Is there an increased risk of prostate cancer in balding men?

The risk of prostate cancer in balding men

About 50 percent of men will be affected by male pattern balding throughout their lifetime. The medical term for male balding is "androgenetic alopecia."

Which men will developing balding and which will not? Well there are still some things we need to learn about balding. But in general, male balding is influenced by genetics, hormones and occurs with advancing age. Prostate cancer is one of the most common cancer in men. It  too is influenced by genetics, hormones and occurs with advancing age.

Is their any link between the male balding and prostate cancer?

Well, researchers at the Cleveland Clinic in Cleveland, Ohio recently set out to look at this question. They looked at all the high quality studies published so far which have examined the risk of prostate cancer in balding men.

In total, the researchers looked at the development of prostate cancer in 8994 patients - 4078 with prostate cancer and 4916 healthy men.

What did the researchers find?

When all of the studies were pooled together an interesting finding was confirmed - and that is that men with hair loss in the top of the scalp  or “vertex” have a small but significant increased risk of prostate cancer. It's important to note that the increased risk was quite small - but nevertheless the data pointed to an increased risk. The authors indicated that further studies in the future are needed to confirm these interesting findings.

SOURCE: Amoretti A, Laydner H and Bergfeld W. Androgenetic alopecia and risk of prostate cancer: A systematic review and meta-analysis. J Am Acad Dermatol 10.1016/j.jaad2012.11.034)

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Dr Donovan Answers Reader Questions: Hair Coming out in "Clumps"

Here is a recent question from our website visitor:

I have been visiting a dermatologist for 2 months now. My hair was coming out from the root in clumps. Half my hair is gone (thank god I have lots of hair). He has been giving me the cortizone shots. First time i Went he advised me to wash hair every other day and the last time i went he told me to wash every day. Now sometimes when I go a day without washing my hair my scalp hurts a lot. I can say with washing my hair every day its falling out less but it still falls out. I took test for iron and thyroid and everything came back ok. I do dye my hair and he ruled my hair loss from that but something is just not right. I know its only been 2 months but I want my hair back...badly. Should I just give it more time or should i see someone else. Will a natural remedy help or maybe scalp massages?

Dr Donovan's response:

Thanks for the interesting question. The key question is: what diagnosis was given for your hair loss? There are 100 causes of hair loss and cortisone injections can be used in over 20 of them!!! Most likely you were diagnosed with alopecia areata because that's the most common reason that cortisone injections are given. But cortisone injections are also used for scarring alopecia and other conditions as well. Without a diagnosis, I can't comment much more.

Washing your hair everyday or every second day is fine. If you have some seborrheic dermatitis in the scalp ( a distant cousin of dandruff) or if you are using alot of topical medications (lotions, creams), then washing your hair every day will just make it feel better. Patients with alopecia areata and scarring alopecia often feel better washing their scalp everyday too. It just feels better.

If you were diagnosed with alopecia areata, there's a good chance your hair will improve with injections. But whether it comes back fully is hard to predict.  Please note that ccortisone injections do not help everyone with alopecia areata.  If you are getting injections because you were diagnosed with a scarring hair loss condition (like lichen planopilaris), you probably won't improve much at all - but hopefully the cortisone injections will prevent your hair loss condition from getting worse.  That's why we use cortisone injections for lichen planopilaris.

As you can see, the cause of your hair loss is critical to know before fully answering your question. Cortisone injections help some hair loss conditions but not all.

As for scalp massages, they have no benefit in any hair loss condition. As for natural remedies, most have not been well studied. One exception would be the use of aromatherapy for patients with alopecia areata. Check out the discussion I wrote a few years ago about this subject 

AROMATHERAPY FOR ALOPECIA AREATA

Treating hair loss can sometimes be challenging. If you trust your physician's opinion, stick with him or her. You will hear many answers for your hair loss if you "shop" around.  Make sure you ask what your diagnosis is and make sure you ask if hair regrowth is even possible in this condition.

This blog has been filed into the following folders:

Frontal Fibrosing Alopecia: Do we Need a New Name for the Condition?

Frontal Fibrosing Alopecia: Do we Need a New Name

Frontal fibrosing alopecia is an uncommon hair loss condition that usually affects post menopausal women. The cause is not known. 

Frontal Fibrosing Alopecia: What does it mean?

At first glance, the name seems like a good one. Women with frontal fibrosing alopecia lose hair in the front of the scalp and it occurs with scarring (fibrosing process). The women in the photo on the right has typical frontal fibrosing alopecia. 

FRONTAL: Hair from the front of the scalp is lost

FIBROSING: Occurs with scarring (fibrosing process)

ALOPECIA: Simply a medical term for hair loss

Once the hair is lost, it's lost permanently. Only with hair transplant surgery can hair density in the front be improved. But surgery can only be done when the condition is quiet or else the newly transplantedn hairs are likely to die.  An ongoing research study in our office is seeking to understand when it's best to transplant women with frontal fibrosing alopecia.

But is this a good name for the condition?

As time passes, we're learning more and more about frontal fibrosing alopecia. Many women not only lose hair in the front of the scalp (hairline), but also at the sides (above the ears) and at the back as well. The women in the photo shows a typical picture of hair loss occuring at the back. In addition, women with frontal fibrosing alopecia often lose eyebrows (in three quarters of patients) and often lose body hair as well ( in one quarter of patients).

Conclusion

The term frontal fibrosing alopecia has been with us for almost 20 years now. When hair specialists use the term, we know exactly what condition is being referred to. But the term has its limitations - and someday it might take on even a different name - one that encompasses the hair loss from the back and sides of the scalp,  body hair and eyebrows.

Alopecia Areata : Is it Genetic ?

Alopecia Areata  : Is it Genetic ?

I'm often asked if alopecia areata is "genetic." It's sometimes hard to believe that alopecia areata is so strongly tied to genetics when only 10-20 % of patients have a family history of the condition. But dozens of high quality research studies back up the statement: alopecia areata is "genetic."

Alopecia Areata is a Multifactorial Genetic Trait

There is not just one gene that is involved with the developing of alopecia areata- there are many. For this reason, alopecia areata is said to be a multifactorial genetic trait.  If one of your first degree relatives is affected by alopecia areata, you have a ten fold increased risk of developing alopecai areata.  But the inheritance patterns are complex- even if one identical twin develops alopecia areata - the other twin has only a 55 % chance of developing alopecia areata.

We're learning more and more every day about the complex genetics of alopecia areata. We've come to learn that alopecia areata is likely much more closely related to type 1 diabetes and rheumatoid arthritis than we ever imagined. The exact genes and segment of genes that increase one's risk of developing the condition are slowly being worked out.

Right now alopecia is 'genetic' but is influenced to some extent by the environment too. That's why one twin develops aloepecia and the other twin does not. The exact environmental factors that contribute to alopecia areata are still being worked out as well.

DPCP for Children and Adolescents: Is it Effective?

DPCP for Children and Adolescents

Diphencyprone or “DPCP” is frequently prescribed for individuals with alopecia areata who develop more extensive amounts of hair loss or for individuals who aren’t improving with steroid injection treatments.  As shown in the photo to the right, DPCP is a liquid and is applied to the scalp weekly, usually in a dermatology clinic setting.  It causes a mild allergic reaction in the scalp skin, which in turn promotes hair regrowth in some individuals. In adults, DPCP treatment promotes hair regrowth in approximately 30-50 % of individuals. 

What about DPCP in Children & Adolescents?

We decided to examine this question. Prior to our study, the use of DPCP in children had not been thoroughly explored is whether DPCP is effective for children with alopecia areata. In fact, the use of DPCP in children has been the focus of only a 3-4 of research studies - and these studies were quite small.  One previous research study of 26 children indicated that DPCP helped with hair regrowth in 35% of patients. A second study of 12 patients indicated hair re-growth in 67% of patients.  

We recently published our research findings in the journal Archives of Dermatology. We looked back through the medical charts of 108 children who received DPCP at Sunnybrook Hospital in the past 10 years.    Children ranged in age from 4 months to 18 years. Most children had tried other treatments, such as steroids or minoxidil, prior to starting DPCP. However, none of those treatments were helpful and so DPCP was started.

Does DPCP have side effects in Children and Adolescents?

Overall, treatment with was safe, but minor side effects did occur in about one-half of patients. These included swelling, hives, small blisters and skin breadkdown and swollen lymph nodes.  About 13 % of patients stopped treatment after 2 months owing to a variety of factors, such as these side effecsts, difficulties commuting to the treatment center, and/or the disruption caused by weekly absences from school.

Was DPCP Beneficial ?

Overall, our research data showed that about one-third of children benefitted from DPCP treatment. 25 % of children had a partial improvement and 10 % had full regrowth.   

Conclusion

Our study is one of the largest research studies looking at whether DPCP is beneficial for children and adolescents with alopecia areata. It is a valuable study because it provides us helpful information that we can share with parents who bring their child to the DPCP clinic. Overall,  DPCP will help about 1 out of every 3 children who go through treatment.  However, only 1 out of every 10 children will experience full regrowth with treatment.  Right now, it’s not possible to predict which children will benefit from DPCP and who will not.  Certainly, more research is needed to understand how to make DPCP even more effective for children.

 References of Interest

1. Salsberg, J and Donovan, J. The Safety and Efficacy of Diphencyprone for the Treatment of Alopecia Areata in Children.  Archives of Dermatology 2012; 148: 1084-5.

2. Schuttelaar ML, Hamstra JJ, Plinck EP, et al. Alopecia areata in children: treatment with diphencyprone. Br J Dermatol. 1996;135(4):581-585.

3. Hull SM, Pepall L, Cunliffe WJ. Alopecia areata in children: response to treatment with diphencyprone. Br J Dermatol. 1991;125(2):164-168.

4. Mukherjee N, Burkhart CN, Morrell DS. Treatment of alopecia areata in children. Pediatr Ann. 2009;38(7):388-395.

 

Topical Estrogen for Androgenetic Alopecia:

Topical Estrogen for Androgenetic Alopecia:

Topical estrogens were used many years ago for the treatment of androgenetic alopecia as well as other hair loss problems. Their use dimished when other medications, such as minoxidil, became available.

In 2004, researchers from Greece studied the benefit of estrogens in 75 post menopausal women with androgenetic alopecia

25 patients applied the medication for 12 weeks (15 drops every evening for 4 weeks and then every other night for 8 weeks),

25 patients applied the medication for 24 weeks (15 drops every evening for 4 weeks and then every other night for 8 weeks),

25 applied placebo medication for 12 weeks.

What were the results ?

Side effects included  mild itchiness, redness and scaling in the scalp. 2 women receiving the 24 week course developed uterine bleeding about 4 and 5 months into the study. Overall, about 60 % of patients receiving the estrogen had an increase in the number of growing hairs (anagen hairs) and a decrease in the number of telogen hairs (resting hairs). “Before and after” data or assessments of patients views on their treatment were not included in this particular study.

Comment:

This 2004 study is an interesting research paper.  It reminds us of the well known fact that estradiol has important benefits  for hair. Estrogen therapy is too often forgotten about in the treatment algorithms of hair specialists. More studies in how best to administer topical estrogen are needed – especially in combination with treatments such as minoxidil, prostaglandin analogues (like Latisse) and the laser comb.

REFERENCE

Georgala S et al. Topical estrogen therapy for androgenetic alopecia in menopausal females. Dermatology 2004; 208: 178-179

 

Question from Website Visitors: H1N1 Vaccine and Hair Loss

H1N1 Vaccines: Do they cause Hair Loss/

QUESTION FROM READER 

I have had hair shedding for about 2 and a half years now.  Been told I have telogen effluvium, but I also have burning, itching and scalp pain.  The burning comes and goes and sometimes my scalp is so red. Recently I also had a blood test showing elevated DHT levels. This all started about 4 months after I received the H1N1 vaccine in November of 2009, but is now getting worse. Could there be a relation between this vaccine and hair loss?  Also could the burning be a sign of scarring alopecia?

ANSWER FROM DR. DONOVAN

Thanks for this interesting question.  My main recommendation would be to ask your dermatologist for a biopsy.

You are absolutely correct that individuals with itching, burning and pain in the scalp may have an increased chance of having a scarring alopecia. However, many other conditions are possible too (inclduing conditions called chronic telogen effluvium and alopecia areata) and a thorough scalp evaluation and detailed medical history are required before reaching a diagnosis. If you haven't already, a basic blood work profile for hemoglobin levels, thyroid tests, lupus, and iron studies should be done. Other blood tests might be helpful too depending on the answers to a range of medical questions your doctor will ask you.

The elevated DHT levels may be normal, but a thorough work up for free testosterone and total testosterone and possibly other hormones could be considered to get a better sense of whether or not your elevated DHT levels are concerning or not.  

It would be anyone's guess as to whether your vaccination had any contribution to your hair loss. We do know that in a very, very small proportion of individuals vaccinations and infections can trigger various autoimmune conditions. In terms of autoimmune hair loss conditions, a very small number of individuals note that a hair loss condition known as "alopecia areata" is worsened by vaccinations. However, this proportion is very small and the vast majority of individuals recieve vaccinations without any hair loss.

At present, there is no evidence that the H1N1 vaccine causes hair loss. It is intriguing that a Japanese study from 2012 reported 7 patients who developed the hair loss condition alopecia areata within 1-4 months of getting an infection with the H1N1 virus. These patients had an actual infection with the virus not the vaccine. It's really difficult to know if this was coincidence or not because 2 % of the world will develop the hair loss condition alopecia areata at some point in their lives (it's that common).  Whether the H1N1 vaccination could cause hair loss is not known.

You might find the previous blog I wrote on scalp redness helpful as well.

What are the Causes of Scalp Redness? 

I hope this information offers you help.

- Dr. Jeff Donovan  

Reference

Ito T. Alopecia areata triggered or exacerbated by swine flu virus infection. J Dermatol 2012; Oct 39:863-4

 

Dr. Donovan Interviewed by CityNews Toronto

Dr. Donovan Interviewed by CityNews Toronto

Dr. Donovan was interviewed today by Andrea Piunno of CityNews Toronto on a new research study which showed that men and women with signs of aging (such as hair loss) have an increased risk of heart disease.

Heart attacks more likely the older you look:

Click for a link to the CityTV video

 

A New Era in the Treatment of Androgenetic Alopecia: Focus on the "Prostaglandin Pathway"

The "Prostaglandin" Pathway

Recently, we've been hearing a lot about a group of hair growth drugs that affect "prostaglandins".  Several recent blogs of mine have discussed the role of prostaglandin F2a analogues in stimulating eyelash growth (click here for article).  A few months ago a major buzz was created in the hair world when Dr. Cotsarelis at the University of Pennsylvania showed that blocking the prostaglandin D2 pathway might be relevant to the treatment of androgenetic alopecia (click here for article).

New Study Highlights Role of Prostaglandin Analogues

Latanoprost is a prostaglandin F2alpha drug that is often used in treating glaucoma (an eye disease characterized by elevated eye pressures). Recently the drug has been shown to be useful in stimulating eyelash growth. 

In yet another study, researchers from Germany examined the use of the drug latanoprost 0.1% in the treatment of men with androgenetic alopecia (male balding). 16 men participated in the study.  All men had early staged androgenetic alopecia  Men applied one drop (50 microliters) of latanoprost solution to one small area of the scalp daily and one drop of the placebo drug (mock drug) daily for 24 weeks. 

What were the results?

Overall about 50% of men benefitted from the drug.  Patients who did end up benefitting from the drug showed evidence of improved growth by 16 weeks. The drug was well tolerated with the most common adverse effect being scalp redness. Interestingly, the patients who developed scalp redness also experienced hair growth.  How exactly these two are related remains to be clarified.

Comment

These results are exciting and highlights the importance of this prostaglandin pathway.  We will certainly be hearing a whole lot more about the pathway in the years ahead. Its important to note that all participants in the study were men, so we don't know if the results are generalizable to women.  Furthermore, all men in the study had early stage androgenetic alopecia so we dont know if the drug will have benefit for men with more advanced stages of balding.

Reference

Blume- Peytavi et al. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24 week topical treatment by latanoprost 0.1 % on hair growth and pigmentation in healthy volunteers with androgenetic alopecia.  Journal od the Amaerican Academy of Dermatology 2012; 66:794-800.

Do Patients Receiving DPCP for Alopecia Areata Treatment Get Absorption into the Bloodsteam?

Do Patients Receiving DPCP Get Absorption into the Bloodsteam?

DPCP is a liquid chemical which is used as a topical treatment for alopecia areata. It's used in both children and adults with alopecia areata. One question that I’m often asked is whether DPCP gets absorbed into the body.

Does DPCP get absorbed?

In 1994, researchers from the UK set out to determine if DPCP is absorbed following topical application.  The researchers analyzed the blood and urine of 18 patients with alopecia areata who received approximately 0.5 mL of a 1 % DPCP solution. DPCP was not detected in any of the blood or urine samples.  These data suggest that DPCP is not absorbed following topical application onto the scalp.

Reference

Berth-Jones et al. Diphencyprone is not detectable in serum or urine following topical application. Acta Derm Venerol 1994; 74: 312-3.

 

What is the best test to do if I think I have celiac disease?

What is celiac disease?

Celiac disease is an autoimmune disease of the bowel. When individuals with celiac disease eat foods containing "gluten" (such as barley, rye, wheat), inflammation develops in the small bowel. This leads to damage to the small bowel which prevents it from properly absorbing food.  Celiac disease can develop at any age. It’s more common in Caucasians and those of European ancestry. Women are affected to a greater extent than men.

Patients with celiac disease may have many symptoms.  The most common symptom is diarrhea that lasts many weeks or months (termed "chronic diarrhea") as well as weight loss.   But a range of symptoms are possible, including abdominal pain, weight loss, bloating, gas, and constipation. In fact, celiac disease can sometime be challening to diagnose because it has many different ways of presenting.

Should patients with hair loss be tested for celiac disease?

Many patients with hair loss wonder if they should stop gluten or if they should be tested for celiac disease.  In most cases, the answer is "no."  However, testing for celiac disease may be recommended f the patient has abdominal symptoms or long standing weight loss. Sometimes I also check for celiac disease if a pateint has low iron levels that just don't seem to raise despite use of iron pills.  A very small percent of patients with autoimmune hair loss conditions (i.e. alopecia areata) do have celiac disease.  

The most common tests that are ordered to SCREEN if someone has celiac disease are:

1. Tissue transglutaminase Antibodies (tTG)

2. Endomysial Antibodies (EMA) 

3. Other tests "may" be ordered by the physician as well including IgA antibodies and specific genetic tests such as HLA-DQ2 and HLA-DQ8.

Overall, the tTG test is the best screening test. It's inexpensive, quantitative and a highly reproducible test.

What is done once a patient is diagnosed with celiac disease? 

Once diagnosed with celiac disease, a gluten free diet will be recommended. In some cases, a referral to a gastroenterologist may be recommended. Follow up blood tests may be ordered to assess how well an individual is doing with their gluten free diet.

 

Hair Loss Treatments on the Horizon

Hair Loss Treatments on the Horizon

I returned from an outstanding meeting of the 21st Annual Meeting of the European Academy of Dermatology and Venerology in Prague.  This video highlights some of the exciting hair loss treatments that may be on the horizon including the latest in hair cloning research and new topical medications produced by L'Oreal.

Hope you enjoy it!

More Pieces to the Vitamin D Puzzle

More Pieces to the Vitamin D Puzzle

At least once a day, I’m asked about the role of vitamin D in hair loss. Back in July, I wrote a blog article about the role of vitamin D in hair loss.   Vitamin D does its job inside cells by binding to the vitamin D receptor or VDR.

How important is vitamin D in helping prevent hair loss in humans?

Modern science still doesn’t have all the answers. But by turning to research in mice, we have learned a lot or valuable lessons.  About 10 years ago, we learned that hair loss develops in mice that lack the vitamin D receptor (VDR). Researchers in San Francisco recently discovered a molecule called MED1 which helps the action of the vitamin D receptor. In fact, the researchers found that if they blocked the actions of MED in mice those mice grew less hair. The research findings were recently discussed on the NBC today's show:

Visit NBCNews.com for breaking news, world news, and news about the economy

These data suggest that defects in MED1 or defects in vitamin D signaling could potentially be involved in the development of certain types of hair loss – but more research is needed.

CONCLUSIONS

1. Vitamin D has an important role in hair growth – mice that lack the vitamin D receptor (VDR) develop hair loss and mice that lack an activator of the VDR (called MED) develop hair loss

2. It’s more complicated than simply taking more vitamin D pills. Don’t think for a minute that popping more vitamin D pills is going to lead to more hair growth.

REFERENCES

Xie et al. Lack of the vitamin D receptor is associated with reduced epidermal differentiation and hair follicle growth. J Invest Dermatol 2002; 118: 11-6.

Oda Y et al. Coactivator MED1 Ablation in Keratinocytes Results in hair Cycling Defects and Epidermal Alterations. Journal of Investigative Dermatology 2012; 132: 1075-83

Finasteride Use by Young Men: Not only for Baldness in the Crown !

Finasteride Use by Young Men

For years, we've largely assumed that finasteride helps men with hair loss in the crown, but does little for men with hair loss in the front of the scalp or the temples.

A new study by US researchers has nicely shown that finasteride 1 mg daily can help young men with male pattern balding regardless of where on the scalp the man has hair thinning.

The researchers studied men 18 to 60 years of age for a period of two years. Four areas of the scalp were examined: (1) vertex (crown), (2) the mid-scalp, (3) the frontal hair line and (4) the temples.

What were the results of the study?

The study showed that young men benefitted from taking finasteride - regardless of where there hair thinning occured. Young men (age 18-40) with hair loss in front, temples, mid-scalp or crown all had benefit from taking finasteride. However, the same was not true of men age 41-60. Men in this slightly older group benefitted most if their hair loss was in the crown and the mid-scalp.

Reference

Olsen EA et al. Global photographic assessment of men aged 18 to 60 with male pattern hair loss receiving finasteride 1 mg or placebo.  J Am Acad Dermatol 2012; 67: 379-86. (click for abstract)

 

More Benefits of Checking Iron Levels in Women with Hair Loss

Checking Iron Levels in Women with Hair Loss

As many of my patients know, iron metabolism is one of my favourite subjects. It also forms one of the components of the hair loss research that I do. 

I generally recommend that all women with concerns about hair loss have their iron levels checked using the simple blood tests called ferritin. Other blood tests may also be ordered for women with hair loss, such as thyroid tests and a complete blood test to measure the hemoglobin level.

Although it is somewhat contraversial among hair experts around the world, the iron level I like my patients to aim for is a ferritin level above 40-50 ug/L.  If the blood test shows less than this, then I recommend supplementation with iron pills.

New research outlines additional benefits of checking iron levels in women

In a recently published study, Swiss researchers studied 198 premenopausal women who had ferritin levels less than 50 ug/L and symptoms of fatigue. A proportion of women in the study received ferrous sulphate pills and another proprotion of women received placebo pills.

 

What were the results of the study?

At the end of the 12 week study, women who received iron noted a significant improvement in their overall level of fatigue compared to women receiving the placebo pills.  The ferritin level in women recieiving the iron pills increased by approximately 12 ug/L over the 12 weeks of the study.

 

Comment

Many premenopausal women have low iron levels. This study reminds us that there are many improtant benefits of iron, including helping improve the overall feeling of fatigue (if levels are low). Although I routinely follow iron levels in  my patients, this study reminds us that asking about improvement in fatigue levels may also be an important parameter to assess in making a decision about continuing iron supplements for the longer term.


Reference

Vaucher P et al. Effect of iron supplementation on fatigue in nonanemic 
menstruating women with low ferritin: A randomized controlled trial. CMAJ 
2012 Aug 7; 184:1247. (Click link for article)

 

Plan to Attend the Canadian Skin Patient Conference !

The Canadian Skin Patient Alliance (CSPA) is a Canadian Organiziation created by patients for patients with a variety of skin problems – including various types of hair loss. The CSPA is planning to hold its first-ever Canadian Skin Patient Conference, October 12 to 14, 2012. The conference is being held at the Toronto Downtown Marriott Eaton Centre Hotel.  Attendees will have access to the latest information and opportunities to get to know other skin patients and how they cope.  Click on the link to learn more about this unique conference and watch the video for more information.

Hope to see you there!

Jeff.

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Can hair follicles make nerves?

Can hair follicles make nerves?

The hair follicle is an amazing structure.  Above the surface of the skin, we see only the hair fiber which is composed mostly of a non-living substance called keratin.

Nestin: A key marker for stem cells

It's only when you look below the surface of the skin, that you begin to see the complexity of the hair follicle. Just a short distance under the skin, within a part of the hair follicle called the bulge ... there exists cells that have the potential to become neurons, muscle cells and pigment producing cells. Scientists can now easily identify these cells because they contain a protein called 'nestin.'

For example, if these special hair follicle cells are transplanted (i.e. into a mouse) they can become blood vessels and neural tissue. Further research is needed to understand the full potential of the hair follicle.

Reference

Hoffman RM. The potential of nestin-expressing hair follicle stem cells in regenerative medicine. Expert Opin Biol Ther 2007

 

Hair loss and lupus: Doc, do you think my hair loss could be from lupus?

Hair loss and lupus:

Anyone who is losing hair knows how frustrating it can be to find accurate information. It is often difficult to figure answers by searching the internet. Confiding in a friend about hair loss leads to one piece of advice, while a second friend offers completely different advice. It seems daunting to pinpoint which of the 100 causes of hair loss are responsible.

In the search for answers, it's not uncommon for a patient to ask me "Do you think my hair loss could be from lupus?" Are you going to test me for it?

What is lupus?

Lupus, also known by the medical term "systemic lupus erythematosus" is an autoimmune condition. It has the potential to affect nearly every body system from the skin to heart to lungs to brain to kidney (....and that is why the word "systemic" is used). It affects approximately 50 out of every 100, 000 people. Current estimates suggest there are 500,000 individuals in the USA and 50,000 individuals in Canada affected by lupus. Women are affected nearly 9 times more commonly than men. Black women are particularly affected.

What are the signs of lupus and should I get tested?

For every patient with hair loss that I see, I run through a series of simple "screening questions. " If the answers to all these questions are "NO" then I usually don't give any further thought to the patient in front of me having lupus. If the answer to one or more of the questions is "YES" it certainly does not mean the patient has lupus, but means that I might ask more "in depth" questions.

Typically, my "screening questions" for lupus that I ask patients with hair loss include the following 13 questions:

HAIR CLINIC SCREENING QUESTIONS FOR LUPUS:

1. Have you been experiencing extreme levels of fatigue lateley?
2. Do you experience headaches... and if so...how often do you get them?
3. Have you ever experienced a seizure in your life? how many?
4. Do you see or hear things that you think other people might not hear or see?
4. Do you have joint pains ...and if so ...which joints?
5. Do you have high blood pressure? Has it been difficult to control with medications?
6. Do you have pain in the chest when you take a deep breath?
7. Do you experience dry mouth or dry eyes?
8. Do you experience ulcers in the mouth, nose (and for women in the vagina) that you are aware of?
9. Do you develop rashes on the face or skin when you go out in the sun? Do you find you burn much easier than before?
10. Have you ever been told you have abnormal blood work results? ( especially, low hemoglobin, low white blood cells, low platelets)
11. Has anyone in your family been diagnosed with lupus in the past?
12. Have you ever had a blood clot?
13.(Women) Did you ever have a miscarriage and if so, how many?

Many, many individuals will answer " YES" to a question or two from the above list. It does not mean they have lupus. But if they answer "YES" to a few questions it points me down a path of very, very detailed questioning. The formal American College of Rheumatology criteria for diagnosing lupus can be found by clicking here.


Should I get a blood test for lupus?

The vast majority of patients with hair loss do NOT need to have a test for lupus. This can't be overstated enough. However, if the answers to a few of the screening questions above are " YES" then testing 'could' be at least considered. If I am even slightly suspicious, I usually order a blood test known as the ANA (anti-nuclear antibody test).   If the ANA blood test returns "positive", additional blood tests (Group 2) may be ordered. It takes alot of experience to interpret these tests and it can sometimes be challenging to diagnose someone with lupus.  Referral to a rheumatologist is often required.

Group 1 test for lupus

ANA (anti- nuclear antibodies)

• 99 percent of people with lupus will have a positive test. However, many other conditions (and even normal healthy people) can have a positive ANA test. So having a positive ANA does not necessarily mean you have lupus.  Rarely, patients with lupus can even have a negative ANA test (especially early in the disease).

Group 2 tests for lupus (ordered if the ANA test is positive)

1. CBC (complete blood count)

• Individuals with lupus may have low levels of red blood cells, white blood cells and platelets

2. Urinalysis

• To check if there is protein or blood in the urine. This can be a sign of kidney damage.

3. Creatinine

• Another measure of kidney health. Patients with kidney disease may have increased creatinine levels.

4. ESR ( erythrocyte sedimentation rate)

• A measure of inflammation in the body. Many conditions can increase ESR, not just lupus.

5. C3 and C4 (complelment levels)

• Complement levels may be lower in patients with autoimmune diseases and used to monitor activity of the disease

6. ENA (extractable nuclear antigens) which include the anti-Smith test

• The ENA test measures many antibodies, including Jo, Sm, RNP, Ro, La, Scl-70. These antibodies can be positive in many different types of immunologic conditions. Patients with lupus may have a positive anti-Smith test (and sometimes other positive results from the ENA panel of tests too).

7. Antiphosphopilid antibodies

8. Anti-ds DNA test (anti-double stranded DNA test)

In summary, is the diagnosis of lupus should only be made by a medical professional. There are well over 100 causes of hair loss and certainly lupus is on that list and therefore needs to be at least considered. Simply having a positive ANA test doesn't automatically mean an individual has lupus. Obtaining a very detailed medical history and performing a detailed physical examination is very important in the overall evaluation of a patient suspected of having lupus.  Because lupus is a disease that affects many organs in the body, patients diagnosed with lupus are often treated by rheumatologists as well as other specialists (cardiologists, respirologists, neurologists, nephrologists, dermatologists). 

 

Genetic Balding in a 6 and 8 year old?

Genetic Balding: How young does it  affect?

Androgenetic alopecia ( also known as genetic /hereditary balding) occurs in 50 % of men and 30 % of women by age 50.  Genetic balding can occur in teenagers but rarely occurs under age 11.

Italian dermatologists recently published an interesting report in the journal Pediatric Dermatology.  They described two healthy sisters aged 6 and 8 years who presented with a one year history of hair thinning which the dermatologists diagnosed as androgenetic alopecia.  Lab tests were normal in these two girls.Treatment with 2% minoxidil was successful in improving hair density.

Comment:

Although androgenetic alopecia is rare in the pre-teen years, it may rarely occur.  In these rare situations the first occurance is just before puberty during a period of hormonal change called "adrenarche." A strong genetic predisposition is often found... and the mother of the two girls in the study also had early onset of androgenetic alopecia at age 18.

Reference

Familial Androgenetic Alopecia in Siblings with Normal Endocrinologic Status. Pediatric Dermatology. Vol 29.  p 534-35.

Do physicians understand how much hair loss affects their patients?

Do physicians understand emotions of hair loss?

Some patients are extremely distressed by hair loss, even if the amount of hair loss is minimal.  Are doctors very good at picking up how a patient's hair loss affects their quality of life?

Researchers from Chicago examined set out to determine if dermatologists can predict how much their patients' quality of life is affected by their hair loss. The researchers examined 104 women with three hair loss disorders (androgenetic alopecia, telogen effluvium and alopecia areata).

Dermatologists downplay hair loss severity

The researchers found women rated their hair loss as more severe than their dermatologists rated the hair loss. Moreover, the degree of a patient's hair loss did not correlate with how much patient's quality of life was affected. For example, some with minor amounts of hair loss were quite distressed by their hair loss whereas some patients with more extensive loss were minimally affected.  Interestingly, the amount of hair loss a patient perceived they had experienced did correlate with how much it impacted their quality of life.

Implications of hair loss study

This study has important implications for physicians who see patients with hair loss. If physicians want to understand how a patient is affected by their hair loss, they need to ask patients just how much hair loss they perceive to have occurred.  I generally try to get a sense of this by asking patients "how much hair loss do you think you've had - ....a little bit? ... a moderate amount? ... or a lot?"



Reid EE et al.  Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium and androgenetic alopecia. J Am Acad Dermatol 2012; 66:e97-102