Hair Loss

Question 1

How many hair follicles do we have?

Answer 1

~125,000

Question 2

How much hair do we lose per day?

Answer 2

40-100 hairs on non-shampoo day
200-300 hairs on shampoo day

Question 3

True or false: the greatest genetic influence of hair loss comes from the paternal side

Answer 3

false
the maternal side

Question 4

What are some situations that involve hair loss?

Answer 4

tinea capitis
anorexia
sever acute illnesses
alopecia areata
cancer chemo/radiation

Question 5

What is alopecia areata?

Answer 5

autoimmune disorder that causes hair loss

Question 6

Is there a preventative measure to hair loss from chemo?

Answer 6

no
often the key decision point for patients

Question 7

When does chemo-induced hair loss start to show up?

Answer 7

1-3 weeks after first round

Question 8

What are the many reasons for hair loss in women?

Answer 8

female-pattern baldness
menopause
stress
pregnancy

Question 9

What is the hormonal impact on hair loss in women?

Answer 9

post-partum hair loss starts 1-3 months after delivery
hormones for menopause can aggravate hair loss
birth control pills (starting or stopping) can be a factor

Question 10

What is the most common form of hair loss in women?

Answer 10

female-pattern baldness
-1/6 women
-vertex
-thinning is more gradual/subtle

Question 11

What is androgenic alopecias?

Answer 11

male-pattern baldness
-most common form in men
-1/3 men

Question 12

What is the etiology for androgenic alopecias?

Answer 12

DHT has a negative impact on hair
(remember testosterone is converted to DHT by a-reductase)
DHT is converted to estrogenic compounds by aromatase
-women have more aromatase, estrogenic compounds
nullifies DHT

Question 13

What is the main treatment for hair loss?

Answer 13

Rogaine (minoxidil)

Question 14

When is minoxidil used in men?

Answer 14

AGA only
best if hair growth needed on crown
-new hairs are bably-like
best in patients <40
best if starting with small area

Question 15

What are some things to make patients aware of with minoxidil?

Answer 15

need to use it for a minimum of 2-4 months
needs continuous application
discontinuation results in new hair lost within 3 months
stop trying after 8-12 months if no results are seen

Question 16

What are the side effects of minoxidil?

Answer 16

almost none, generally well tolerated
maybe some scalp irritation
small chance of cardiovascular effects

Question 17

True or false: a patient with psoriasis can use minoxidil

Answer 17

false
must have a healthy scalp

Question 18

How do you use minoxidil solution?

Answer 18

apply 1ml BID to dry scalp
-pump spray: 6 sprays=1ml
-1ml dropper
needs 4hrs of contact, dont shower

Question 19

What is something that you must make patients aware of with minoxidil?

Answer 19

increase in hair loss during the first 2-6 weeks

Question 20

What is the mechanism of action of finasteride?

Answer 20

type II alpha reductase inhibitor
-prevents conversion of testosterone to DHT
-DHT has harmful impact on hair

Question 21

In which group is finasteride contraindicated in?

Answer 21

pregnant women
-has been tried in women if minoxidil fails, contraception is a
must

Question 22

Which strength of finasteride is used for androgenic alopecia in men?

Answer 22

1mg (Propecia)
5mg is for BPH (Proscar)

Question 23

Describe the effectiveness of finasteride in hair loss.

Answer 23

growth mainly seen on crown
growth occurs within 3 months
requires continuous use
can slow loss

Question 24

What are the side effects of finasteride?

Answer 24

decreased libido (2-3% of men)

Question 25

What is hirustism?

Answer 25

excessive terminal hair in a male-pattern distribution in women
potential sign of PCOS

Question 26

What is the difference between mens and womens Rogaine?

Answer 26

they are the same product, just different dosing
-men are BID
-women are OD

Question 27

What are the forms of Rogaine for men?

Answer 27

2% solution or 5% foam
-5% is likely better than 2%

Question 28

What are the forms of Rogaine available for women?

Answer 28

5% foam
-1/2 capful OD