 

 

Shedding in hair disorders

If a person has a hair disorder (hair loss condition), the shedding may or may not be equally distributed.  If the person has androgenetic alopecia (male balding and female thinning), then the shedding occurs much more in the area of thinning at the front. For example, in androgenetic alopecia the rate of shedding is slightly increased and perhaps 60 hairs would be shed in the front and 30 hairs in the back half of the scalp. If the person has telogen effluvium, the shedding is equally distributed all over the scalp - but at higher rates than normal. For example, patients with telogen effluvium might experience loss of 60 hairs in the front and 60 hairs in the back. In telogen effluvium, this could even be 200 in the front and 200 in the back but the key point is that the shedding is always equal.  If the individual has alopecia areata as the reason for their hair loss, shedding may not be equal. Shedding could be as high as 300 in a small section of the scalp and just 30 in another area.

 

Conclusion

In general, in the absence of any hair loss condition, the shedding is the same all over the scalp. 


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

I frequently get asked if wearing hair extensions is okay. Often it is fine, but one needs to monitor over time if any hair damage is occurring. Individuals feeling pain, "pins and needles" should consider loosening the extensions or changing the method of application. Individuals showing clinical signs in the office of hair damage may also consider changing the method of application.

Consider the patient shown in this picture. She has been using extensions for some time now. She has a few broken hairs (labelled B) and several miniaturized hairs (labelled V for vellus) in any area that did not previously show miniaturization. These two signs are evidence of hair damage. A recommendation was made to change the extension in this case and treatment with a corticosteroid was given to reduce inflammation that is common in such cases of early 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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