Dr. Marc Avram

An article from the Journal of the American Academy of Dermatology (JAAD) Volume 65, Number 6:

 

A randomized, single-blind trial of 5% minoxidil foam

once daily versus 2% minoxidil solution twice daily in

the treatment of androgenetic alopecia in women

 

Ulrik Blume-Peytavi,MD, PHD, Kathrin Hillmann, MD, Ekkehart Dietz, PHD, Douglas Canfield,

and Natalie Garcia Bartels, MD

Berlin, Germany and Fairfield, New Jersey

 

Background: Although twice-daily application of propylene glycol- containing 2% minoxidil topical solution (MTS) stimulates new hair growth, higher concentrations of minoxidil in a once-daily, propylene glycol-free formulation may improve efficacy and reduce unpleasant side effects.

Objective: WE sought to compare the efficacy, safety and acceptability and to show noninferiority of once-daily 5% minoxidil topical foam (MTF) with twice-daily 2% MTS in woman with androgenetic alopecia.

Methods: A total of 113 women with androgenetic alopecia were randomized to 24 weeks of treatment with 5 % MTF and 2% MTS. The primary efficacy parameter was change from baseline in nonvellus target area hair count at week 24. Secondary end points included change in nonvellus target hair width, overall efficacy by global photographic review as assessed by treatment-blind evaluators and the subject herself, adverse events and participants’ assessment of product aesthetics.

Results: After 24 weeks, women randomized to 5 % MTF once-daily showed noninferior target area hair count and target area width and experienced great, but nonsignificant , improvements in target area hair count, target area hair width and overall efficacy by global photographic review than those randomized to 2% MTS used twice-daily. 5% MTF was significantly superior to 2% MTS in participants’ agreement with “the treatment doesn’t not interfere with styling my hair” (P=.002). Women randomized to 5% MTF experienced significantly lower rates of local intolerance (P=.046) especially in pruritus and dandruff with 2% MTS.

Limitation: Because of differences in the formulations tested, study participants were not blinded to treatment.

Conclusions: Once-daily 5% MTF is noninferior and as effective for stimulated hair growth as twice-daily 2% MTS in women with androgenetic alopecia and is associated with several aesthetic and practical advantages. (J Am Acad Dermatol 2011;65:1126-34.)

Key words: androgenetic alopecia; female pattern hair loss; hair preparations; hypertrichosis; minoxidil; topical administration; topical foam; topical solution. 

 

INTERNATIONAL SOCIETY OF HAIR RESTORATION SURGERY MAINTAINS SAFETY AND EFFICACY OF PROPECIA
(FINASTERIDE 1MG) FOR MALE HAIR LOSS IS BACKED BY PROVEN SCIENTIFIC DATA
Task force formed to study reports of sexual dysfunction in some men taking Propecia for hair loss
GENEVA, IL. – December 13, 2011. The International Society of Hair Restoration Surgery (ISHRS) – the world’s leading medical authority on hair loss and hair restoration – cautions that recent anecdotal reports of persistent sexual dysfunction by some men who have used finasteride 1mg (Propecia) to treat hair loss should not define the safety and effectiveness of this drug. Propecia is the only oral medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of hair loss in men.
From a scientific standpoint, the ISHRS reports that there are no evidence-based data substantiating the link between finasteride and persistent sexual side effects after discontinued use of the drug in numerous, double blinded, placebo controlled studies conducted evaluating the use of Propecia 1mg for hair loss.

“The health and well being of our patients is the utmost concern of the 900 physician members of the ISHRS – whether prescribing medications like Propecia or performing hair restoration surgery,” said ISHRS President Dr. Jennifer Martinick. “ISHRS members devote an average of 72% of their practices to medically and surgically treating hair loss, and collectively they have treated millions of men around the world suffering from hair loss with finasteride 1mg with virtually no side effects.”
Since receiving FDA approval in December of 1997, 20.5 million and 6.7 million patient-years of exposure using Proscar (finasteride 5mg) and Propecia (finasteride 1mg) respectively are recorded with a low adverse event profile. The ISHRS believes that these are the most current and reliable data available until further studies are conducted.
Sexual dysfunction is a complex disorder, and Dr. Martinick noted that it often can be hard to pinpoint the exact cause – particularly when multiple factors such as nicotine, alcohol, prescription medications, stress, anxiety, fatigue and depression can contribute to erectile dysfunction (ED).
“The incidence of ED in the general population is known to be quite high – as high as 49% in middle-aged and older men according to one study published in 2006 in the Archives of Internal Medicine,” said Dr. Martinick. “That being said, we owe it to our patients to address valid concerns in a scientific manner and to clarify any misleading reports so that men can make informed choices regarding the use of this medication.”
Recently, the ISHRS formed a task force to more closely examine anecdotal reports of sexual dysfunction by some Propecia users who have used the drug to treat hair loss. In addition, the ISHRS has called on the medical communities of dermatologists, hair loss physicians, urologists, endocrinologists and sexual medicine specialists to join in a colloquium to share all data and experiences with finasteride in a fact-based manner.

Robotic Follicular Unit Extraction in the Donor Area.

Over the past several years, an increasingly popular option for removing donor hair from the posterior scalp is follicular unit extraction. Follicular unit extraction is where a 1 mm punch biopsy is utilized to harvest individual follicular units from the donor area. The advantage of this technique is that the small incision made to remove the donor hair allows hundreds of hair follicles be removed with minimal or no visible detected donor scar on the posterior scalp.

For many patients, a scar on the posterior scalp is of no cosmetic, functional, or practical concern and therefore an ellipse is performed. For other patients that like to wear their hair short, or may want to wear their hair short in the future or who prefer for psychological reasons not to have a donor scar, follicular unit extraction is appealing.

The chief disadvantage of follicular unit extraction is the increased time it takes to remove the hair and less hair that is harvested during each procedure compared to a donor ellipse. Recently, a robotic device has been developed by a company in Silicon Valley named Restoration Robotics. This device may offer an opportunity to harvest large numbers of follicular groupings that will be comparable in number to what can be attained with a donor ellipse. This is a potentially significant advancement in hair restoration surgery since it will allow the best of both worlds; a large number of follicular groupings from each surgery with no visible scar in the donor area. Further experience over the next several months will better define the role of the robot in hair restoration surgery.

Corrective Hair Transplant Surgery After Hair Loss Due to Facelifts and Endoscopic Brow Lifts.

A small percentage of patients undergoing facelift or forehead lift procedures will lose hair along their hairline. The vast majority of patients who do lose their hair after surgery have it re-grow within six to twelve months with no further medical intervention. For some patients, unfortunately, hair does not grow and this becomes a cosmetic concern. The chief complaint is the inability to wear one’s hair back in a pony tail, which leads to limited hair styling options and a woman being self conscious about her appearance.

A large number of one to three hair follicular groupings can help restore a natural hairline if placed by a skilled team at the correct angle. Success in the procedure is judged by a patient’s ability to wear her hair back and not feel self conscious.

In addition to correcting hair loss due to face lifts and forehead lifts, transplantation is also used for patients that have lost hair from either traumatic injuries and/or removal of benign and cancerous tissues in the scalp.

Update on Hair Cloning

Over the past several years, there has been great public interest regarding the possibility of being able to clone our own hair follicles. Current methods in hair transplantation allow consistently natural appearing transplanted hair for men and women. The majority of patients have ample donor hair from the back of their scalp to make a substantial natural cosmetic impact in thinning areas of the scalp. A small minority of patients do not have adequate donor hair and therefore cannot benefit from transplantation. For these patients, cloning hair follicles will be a significant breakthrough in restoring natural growing hair to their scalp. Cloning of hair follicles will not improve the current aesthetic result of a hair transplant but will allow millions more women and men to benefit from the procedure.

Currently, there are several independent, well funded groups investigating cloning. They have made substantial progress but, to date, cloning remains unavailable to patients. It is anticipated it will be several years before it is cloning is available to patients.

Laser Hair Removal

Laser hair removal is highly effective in permanently removing unwanted  pigmented  hair follicles.  All skin types are candidates for laser hair removal.  Thicker hair follicles respond better than fine or thin follicles.  All patients on average require five to eight treatments for a 60 to 80 percent permanent reduction in hair follicles.  The vast majority of patients see a substantial improvement and are happy with the treatment after five to eight treatments. In a small percentage of patients, less hair is reduced after multiple treatments.  The reason for failure is unknown.  Typically, if a patient does not see some improvement after two to three improvements with a laser , we try an alternate laser hair removal device in our office. 

The overwhelming number of patients have no side effects with laser hair removal.  As with all laser devices side effects can occur.  The most common ones include – increased  pigmentation( hyperpigmentation), loss of pigmentation (hypopigmentation), scarring, and infection.  Risk of side effects can be reduced by using the appropriate laser for a patient’s skin type, energy, pulse duration, and technique . 

In summary, laser hair removal is a highly effective treatment for removal of unwanted pigmented terminal hair follicles.  Currently, there are no lasers that permanently remove unwanted gray, blonde, or red hair follicles.  The patient satisfaction is high; the treatment is safe with low risk of side effects, which can be minimized with appropriate laser and candidate selection. 

Frontal Fibrosing Alopecia

Frontal Fibrosing Alopecia

Eyelash Enhancement

Download latisse.pdf

 

Traction Alopecia

Traction alopecia occurs due to excessive tension on hair follicles, which cause the hair follicles to break, and if sustained, tension permanent loss of hair.  Traction hair loss most often occurs over the frontal temporal scalp of women, although men that braid their hair, wear extensions, or wear a tight pony tail, can suffer from traction alopecia as well.  Common contributing factors include excessive heat applied to hair follicles, excessive chemicals, and tension through extensions and hair styling.

 

If caught early, traction alopecia is often reversible by reducing the amount of heat, chemical, or tension to the follicles.  In addition, anti-inflammatory injections into the skin over several months can often restore the growth of hair follicles.

 

For patients that have long term loss or who do not respond to any medical therapy, hair transplantation can be a highly effective treatment option.  Transplantation, by removing hair from the back of the patients scalp into the areas of thinning of the frontal temporal scalp, can help restore natural frame around the patient’s face.

 

A typical cosmetic goal of a patient is to be able to wear their hair back in a pony tail without being self-conscious of having a high or recessed hairline.  The typical patient needs two procedures in order to help recreate a natural hairline through transplantation. 

Hair Care

In our practice, on a daily basis, we see women with substantial hair loss due to inappropriate hair care over many years.  There are a variety of myths and opinions regarding appropriate hair care.  While there is no definitive data, in this blog I am suggesting certain culprits that are common offenders toward damaging and destroying hair follicles.

 

Excessive heat, i.e. hot combs, tension - either through extensions, braiding, or wearing the hair in a tight bun, and harsh chemicals such as relaxants and Japanese hair straightening can, over time, cause damage and permanent hair loss.  Our office recommends women who do lose hair to any of the conditions above to make their hair stylist aware of their hair loss and to work as a partner to help minimize future loss. As with many things in life, striking a balance of how we like to wear our hair and present ourselves to the world, and what is possible without damaging the hair, is something that varies from individual to individual.

 

Women that do suffer from hair loss due to chemicals or traction can often successfully be treated in earlier stages of hair loss with a series of intralesional kenalog injections and topical steroids.  A combination of medical therapy and appropriate hair care often results in stabilization of hair loss and, in many cases, re-growth of lost hair.  For patients that do not see re-growth of hair after twelve to eighteen months of treatment, hair transplantation offers a safe alternative to help restore lost hair.