Hair Restoration Blog

Hair transplant surgery with follicular unit transplantation is the gold standard for the treatment of male patterned baldness for most men. There are several conditions a hair transplant surgeon should take into extra consideration before performing a hair transplant surgery. Most of those conditions are skin related problems that may lead to the loss of hair after hair transplant surgery like alopecia areata (AA) or cicatricial alopeica.  The patients may experience poor hair growth after hair transplant surgery or they may not grow hair at all.  Some systemic diseases may also hinder the full growth of the grafts such as thyroid diseases.

Diabetes is definitely not a contraindication for hair transplant surgery, however, like any other surgery it may delay the healing of the surgical wound.  Wound healing problems are not only limited to hair restoration surgery, but could be seen in any other skin procedure especially if diabetes is not quite controlled.  We perform hair transplant on patients with diabetes who have normal levels of glucose.  We at US Hair Restoration specifically emphasize on the close monitoring of blood glucose before, during and a few days after hair transplant surgery.

Although the rate of wound complications in diabetic patients always stays or seems higher than an average individual, monitoring and close controlling the diabetes around the time of surgery is critical to significantly reduce the rate of wound complications of a hair transplant surgery in diabetic patients.

Q:

Dear Sir,

I’m 36 years old and having many close round patches about the size of coin (Doctors called it Alopecia Areata) in my head and full body since last 5 years which is increasing slowly. I’m getting medical treatment which is included MINOXIDIL GEL 2%.

One year ago, one doctor injected 1 KANACART OR CANAKART injection/month for 5 times but not any positive result.  Now since last 10 months, I’m using MINOXIDIL GEL 2%, still there is no result. I visited few clinics in UAE.
I’m seriously depress now a days.
Can you advise me!!! what I’ve to do!

Thanks & regards

A:

Although Alopecia Areata (AA) is generally a self limiting condition, in many patients hair loss patches may last for a long time and warrant some types of treatments.  There are several recommended methods for the treatment of alopecia areata such as minoxidil and steroid injections into the hair loss patches.  However, there is no single treatment that can improve the lesions on all patients.  It seems like you have been treated with a variety of medical options in the past without a good result.

The diagnosis of alopecia areata is clinical in most cases, however, in some instances that the lesions do not look typical for AA or the recovery is not complete in a reasonable period of time, the skin lesions or hair loss patches need to be biopsied to confirm the diagnosis of alopecia areata.  You need to be evaluated by a good dermatologist to rule out other conditions that might be presented in a similar fashion.

Dear Dr. Mohebi,

I am 21 years old and I have the beginnings of a small bald spot on the back of my head - one of my friends first noticed the spot about a year ago. My hair is thick and curly and I did not expect to have hair loss this soon, especially because I don’t really have a family history of hair loss (except for my paternal grandfather). My hair type is very similar to my mother’s family, and in her family most people keep their hair into their 80s, though it becomes very white. I currently live in Watertown, NY.

I have had widespread eczema since I was little, and when I was younger they classified it has icthyosis. At one point, when I was about 5, I suffered pretty bad eczema on my scalp and started losing some hair. I used prescription shampoos for a while and that seemed to take care of it. The only other medication I take on a regular basis is Zyrtec. I work in a very high stress field, and sometimes work 16 hour days - could that have contributed?

Do you have any suggestions as to what I can do to control my hair loss?

Thanks!

A:

Bald spots or patchy hair loss on scalp can have many different causes.  The most common cause of patchy hair loss is known as alopecia areata (AA).  We’ve discussed and described this issue on our site and in this blog on many posts before.  If AA is causing patchy hair loss, hair transplant will not be the answer.

You need to find and maintain a good relationship with a good dermatologist who can make your diagnosis and start a treatment plan for your hair loss condition.  You may also need a skin biopsy to confirm your hair loss condition.  Many of the diseases that present themselves with patchy hair loss are chronic conditions and require consistency in treatment.  Some inflammatory skin conditions may also be seen along with scalp hair loss.

Ichthyosis is a family of generalized and mostly genetic skin disorders.  All types of ichthyosis have dry, thickened, scaly or flaky skin. Ichthyosis has been reported along with patchy hair loss condition.  That combination is known as The tay syndrome (congenital ichthyosis with trichothiodystrophy).

Single balding spot of alopecia areata

Alopecia areata (AA) is an autoimmune hair loss condition that presents itself in the form of patchy hair loss in scalp and other hair bearing areas.  The role of emotional stress in alopecia areata has been discussed before in medical literature, however, the exact mechanism of it has never been explored.  I just found a new article on the relationship of the stress response to the pathogenesis of alopecia areata that was investigated by subjecting normal and skin graft-induced AA-affected mice to light ether anesthesia or stress due to restraining the animal.

Plasma corticosterone, adrenocorticotropic hormone, and estradiol levels were determined in this study as indicator or stress level, whereas gene expression in brains, lymphoid organs, and skin was measured by quantitative RT-PCR for corticotropin-releasing hormone, arginine vasopressin, proopiomelanocortin, glucocorticoid receptor, mineralocorticoid receptor, corticotropin-releasing hormone receptor types 1 and 2, interleukin-12, tumor necrosis factor-alpha, and estrogen receptors type-1 and type-2. The mice with alopecia areata had a marked increase in hypothalamic-pituitary-adrenal tone and activity centrally and peripherally in the skin and lymph nodes.

There was also altered interaction between the adrenal and gonadal axis compared with that in normal mice which proved that the stress level has been higher in those animals. Stress further exacerbated changes in the activity of hypothalamus pituitary axis in mice with alopecia areata.

Alopecia areata animals had significantly blunted corticosteroid and ACTH responses to acute ether stress (physiological stressor) and a deficit in habituation to repeated restraint stress (psychological stressor). All the findings in the study suggests that altered brain responses during stress may be associated with the occurrence of alopecia areata, which prove the hypothesis that the stress is an important factor in occurrence of alopecia areata.

As we said before, treatment of alopecia areata is through observation of the patient and in some cases injections of steroid could be useful.  More experimental studies have shown some improvements in extensive types of alopecia areata such as alopecia totalis.  Hair transplant should not be done in patients with active alopecia areata since patients may lose transplanted hair through the same mechanism.

I am a 26 year old female and felt like the world was mine, and then this happened and now I would rather hide, so I understand about feeling like a freak. But I think we all have to remember that we have nothing to be ashamed of This disease is more widespread than we think and people are more understanding than we give them credit for. We can all still live long and happy, if a little self consciously. Since getting AU, I have heard of so many people who have friends or family with this disease - there are a lot of us, and we are still lovable, attractive, successful and admired. We may look different but if we can overcome the self-imposed stigma of it, I think it will just serve to make us stronger.

Speaking as a woman, let’s give our daughters, sisters and mothers a good example for self-respect, and show them how to be fearless, how to overcome obstacles and show them that women are more than long shiny hair and a media approved image.

I know I am young and have not yet suffered with this disease as long as any of you, so it is likely easier for me to say these things. I just hope to remain this optimistic and not let it get the better of me. We are all more than our hair. And if being bald and shapely or hairy and fat is the choice, I choose to keep my body healthy on the inside instead of just looking it on the outside.

Thanks to all of you, I wish you all the best and just remember, you are more than your hair and do not accept feeling like a freak! Remember the people that love you when you are at home and hairless for all to see, what they see in you is what you truly are, not the you that has to wear a wig so people don’t stare or the one who has come to hate the wind.

A:

I like your attitude.  Treatment of Alopecia Universalis (AU) could be difficult or impossible in some cases.  You have to come to my office and talk to some of my patients who think the world has come to an end because they are losing their hair.

This is what I always say to my patients: It is important to try to look your best.  If you have the option to change your appearance for the better, do it as much as possible, but for the part that you cannot change, accept it.  Learn to use it to your advantage and learn to love it.

Q:

Dear Dr. Mohebi,

Hello, I am really interested in doing hair transplant by you, as my friends in California highly recommended you. I wonder if you can please help me with this questions:

1. Which method would you recommend, FUT or FIT?
2. I have had Alopecia areata in the past in back part of my head. It happened several times, last time 3 years ago. I wonder how it will affect my chance for doing hair transplant. I really appreciate if you can please answer me in details.

Thank you so much for your attention and time.

Sincerely,
S T

A:

Thanks for you interest in our hair restoration services.  I will answer your questions in the order they were received:

1. Follicular Unit Transplantation (FUT) is the gold standard method in doing hair restoration. FUT is done in two methods 1. strip technique and 2. Follicular unit extraction (FUE, also called FIT).  It has to do with your goals in hair restoration and you can read more about advantages and disadvantages of FUE in my hair restoration blog.  Planning on doing one vs. the other needs to be discussed with the patient during the initial consultation.
2. Alopecia areata (AA) is an autoimmune disorder and usually a reversible condition in which a patient loses hair in a patchy fashion.  It affects transplanted hair the same as normal hair.  I generally make sure that patients don’t have active AA before proceeding with hair transplant.  A physical examination is extremely important in differentiating between male patterned baldness and diffuse alopecia areata (a rare type of alopecia areata).  In undiagnosed cases of alopecia areata, if a patient gets a transplant in the balding area that hair is lost due to AA, there is a risk that patient will lose the transplanted hair with the same mechanism.

Dear doctor,

I am a 38 old married woman from Bangalore. I have 2 children (13 years daughter and 9 years son) . I was having alopecia areata problem since I was 10 years old. But I used to get hair back in a year. Like this, hair was falling and getting back was happened 3-4 times. But hair was very lengthy and very beautiful when I got married. After that during second pregnancy I started loosing hair.

After delivery I lost all my hair and became bald including eyebrows, eyelashes and body hair.I was very lean. I took Allopathy medicines in kurnool(AP) like steroids. I got my hair back and became fat. I stopped the medicines gradually as per doctor’s advice. I lost my hair again after stopping medicines. After that I tried homeopathy(Bathra’s) and ayurvedic. No use by these. After that I have tried intra regional steriods(injections). I can see a few hair,but if I stop medicines, they started falling again.

1 year back I got affected with Chikun Gunya. I met rheumatologist in Bangalore. He again suggested some steroids(wysolone) and Azoran(immunosuppresents) for both severe leg pains and alopecia universalis. I have seen a very good progress and got hair back. But those new hairs are very soft and not strong. He reduced the dose of Wysolone(1/2 of 5 mg) and maintaining the azoran -50mg 3 tabs per day. After reducing wysolone again  I am getting so many bald patches.

I recently met my doctor and he again increased the dose of wysolone to 10 mg. I think this is neverending process. I have almost lost the hope and fed up with all these tests, treatments and side effects and unnecessary spending of money. I was very lean and my weight was 50 kgs at the time of second delivery.

Now I am 85 kgs.I am fighting with this desease  since 10 years. Presently I am using the medicines suggested by rhemotologist.I am having brittling nails and will get headache some times. Every 2 months once I will take blood and urine tests before consulting doctor. The reports are showing more ESR. No other problems for now. I have taken thyroid test and found hypothyroidism. Now taking thyroxin tablets for that.
Family background: My mother is having Diabetes and Thyroid problems.

Please suggest any permanent solution for my problem. Please help me out of this problem…..

Thanks

A:
Alopecia Areata or its more aggressive alopecia universalis, in which patients experience whole body hair loss, is an autoimmune disorder. Autoimmune reaction is an abnormal response from the immune system that attacks certain organs or cell lines and causes malfunction on that system.  In alopecia areata (AA), patients may have involvement of some other body organs such as thyroid disease or other appendages of skin such as nails and hair.

It seems like your alopecia areata was activated by pregnancy and led you to get alopecia universalis. A precipitating factor can be found in 15.1% of patients with alopecia areata and include major life events, febrile illnesses, drugs, pregnancy or trauma but no clear conclusions can be drawn. Despite these findings, most patients with alopecia areata do not report a triggering factor preceding episodes of hair loss.

Your thyroid disease could be part of the same autoimmune disorder that affected your hair and skin.  Eight percent of people with alopecia areata have thyroid disease; this is higher than the incidence of thyroid disease in the general population which is 2%. Despite the correlation between alopecia areata and thyroid disease, treating the thyroid disease does not generally remedy the alopecia areata.

The outcome of alopecia areata is unpredictable. Some people lose hair in only small patches. Others may have more extensive involvement like you. Alopecia capitis or alopecia totalis is the loss of 100% of your scalp hair and alopecia universalis is the loss of 100% of body hair. These last two conditions are rare and more difficult to treat. In the majority of patients with smaller involvements of alopecia areata, the hair will re-grow completely within about 1 year without any treatment.

More serious involvements need to be closely followed by a dermatologist or a rheumatologist. Treatment might not be permanent and complete.  If immunal-suppressive treatments are being used, close monitoring to the treatment and correcting the course of treatment based on the initial response is the key to the following treatments.

Parsa Mohebi, MD

Q:

I have had alopecia areata since I was 3 years of age and now I’m 33. I have done as much research as I can to find the causes of this hair loss and there has not been any accurate information of the cause. But my question would be if you are cloning the hair and a patient has alopecia how successful will the procedure be if the hair growth from the patient is unhealthy in the first place?

This procedure is a billion to trillion dollar industry but the research has to be done extensively due to unknown side effects. Please keep posting more information as you go forward. There are many people waiting impatiently.

A:

Alopecia areata is one of those conditions that hair transplant, either from regular methods or through cloning, cannot help much. We have discussed the treatment options for alopecia areata on our website.  Alopecia areata is an autoimmune condition in which the immune system reacts against the hair follicles and destroys them.

If we were to transplant hair to an area with active hair loss due to alopecia areata, the chance of you losing the transplanted hair is very high due to the same mechanism in which native hair has been lost. We do not have much information on cloned hair, but the same phenomenon is likely to happen after transplanting cloned or multiplied hair.

Q:

I have been diagnosed with a thyroid problem called Hashimoto’s Disease.  I am 23 and I am losing hair on head, and also developing some bald spots on my beard area on the neck and scalp too.  My eyebrow hair is also falling out on the sides.  Doctors said that I have low function of thyroid and put me on thyroid pills.  Now that my thyroid is under control, I would like to know whether or not that my hair ever grows back.

A:

Hypothyroidism or low functioning thyroid can cause scalp and eyebrow hair loss.  However the balding spots that you are experiencing are not typical for hypothyroidism.  The patchy hair loss spots are usually due to a disorder called alopecia areata.  Alopecia areata (AA) is an autoimmune disease that could be seen in association with other autoimmune disorders like Grave’s disease or Hashimoto’s disease.  Thyroid disease is reported in almost 10% of the patients who have alopecia areata.

To confirm the diagnosis and start with a treatment plan, you need to see a dermatologist.  If the diagnosis of alopecia areata is confirmed then you can choose to wait for spontaneous recovery as it is in most of cases of alopecia areata or seek treatment methods that can facilitate the recovery and re-growth your hair.

Q:

I have 2 round spots of hair loss on my neck. I also have ridged fingernails with a history of thyroid disease that is now treated. The hair loss spots are shinny with no hair on them with the size of a quarter. I have read online a lot about alopecia areata, but I also heard that alopecia areata could be just general thinning of the hair. Is there any particular test that I can do to evaluate my condition and to make sure my hair loss condition is alopecia areata and nothing else?

Thank you.

A:

Your description matches alopecia areata (AA), but there are some other and generally rare conditions which can resemble alopecia areata. Hair loss spots caused by alopecia areata may be found in groups or individually. The other signs such as nail pitting and ridging are not universal, but if seen with hair loss patterns typical of alopecia areata can support the diagnosis.

Thyroid disorder can also be part of an autoimmune syndrome- along with alopecia areata. A physician can confirm the diagnosis by checking the appearances of the lesions at the site of the hairloss. No other tests are needed to confirm the diagnosis of alopecia areata.

Alopecia areata usually resolves spontaneously without any treatment. In severe cases, or in alopecia universalis, medical treatment might be needed. However, hair transplant is not the proper treatment for alopecia areata; patients may lose transplanted hair or transplanted hair may never grow.