Hair Restoration Blog

Q:

Hi Dr. Mohebi,

I had been taking 1.25 mg finasteride pills M/W/F and I started experiencing sexual side effects a couple weeks ago.  I’ve since stopped taking the pills and the side effects have decreased.  The side effects have not completely gone away yet.  Previously, I had quit for similar reasons and started up again going from 1.25 every day to 1.25 mg only M/W/F.

What do you recommend I do

Thanks,

A:

You need further evaluations besides stopping finasteride to make sure there is no other reasons for the sex drive changes you are experiencing.

Since you have had your hair transplant only a few months ago and have significant miniaturization (a sign of active hair loss), you need to use Rogaine 5% solution or foam twice a day to minimize the shock loss on the entire area of the scalp that is prone to balding.

Shock loss after a hair transplant surgery could be seen in the few months.  Studies have shown that shock loss could be prevented or minimized significantly when patients are taking finasteride after hair transplant procedures. We recommend Rogaine for women or men who cannot use finasteride for any reason for at least 6 months following their hair transplant to minimize the risk of hair transplant surgery.

Alopecia areata (AA) is a type of local hair loss due to autoimmune reaction of the patient’s body against hair follicles.  Alopecia Areata generally presents as circular coin shape hair loss lesions, but it can progress to involve larger areas of the scalp (Alopecia Capitis) or even the entire body (Alopecia Universalis).

Several treatment options are recommended for inducing hair growth for treatment of alopecia areata. Some patients may recover spontaneously over a period of time; because of this patients should be evaluated and selected carefully.  It is important that the options to forgo treatment are reviewed with the patients, as well as discussing the high failure rate of all the various options available.

Most people who have hair loss on the hair line prefer to treat this condition more aggressively with a variety of medications.  The chance of spontaneous recovery appears to be more in patients who have smaller and fewer hair loss paths.

• Topical Steroids

Topical steroids for treatment of AA has been widely used with little evidence of success.  They are easy to use and more affordable to many patients. However, the current lack of evidentiary success does not make this a valuable recommendation for patients.

• Local Injection of Steroids

Infiltration of long acting corticosteroids into the AA lesions has been studied with some degree of success.  Patients with smaller lesions of alopecia areata may respond better to local steroid injections.

This type of local injections of steroids is most desirable for limited lesions of cosmetically sensitive areas like hair lines and eyebrows.  The most common used medication is Triamcinolone acetonide (5-10 mg/mL).

• Systemic Steroids

Systemic treatment with steroids may stimulate hair regrowth in a limited number of patients.   Continued use of steroids is generally needed in most of these patients to maintain the level of hair growth.  Pros and cons of long term use of steroids should be discussed with these patients before initiating systemic steroid therapy.

• Topical immunotherapy

Topical immunotherapy utilizing allergens has been studied and proven to have some success in patients. The protocol for contact immunotherapy using DPCP has been recommended. Continued use of DPCP is needed to keep the skin irritated for a long time.  The inflammation seems to be able to change the progress of immune reaction that causes hair loss in alopecia areata.

Treatment should be discontinued only after full regrowth is apparent.  This can take an indeterminate length of time, and during this period patients may have to tolerate inflammation of the skin.  A high rate of relapse after discontinuation of treatment makes this option less desirable for most hair specialists.

• Other treatments of alopecia areata

Other medical treatments such as phototherapy, photochemotherapy, minoxidil and dithranol  have shown limited improvements.  Finally patients with extensive stages of hair loss with no response to treatment options may use wigs or hair systems.  That is more desirable for many women with extensive hair loss due to alopecia areata that are having zero to minimal response from any other treatments.

Q:

My daughter, aged 20, has recently become the victim of AU.  I am a doctor myself and understand the etiology.I would like to know if there are any reports on therapy using IV methylprednisolone and endoxon.

I would also like to know if there is any relation of AU WITH ERYTHROCYTOPENIA as my daughter is having Hb around 9-10% RBC COUNT OF 3.3 to 3.6 million.

A:

Yes, several studies have concluded which indicate use of high dose steroids as pulse therapy to improve the outcome of Alopecia Areata (AA) and its more severe forms Alopecia Universalis (AU) if used early on in the process of the disease.

The results of a study  performed on 66 people who suffered from severe alopecia areata were published in 2003 to show a positive response in patients; with Alopecia Universalis results were favorable in about 80% of patients.  There has been a high rate of relapse among the treated patients of the study, but a few have stayed clear of the disease following their first treatment. More information on this study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/12746668

This study provides the best indication of pulse methylprednisolone therapy: first recent episode of extensive plurifocal alopecia areata. These results are less convincing in patients with a long term history of the disease or other advanced forms of alopecia areata.

There have been strong links to support autoimmune etiology for Alopecia Areata and its more severe form of Alopecia Universalis.  The disease has also been seen in other diseases that are autoimmune in nature.  It is not clear, however, why alopecia areata and other autoimmune diseases might be present concurrently in the same person.

There are some suggestions regarding the possible triggers for autoimmune attacks (i.e.- viruses, infection, medicines, sunlight, or other environmental factors) that can prompt the immune system in a extraordinary method to attack the body’s own tissues. Pernicious anemia, a serious form of anemia, is typically caused by autoimmune processes and has often been present in patients with Alopecia Areata or Alopecia Universalis.

I believe a thorough evaluation of your daughter for the causes of her erythrocytopecia is the first priority at this point.  Your daughter may have a systemic condition that aggravated both her skin and hematologic conditions which should be investigated by a qualified dermotologist in your area.

To see more information on hair loss caused by autoimmune and other diseases, please visit our Other Types of Hair Loss page.

Diffuse Unpatterned Alopecia (DUPA) is a hair loss condition in which hair thinning is seen diffusely throughout the scalp.  In DUPA, there is no a reserved area with good quality hair even on the areas of the back and side which are typically designated as the donor area in hair transplant patients.

A microscopic evaluation of the scalp generally shows significant miniaturization (fineness) of scalp hair diffusely.  DUPA can be seen in both men and women but its female type may at times be mistaken with typical female patterned baldness due to its close similarities.

A thorough medical evaluation with supporting lab work to rule out other causes of diffuse hair loss is always warranted before determining eligibility for a hair restoration procedure.  Hair transplantation is generally not a good option for people who have DUPA due to instability of the scalp hair on the back and side areas of the scalp.  Many people who have DUPA may suffer from other medical conditions that cause hair loss such as Iron Deficiency, thyroid or other hormonal imbalances or autoimmune disorders.  Medical treatment such as minoxidil in women and finasteride in men could be helpful in treatment of this condition.

Q:

Hello Doctor,

This is XXXX from India.
My sister is suffering from Alopecia Areata for last 11 years. We tried treating her disease with every thing we knew (Alopathy/ Homeopathy/Ayurved) but it’s of no use. May be because we didn’t have proper guidance. It will be great if you can kindly guide us how should we move forward to treat her.

Thank you in advance.

Regards,
XXXX

A:

Alopeica areata (AA) is an autoimmune condition of skin.  AA usually does not need any medical intervention and the lesions improve spontaneously.  However, at times the balding spots might be very difficult to treat.  Although there is minimal evidence that injections of steroids can change the process of this disease, many physicians treat the balding AA lesions with intramural injections of long acting steroids.  Topical medications including minoxidil may also be used in some cases.  There are several current studies being conducted on the use of irritating agents to possibly change the inflammatory process of the skin.  Use of irritating agents are still not in the main stream treatments of Alopecia Areata.

Hair transplantation is definitely not one of the options at this time, because newly transplanted hair may be going through the same balding process with the same mechanism.  My best recommendation is to find a qualified dermatologist in your area and continue with him or her through future treatments.  You must be patient in circumstances such as these and try to understand that a quick recovery may not be achieved in some patients.