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Unusual Hair Loss Conditions

August 25, 2020 by admin

Chronic Telogen Effluvium (CTE)

What is Chronic Telogen Effluvium – CTE?

CTE is often confused with female pattern hair loss and most commonly occurs in women in their 30s. The onset is usually sudden and there is an abrupt increase in the amount of hairs shed in a day up to 100 hairs, and these shed hairs usually have a white bulb. Hairs may shed while combing, brushing or washing the hair.

The amount of hairs shed in a day tends to fluctuate and CTE can last for years before it ultimately stops. Eventhough hair shedding continues for a number of years, the hair loss is only noticable to those affected and persons very close to them. Sometimes, even their hairdressers are not aware of any hair loss. A reliable way to check if you have been shedding excessive hair is to look at the volume of your ponytail, which may be only 30-50% of normal.

The good news about CTE is that there is no problem with the production of hair although there is excessive hair shedding – so that means you would not go bald with CTE, although the volume of your hair could be much less than before.

What causes Chronic Telogen Effluvium?

There are a number of triggers including iron deficiency anaemia, childbirth, major illness, crash diet, starting or stopping certain medications, major life stress, etc. However, in most women, no cause is identified.

Chronic Telogen Effluvium is not caused by hormones or genetics.

What investigations are required to diagnose CTE?

It is important to have some blood tests done via your doctor – iron studies and thyroid function, as well as reviewing the medications you are taking. If all these investigations are normal, a scalp biopsy may be required to distinguish CTE from female pattern hair loss (FPHL).

Sometimes, CTE can progress to FPHL or they can co-exist. Hence, scalp biopsy may need to be repeated every year or two to confirm diagnosis as management differ between the two conditions.

How do you treat CTE?

As CTE is not caused by hormones, it does not respond to hormonal treatment. There is not effective treatment for CTE although minoxidil lotion (Regaine/Rogaine) could be trialled for three months and this may sometimes stop the hair shedding.

Treating pre-existing conditions like iron deficiency or thyroid problems are necessary in case they are the underlying causes for CTE.

Lichen Planopilaris (LPP)

What is Lichen Planopilaris (LPP)?

Lichen planus is a condition that can affect the skin, the mouth, the hair, and the nails. When it affects the hair, it is called lichen planopilaris. LPP can occur without any skin or nail involvement – in these cases, diagnosis can be difficult.

In LPP, the inflammation in the scalp destroys the hair bulbs. This means that once hairs are lost, there is no potential for regrowth. Once LPP develops, it is difficultto predict what will happen over time without treatment. In general, the area affected by LPP that goes untreated would progress and enlarge up to a point where the condition burns out and spontaneously stops. No one knows why this happens and when LPP burns out, it does not continue to extend.

If lichen planus affects the skin elsewhere, it generally appears as either multiple tiny pin head-sized red lumps on the skin or as red bumps, particularly on the front of the wrists and the shins. If it affects the nails, it can produce thinning or roughening of the nails. If it affects the mouth, it can produce white areas that may be sore.

LPP is not contagious and does not predispose to cancer.

What causes Lichen Planopilaris?

The cause of LPP is unknown. While certain drugs can cause lichen planus on the skin, it is not known if they can also cause it on the scalp. When a drug is the cause for lichen planus on the skin, it may only occur two or three years after starting the medication. Whether changing your medications will help LPP is not known.

LPP is not caused by hormones or genetics, and no triggers have been identified.

How is LPP diagnosed?

A scalp biopsy is always required to confirm the diagnosis. However, sometimes biopsies are not always conclusive and hence the diagnosis is not always able to be conclusively established.

What are the treatments available for Lichen Planopilaris?

It is not easy to control the inflammation in Lichen Planopilaris and there is no single effective medication suitable for everyone. It is common to have to try a few different medications before finding one that is effective.

Although it is not possible to stop the inflammation in everyone, a fair proportion of people experience some success with treatment. It is hard to predict who will benefit from treatment.

Filed Under: Blog

Hair Loss Medication

August 25, 2020 by admin

Spironolactone (Aldactone)

For unknown reasons, androgens cause scalp hairs to miniaturize (alopecia) and body hair to grow or enlarge (hirsutism). In the treatment of hair loss, spironolactone acts by blocking the effects of androgens (male hormones) on scalp hair follicles. At the same time, it can also reduce the amount of body hair that you have.

Due to the feminisation effects of spironolactone, this drug is only used to treat female pattern hair loss and is not used in males.

What should I expect to see with spironolactone (Aldactone) treatment?

Many women affected by FPHL experience an increase in hair shedding or a reduction in hair volume, or both. You may start to notice a reduction in hair shedding within 4 months of commencing treatment with spironolactone.

It is important to note that the hairs you shed now actually died 3 months ago and had been sitting dormant in the follicle until new hairs grow to replace them. As such, there would be a delay of about 3 months before the effects of spironolactone are seen after commencing treatment.

By about 8 months, there may be a reduction in the amount of body hair. By about 12 months, some women may experience a slight increase in their hair density on the scalp. It is important to manage expectations with spironolactone treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus.

What are the side effects of spironolactone (Aldactone) and what should I do before commencing treatment?

This is a relatively safe medicine that has been around for 30 years and was originally developed to treat high blood pressure. Only in the last 10 years has it been used regularly to treat female pattern hair loss.

Common side effects are dizziness and tiredness, which may disappear in the first few days of treatment. Due to their effects on altering potassium levels in the blood, it is important to have blood tests before you commence treatment and during treatment.

Some women may have breast tenderness and menstrual irregularities that usually settle within the first 3-4 months of treatment.

Allergic skin rashes are rare with spironolactone but if you develop a new rash and you suspect that this is related to spironolactone, see your doctor immediately.

It is highly recommended to use an oral contraceptive pill so you do not get pregnant while on spironolactone treatment as it is harmful to the unborn baby.

What if I stop taking spironolactone (Aldactone)?

The effects of spironolactone will only be seen with continued medication and will wear off quickly once it is stopped. It is recommended that treatment should continue for at least 12 months before assessing any benefit from it.

Many thanks to the Autralasian Hair and Wool Research Society “Using spironolactone” patient information handout.

Cyproterone Acetate (Androcur)

For unknown reasons, androgens cause scalp hairs to miniaturize (alopecia) and body hair to grow or enlarge (hirsutism). In the treatment of hair loss, spironolactone acts by blocking the effects of androgens (male hormones) on scalp hair follicles. At the same time, it can also reduce the amount of body hair that you have.

Due to the feminisation effects of spironolactone, this drug is only used to treat female pattern hair loss and is not used in males.

How is cyproterone acetate (Androcur) taken?

Post-menopausal women or those who have had a hysterectomy (removal of the uterus) can take 1 or 2 tablets of Androcur daily (please follow your doctor’s advice). In women who are still having regular periods, Androcur is generally taken for only 10 days each month to prevent any irregularities of periods. If you are on the contraceptive pill, it is recommended that you take 1 or 2 tablets of Androcur (as advised by your doctor) with the first active pill of the month.

Androcur is stored in the fat and slowly released into the bloodstream. Therefore, it continues to work for the entire month even if it’s only taken for part of the month. Sometimes, the release can be slower than usual and cause your period to be delayed or absent. This is not a cause for concern.

What should I expect to see with cyproterone acetate (Androcur) treatment?

Many women affected by FPHL experience an increase in hair shedding or a reduction in hair volume, or both. You may start to notice a reduction in hair shedding within 4 months of commencing treatment with spironolactone.

It is important to note that the hairs you shed now actually died 3 months ago and had been sitting dormant in the follicle until new hairs grow to replace them. As such, there would be a delay of about 3 months before the effects of spironolactone are seen after commencing treatment.

By about 8 months, there may be a reduction in the amount of body hair. By about 12 months, some women may experience a slight increase in their hair density on the scalp. It is important to manage expectations with spironolactone treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus.

What are the side effects of cyproterone and what should I do before commencing treatment?

This is a relatively safe medicine that has been around for 15 years and was originally developed to treat high blood pressure. Only in the last 10 years has it been used regularly to treat female pattern hair loss.

Some women may have breast tenderness and menstrual irregularities that usually settle within the first 3-4 months of treatment. If your periods become highly irregular, it is recommended to take the oral contraceptive pill to help regulate your periods. It is highly recommended that you do not get pregnant while on cyproterone acetate (Androcur) treatment as it is harmful to the unborn baby.

Depression or low mood may be seen in susceptible people.

What if I stop taking cyproterone acetate (Androcur)?

The effects of Androcur will only be seen with continued medication and will wear off quickly once it is stopped. It is recommended that treatment should continue for at least 12 months before assessing any benefit from it.

Many thanks to the Autralasian Hair and Wool Research Society “Using cyproterone acetate” patient information handout.

Finasteride (Propecia/Proscar)
Finasteride is a medication that prevents the conversion of testosterone to its more active form, DHT (dihydrotestosterone) by inhibiting an enzyme called 5-alpha reductase type II in the scalp hair follicles. Lower levels of DHT in the scalp can slow down or prevent hair loss. However, because finasteride does not completely block this conversion, it will not complete arrest hair loss.

What evidence do we have that finasteride (Propecia/Proscar) works?
Finasteride has been tested extensively all around the world by scientists and doctors in large clinical trials and was found to be very effective in treating male pattern baldness (androgenetic alopecia). At the end of 2 years after commencing finasteride, it was found that 99% of men retained all the hair they had when they first started treatment, while those on placebo (sugar tablets) lost their hair with the balding process. Moreover, 48% of men who was on finasteride actually had more hair at the end of the first year after commencing treatment. At the end of 2 years, 66% had more hair than when they first commenced treatment.

What should I expect to see while on finasteride (Propecia/Proscar) treatment?
The main aim of treatment is to stop you becoming bald. Finasteride arrests hair loss and helps you keep the hair that you have left. In other words, if you do not take finasteride, you would expect to lose more hair over the years. Some men have reduced body hair growth while on higher doses of finasteride.

It is important to manage expectations with finasteride treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus. Some men actually experience some hair regrowth as early as 4 months after commencing treatment but it usually takes up to 2 years before any regrowth is noticed. Even so, only a third of men on finasteride will actually grow enough hair for their family and friends to notice the difference.

For men who start to go bald in their late teens and early twenties, finasteride is a desirable treatment for many to delay the process as long as possible until their thirties or fourties when they do not mind the prospect of becoming bald after establishing their careers and family lives.

Why am I losing more hair now when I have just started finasteride (Propecia/Proscar)?
On the balding scalp, there are many hairs sitting in the dormant or resting phase on the scalp. Sometimes, finasteride can cause rapid reactivation of the hair follicles to produce new hairs causing the old hairs to be pushed out all at once, so you notice more hair shedding. This is not a serious cause for concern if it happens, and should settle within 6 months. This is an indication that finasteride is having an effect on your hair follicles and “reawakening” them.

What happens if I stop taking finasteride (Propecia/Proscar)?
Once you stop the medication, you will continue to lose your hair and the balding process will take over once again at the same rate had you never have taken finasteride. Finasteride helps to delay this outcome as long as you continue taking this medication.

Filed Under: Blog

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