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Hair Loss

Hair Loss

October 13, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • Sherrie Bullard, MD – Dermatologist

The average adult head has about 100,000 to 150,000 hairs and loses up to 100 of them a day. Hair loss can start with finding a few strands in your hairbrush and can lead to a bald scalp. Excessive hair loss can be a result of genetics, medications, or underlying medical conditions.

Cleveland_Clinic_Host: Today's Live Web Chat, "Hair Loss" with Sherrie Bullard, MD will begin at 12:00 p.m. (EST). Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Hair Loss" with Sherrie Bullard, M.D. We are thrilled to have her here today for this chat. Let’s begin with the questions.

SFriedman: I first saw a doctor for hair loss several years ago. He gave me protopic cream. This did not help. He then gave me 6 or 7 injections into the scalp. This did not help. Dr. then suggested I see other Dr. He prescribed Lovenox 0.3 Ml. which I did not inject as I was told by my doctors not to. He also prescribed Clobetasol which I did use I then saw Dr. he prescribed Viviscal and Biotin 2.5. I had previously seen Dr and she suggested Biotin 5000MCG. over counter. I see that this is equal to 5 mg. I have been taking both Biotins. What is the difference? I was then referred to Dr. Marta Rendon, Dr. Rendon suggested taking the Lovenox and starting Plaquenil Therapy. I am not doing that at this time. I was then sent to Dr. M. Ross (Arthritis and Rheumatology) to rule out Lupus. After several biopsies and blood tests this was ruled out. Please if you can be of help to me, I would truly appreciate your input. Thanking you in advance.

Sherrie_Bullard_MD: I would very much like to have you come in and evaluate your scalp myself and go over your history. Please schedule an appointment and bring in all of your records.

JanieGee: Does Psoriasis of the Scalp cause hair loss?.

Sherrie_Bullard_MD: Yes it can.

Jazz: Having a lot of hair loss the pass week and being put to sleep for a procedure cause this to happen?

Sherrie_Bullard_MD: Yes, undergoing general anesthesia can cause hair loss. This would be considered a condition called Telogen Effluvium. This hair loss is temporary.

Granny: I am 85 years old and I am losing my hair. I take 8 different prescriptions, and feel that they may be the cause. They are: Spiriva, Ranitidine, Atenolol, Hydrochlorothiazide, Levothyroxine, Plavix, Crestor, and Clonazepam. I have been told that Biotin might help the problem, but I understand there are different kinds. Please give me your opinion. Thank you!

Sherrie_Bullard_MD: Hair loss is ongoing from birth. There is hair loss that is hereditary and due to medications and aging. You may have one or a combination of these. Biotin promotes healthy hair growth in general, but may not address these other issues. Just take the recommended daily allowance. Brand may not matter.

Mbur7: What are the adverse reactions to use comb laser?

Sherrie_Bullard_MD: I am not aware of any adverse effects. It is a light therapy and exposing the scalp to the light for an inordinate amount of time can potentially cause a burn. Be careful and follow directions for use.

Cleveland_Clinic_Host: If you would like to view the entire transcript of this chat after the event, it will be available at clevelandclinic.org/webchat. If you have logged in during the middle of this chat and want to view what has already been discussed, click on the transcript button on this page.

Karyn: Any new treatments in Alopecia?

Sherrie_Bullard_MD: There are treatments undergoing investigation, but nothing immediately on the horizon.

JanieGee: Does taking Synthroid for hypothyroid affect hair loss? Can this be corrected?

Sherrie_Bullard_MD: Some people experience hair loss while taking Synthroid. It is hard to say if it is the actual medication or the hypothyroidism leading to the hair loss.

Mjohnson: I had a hair transplant procedure 7 years ago. The scar on the back of my head is raised, feels like a bump that runs from one side of my head to the other. What can be done to reduce the hump or make the scar less noticeable? Thank you.

Sherrie_Bullard_MD: You can have intralesional injections of Kenalog, a medical steroid.

Carie: Can anything be done to reverse hair thinning in an otherwise healthy postmenopausal woman?

Sherrie_Bullard_MD: Again, the actual cause of the hair loss must be determined. It is reasons finasteride can be given to post menopausal women. It is not FDA approved for women, but many dermatologists use it. Side effects of loss of libido are reversible when the medication is stopped. Also, Rogaine 5% for hereditary hair loss. Heredity tends to be the main cause of hair loss in this age group. However, some women at this age also experience nutritional issues that contribute to hair loss and taking the right supplement can help this.

Tlg43: I had a single bypass and a maze procedure for heart problems. I am now OK. Would this cause a thinning of hair and some loss? I take Coreg, Crestor, and Coumadin.

Sherrie_Bullard_MD: Some people taking Coumadin experience hair loss. Also the stress of the procedure most likely caused some thinning.

Sunsetorange: I feel I am loosing hair at maybe more than a normal rate. Are there any OTC drugs, vitamins, special dietary additions that would help this problem? Are there any other things you can add?

Sherrie_Bullard_MD: You should see your Dermatologist for a full evaluation of your scalp and nutritional analysis, then follow their recommendations. In general, Biotin, Zinc, iron (if needed), the B vitamins in general, and adequate protein are important.

Jojota: I take Biotin regularly for my hair loss and to strengthen my nail. I don't see much difference. Does it really work?

Sherrie_Bullard_MD: There may be other issues that may need to be addressed. I suggest an evaluation of your scalp and blood work.

Cleveland_Clinic_Host: We are receiving many great questions so far! We will answer as many as possible during this chat. To answer a few of you in regards to technical questions: There is not a call in number, all questions possible are answered through this on line chat room. If you have logged in during the middle of this chat and want to view what has already been discussed, click on the transcript button on this page. I apologize for those of you who have not had your questions answered. We have received a large number of questions and will answer as many as we can. Thank you for your patience.

JoyD: I am using Minoxidil and am wondering how long before I should see improvement?

Sherrie_Bullard_MD: If the cause of your hair loss is due to heredity it will stop hair loss. If there is going to be any hair regrowth, it can take months to years.

Verushka: Is 5,000 mcg of Biotin any good to avoid further hair loss? How about the over the counter Hair, Nails, Skin vitamins? What else is there to stop hair loss and make hair grow back?

Sherrie_Bullard_MD: I would only take the recommended daily allowance. Biotin promotes healthy hair growth, but will not make hair grow in situations of hereditary hair growth, scarring causes of hair loss, etc.

JoyD: Does the HairMax LaserComb (at home treatment) or the laser treatment at a hair loss club offer any improvement? How can I judge my progress?

Sherrie_Bullard_MD: In order to know if this is an appropriate treatment for you, you should obtain an evaluation. If is not appropriate, it will never work.

Syrsam: What is the best current treatment for alopecia? I have heard Spectral DNC is better than Rogaine, any opinion?

Sherrie_Bullard_MD: I am in general not familiar with this product. It contains 4.5% Minoxidil. The delivery system of nanosomes may help it penetrate better and there are additional ingredients, but I cannot comment on whether it is better than Rogaine. That would take a study.

Jojota: Would the Brazilian Keratin treatment damage your hair eventually?

Sherrie_Bullard_MD: As I understand it, Brazilian keratin treatment contains Lye. I am not certain if this is true. However, a documentary that I watched on television stated this. Lye is damaging to the hair. It changes the hair structure and makes it more fragile and vulnerable to damage.

Contren: Does Biotin help restore hair loss?

Sherrie_Bullard_MD: Biotin is not a miracle drug for hair loss. It helps promote healthy hair growth. However, if there are other reasons for hair loss such as damage to the scalp, heredity, ongoing stress, medications, this will not restore lost hair.

Syrsam:I s saw palmetto effective in any way?

Sherrie_Bullard_MD: Difficult to say. It is an herbal supplement and these are not extensively studied. It is supposed to lower DHT and is an anti-androgen. It is reasonable to try this if not contraindicated and sanctioned by your primary care physician.

Karyn: Besides stress, can low iron exacerbate alopecia or any other common environmental issues?

Sherrie_Bullard_MD: Stress, low iron, medications can all contribute to hair loss.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Verushka: Is Hair Nails Skin supplement any good for hair loss?

Sherrie_Bullard_MD: This contains B vitamins and can help promote healthy hair growth.

Spunky: Is there a good hair transplant method for women to fill in thinning hair?

Sherrie_Bullard_MD: Yes. Hair transplants can be successful on the right candidate.

JoyD: I have been to two dermatologists, an endocrinologist and a cardiologist and an internist and not one of them can definitively say that my hair loss at post menopausal is hereditary, but all are inclined to think it is. Is there a specialist that does more than run her fingers through my hair and ask 2 or 3 questions about my symptoms? I do not feel that is adequate and would like to know how you would handle the appointment.

Sherrie_Bullard_MD: Yes. This can be frustrating. A scalp biopsy can be performed. I find this helpful in diagnosing hair loss.

Spunky: What specifically are you looking at in the blood work?

Sherrie_Bullard_MD: We are looking for hormonal abnormalities, low ferritin or iron and thyroid abnormalities.

Mbur7: The cheapest comb lasers are effective than the expensive hairmax comb laser?

Sherrie_Bullard_MD: It is difficult to given an answer on this. I would say as long as the wavelength of light is the same, there should not be a difference.

Spunky: Is Spironolactone effective in a patient with PCOS?

Sherrie_Bullard_MD: This can be helpful. Not only for stopping hair loss, but also for stopping excessive hair growth. Hair regrowth may or may not occur.

Syrsam: I have read that Nizoral shampoo, even the otc version, help block something that causes hair cycle to shorten.

Sherrie_Bullard_MD: That is not true. It is an antifungal that temporarily reduces yeast overgrowth in the scalp.

Mbur7: Do you offered in your clinic hair transplants and what is the average price?

Sherrie_Bullard_MD: We do not offer hair transplant in our office.

Cleveland_Clinic_Host: We apologize for this short time lapse. The doctor was called away for a brief moment. We will stay on line for a past 1pm to answer a few more questions.

Jojota: I heard Vervain leaves mixed with teal oil helps grow hair. True or false?

Sherrie_Bullard_MD: This is an herbal supplement and again, these are untested and unregulated by the FDA. I am not aware of any testing that has been done. Claims may be anecdotal.

Spunky: My Physician prescribed Spironolactone 50 mg once daily to help with Alopecia and told me I could take Propecia off label. I am 52 yrs old and have lost approximately 30% of my hair. I had a history of polycystic ovaries in my twenties. I take Zoloft 50 mg and Klonopin .5 mg. Do you recommend Spironolactone, what dose and for how long? Also, do you recommend Propecia? Is Nioxin shampoo helpful?

Sherrie_Bullard_MD: Yes, Spironolactone is reasonable if you in this situation. The Zoloft and Klonopin should not significantly affect the hair. Have you had a scalp biopsy and a diagnosis made of Androgenetic Alopecia. If so, you will lose a percentage of your hair that will not return. You may be a candidate for hair transplantation to fill out thinned areas. The Spironolactone and Propecia are to prevent further hair loss. You may not get much hair regrowth with them.

Karyn: Is there any difference in hair loss causes related to where on the body you loose hair. Is it mostly all the same cause or one cause may effect one area and a different area be caused by something else?

Sherrie_Bullard_MD: Yes. Hair loss in different areas of the body may be due to different causes. This may have a different cause.

Verushka: My mother suffered from thinning hair. I am starting to see thinning in the front, above my forehead. How can I avoid further thinning of my hair?

Sherrie_Bullard_MD: Depending on your age. You can use Rogaine 2% if you are premenopausal and Rogaine 5% and Propecia if you are postmenopausal.

Cleveland_Clinic_Host: I am sorry to say that our time with Sherrie Bullard, MD is now over. Thank you again, Doctor, for taking the time to answer our questions today about Hair Loss. To make an appointment with any of the specialists in our Dermatology Department, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

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