In these two articles I have been describing the best hair loss treatments that can slow the rate of hair loss, stop the hair loss, and encourage new hair growth. Avoiding ‘miracle-cures’ I have focused on hair loss treatments backed by clinical trials and medical research. In last weeks article I discussed the importance of diagnosing the root cause, Finasteride, Anti-androgen therapy,  Topical formulations such as Minoxidil and Topical steroid cream. There are a number of other treatments that can be effective.

6. Injections into the scalp

Injections of low-dose steroid directly into the scalp can be very effective treatments for alopecia areata and some of the scarring alopecias. The dose, quantity and site of injection are all important in obtaining the best outcome without any side-effects.

7. Immunotherapy

For resistant cases of alopecia areata immunotherapy in the form of DCP therapy can sometimes be used with good results. This treatment involves making a patient allergic to a particular synthetic chemical and then using a weaker concentration of this chemical on the scalp on a weekly basis to try and elicit a mild dermatitis on the scalp. This treatment is time-consuming and fiddly and is offered only in specialist centres.

8. Systemic treatments such as tablets

For some of the scarring alopecias and more severe cases of alopecia areata systemic medications are sometimes required to slow down or arrest the inflammatory process. This may include antimalarial medications for some of the scarring alopecias or immunosuppressive medication for alopecia areata or the scarring alopecias. Very occasionally systemic steroids are indicated for rapid hair loss due to alopecia areata or some of the autoimmune scarring alopecias. 

9. Biologics and other treatments

Recent research with some of the newer biologic agents which are delivered as injections into the body which are now being used for more severe cases of psoriasis have also been tested for some forms of hair loss. Unfortunately to date all the biologic medications have been disappointingly ineffective for alopecia areata. Another treatment sometimes cited in the literature is PUVA or phototherapy, however results of this treatment are slow and sporadic. 

Unfortunately, there is a proportion of the population who do not respond to treatment to hair loss.

Monitoring response to any hair loss treatment is vital and so at my clinic I make use of a medical digital photography system which allows accurate, reproducible photographs to be taken at specified time intervals for comparison.

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Find out more about hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

Hair loss affects a large proportion of the population, including women and children. Our society puts a lot of value on appearance, and a full head of hair is sometimes viewed as an indication of good health, virility and beauty. Losing one’s hair, particularly at an early age, can be a highly distressing and upsetting. There are multiple reasons why people lose their hair, and many conditions which contribute. I won’t discuss the reasons in this week’s article, but instead want to focus on the treatment used to slow the rate of hair loss, stop the hair loss, and encourage new hair growth. Given the highly emotive impact of hair loss, there are many products and so called ‘miracle-cures’ out in the market place. While there are no miracle-cures, clinical trials and medical research have demonstrated that a number of treatments do work for treating some types of hair loss. It is these treatments I will focus on in this article.

1. Eliminating the root cause

Lifestyle factors are over-rated with respect to hair loss, however a poor diet, low iron levels and stress can contribute to some forms of hair loss. With male patterned baldness, however, it has a purely genetic basis, but can be accelerated by the use of exogenous androgens (anabolic steroids).

2. Finasteride

Finasteride is a drug which blocks the conversion of Testosterone into dihydrotestosterone. It is mainly indicated for male patterned baldness where it can either reverse the miniaturisation process, slow it down or arrest it. This has been tested in large clinical studies and shown to be very effective for men. This drug is also used as an unlicenced indication, prescribed only by medical specialists, for female patterned hair loss.

3. Anti-androgen therapy

Anti-androgen therapy has been shown to be effective in women with female patterned hair loss. The drugs used include Spironolactone, Cyproterone Acetate and the oral contraceptive pill Dianette. A retrospective clinical study has shown that 80% of women can respond to this form of treatment, however regrowth is modest.

4. Topical formulations such as Minoxidil

Minoxidil is an effective topical treatment for some different forms of hair loss. It is mainly used for male and female patterned hair loss where it works to stimulate the hair follicles to produce a thicker hair at a faster rate. It also converts more of the resting hair follicles into the growing phase of the hair cycle. Topical Minoxidil is also used for chronic telogen effluvium and has been reported to stimulate hair growth in patients with alopecia areata. The recommended concentrations are the 5% lotions to be applied twice daily for men and the 2% lotion to be applied twice daily for women. In practice most people only manage to apply the solution on a daily basis. A 5% foam formulation is now available in the US but not yet in the United Kingdom.

5. Topical steroid creams

Inflammatory causes of hair loss or hair loss that have an auto-immune basis may respond to the application of a topical steroid lotion. Conditions such as scarring alopecia, lichen planopilaris or discoid lupus may respond to a topical steroid as may some cases of alopecia areata. Topical steroids will not help male or female patterned hair loss.

In the second part of this article, I discuss the value of injections into the scalp, immunotherapy, systemic treatments, and biologics and some of the newer treatments currently being researched.

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Find out more about hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

I advise all my patients to wear sunblock on their face every day as part of their skin care regime, not just to reduce the risk of skin cancer, but as the most effective single action one can take to reduce aging of the skin. There have been reports that sunblock is not necessary in the winter months in the United Kingdom, however the end point for this study was skin cancer risk rather than aging of the skin. When protecting the skin from the sun, we need to be aware of Ultraviolet A (UVA) as well as ultraviolet B (UVB) rays. An article in USA Today on the 29th December 2009 provided some interesting facts about UVA and UVB. According to Dr Perry Robins, president of the Skin Cancer Foundation, “UVB rays diminish in the winter, however UVA rays remain constant. UVA rays are about 30 to 50 times more prevalent than UVB rays”. “Though UVA rays are less likely than UVB rays to cause sunburn, they do contribute to sun cancer”. “The longer wavelength UVA rays penetrate deeper into the skin than shorter wavelength UVB rays”. Dr Robins goes on to say that “the damage causes skin to lose its elasticity, leading to the classic signs of aging: wrinkles, sagging and brown spots”.

In order to protect the skin it is important to look for a sunblock that protects against both UVA and UVB and is of sufficient strength. SPF (sun protection factor) refers to protection from UVB rays and the number correlates to the degree of protection. An SPF of 15, for example, will give one 15 times their natural protection. In Europe a star system is used to grade UVA protection with 5 stars being the highest protection. I never recommend below an SPF15, but usually suggest SPF30 or above for general daily use. There is diminishing return as the SPF factor increases, in that the difference between SPF10 and 15 is greater than the difference between SPF45 and 50. Some countries cap the level of SPF that can be advertised to try and prevent people thinking they are “invincible” when using a high factor protection. Australia for example caps it’s advertising at SPF30, however a lot of sunblocks there have a higher SPF value.

Sunblocks have come a long way since the white thick creams of the past, and many are now suitable for everyday use, including gel formulations and lotions with a tint that can be worn under make-up. Ensure your chosen sunblock has a UVA filter.

Winter brings with it the opportunity for snow sports such as skiing and snowboarding. The factors of altitude and snow cover, increase the degree of exposure to the sun. As one is at a higher altitude less of the Earths atmosphere has absorbed the sun’s rays before it reaches your skin. In addition, the snow cover provides an excellent reflective surface for the sun’s rays. Even the presence of cloud cover doesn’t remove the risk from the sun and the exhilarating feeling of cool wind on the face can often mask the fact that one is being sunburnt.

For those on the snow then, it is very important to apply a very high factor sunblock to all exposed skin, including under the nose and the ears. Don’t forget area’s like the back of the neck, or exposed wrists as well. As skiing and snowboarding can be strenous and cause perspiration, make sure you reapply sunblock regularly. A tube of sunblock should be one of the essential pieces of kit you take out during a day of skiing.

Also pay special attention to your lips which are exposed to the elements and can be at risk of sun damage. Many lip balms do not have a satisfactory level of sun protection in them. Once again, choose a product that has a minimum SPF of 30 if you are on the snow and reapply regularly.

If you do get sunburnt, then aloe vera is a very good soothing gel to apply in order to reduce inflammation. Ensure that the product you use does not contain alcohol and is as close to 100% pure as possible. Aloe vera will not treat sun damage or skin cancer though.

If you are enjoying the snow this winter, I hope you have a fun safe time. Just don’t forget the sunblock.

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Find out more about skin cancer and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

In the middle of winter, when the days are short, grey and cold, not many of us are thinking about the sun. However now may be a good time to get your skin checked for any unusual moles or lesions that are changing shape, size or colour (skin cancer screening). With the advent of budget airlines more and more of us are travelling abroad, and have swapped the British Riviera for hotter climates such as Spain. Unfortunately the Brits have not grown up with sun-sense education and awareness, and as a result many individuals are getting excessive sun exposure. Separately, the popularity of tanning has resulted in a high use of sun-beds in this country, which also puts the skin at risk of skin cancer.

Exposure to the sun over time causes damage to the skin, resulting in premature ageing of the skin and increasing the risk of melanoma, sunspots and other forms of skin cancer. It is a myth that one needs to have experienced sunburn in order to develop a melanoma or skin cancer.

The medical terms for skin cancer include non-melanoma skin cancer (NMSC), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma and actinic keratoses. Common terms include skin cancer, rodent ulcer, sunspots, brown spots, freckles, melanoma and age spots.

NMSC presents as either a skin coloured lump, a scaling lesion, an erosion that will not heal or an ulcerated lesion.  Any such lesion requires immediate assessment by a medical practitioner.  Dermatologists are specifically trained to diagnose such lesions by looking at them and if there is any doubt by performing a biopsy.

Prevention is the best cure.  Dermatologists are qualified to detect the clinical signs of moles which may have developed into a melanoma or look suspicious. At present there is no system better than the expertly trained human eye at clinically diagnosing melanoma.

A medical photographic service can be used to photograph moles as a baseline to allow comparison in the future if you think one of your moles has changed.

Once your skin has been assessed, our Dermatologist will then tell you of the most appropriate skin surveillance follow-up programme tailored to your skin type and clinical risk.  Sun protection and avoidance advice will be given as well as discussing the role of sunblocks.

Treatment options available may include the use of special creams to kill the cancer cells, scraping the lesion away to the appropriate depth, cutting the lesion out, freezing the lesion with liquid nitrogen, or photodynamic therapy or occasionally radiotherapy.  The choice of treatment will depend on the tumour type and the personal preference of the patient.

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Find out more about skin cancer and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

A recent article in The Telegraph “The bald facts about female hair loss” (14th December 2009) outlined the writer’s experience in suffering from alopecia areata from the age of 19. Unfortunately the author had not had a good experience with her GP who had told her there was no treatment and that her condition was trivial. Most of the patients that see me for treatment for alopecia areata certainly would not agree that this condition is trivial at all. Hair loss, particularly at a young age, can be highly traumatic and emotional.

In this week’s post I wanted to describe just what alopecia areata is, the signs and symptoms, and the treatments that are available.

Alopecia areata affects 1% of the population at any time in their lives and usually presents as patchy hair loss, although this condition sometimes can be diffuse (which makes it more difficult to diagnose) or can result in dramatic total hair loss. Hair loss can occur from the head or the body, wherever hair is present. Alopecia areata actually affects men and women in equal numbers.

When most people say alopecia they are referring to alopecia areata by default, as the word alopecia really only means hair loss.  There are many other causes of hair loss (including androgenetic alopecia and scarring alopecia) and so an accurate diagnosis is vital to allow the best treatment to be selected targeted at the specific condition.

The natural history of alopecia areata can be unpredictable, but tends to be a chronic and relapsing one.  Some people are lucky though, and only ever have one or two patches or episodes of hair loss with this condition.

Alopecia areata is an auto-immune condition where the body’s own immune system is attacking the hair follicles.  The reason for this is not known but it is thought that there is a slight error in the immune system which perceives the affected follicles as abnormal.  This does not mean that the rest of the immune system is faulty or under-performing.  The good news is the hair follicles have not been destroyed and can re-grow a normal hair at some stage in the future.

Often the patients I have seen feel that they have not been taken seriously by their general practitioners and this is a reflection of how difficult an area of medicine this is as well as the fact that many dermatological conditions are often thought trivial as they are not life threatening.

Treatments include topical formulations, injections to the scalp, topical immunotherapy in the form of DCP and sometimes systemic immunosuppressive medications. Unfortunately there is a proportion of the population who do not respond to treatment.

Many people do not realise that a Dermatologist is a qualified medical practitioner (Doctor) who is trained to deal with all hair, skin and nail conditions. A few Dermatologists (like me) have a special interest in hair loss and hair conditions.

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Find out more about female alopecia areata, hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

The cause of female pattern hair loss

A process of miniaturisation occurs in women to cause female pattern hair loss. That is, each time the hair follicle goes through the hair cycle it becomes smaller and smaller and thus produces a smaller hair shaft. Eventually the hair shaft is so small that it does not protrude above the level of the skin in the scalp.

Women begin to lose their hair by going diffusely thin on the vertex (the top of the scalp). Sometimes temporal recession is also seen (loss of hair at the corners of the frontal hair line).

There are a few hair conditions that can result in generalised thinning of hair on the top of the scalp. It is therefore very important that the correct diagnosis is made before embarking on treatment for hair loss in women.

 Treatment for female pattern hair loss and androgenetic alopecia

Women with this trait develop thinning hair but do not usually become completely bald. There is now good treatment for female pattern hair loss which is aimed at reversing the process and promoting regrowth. In peer reviewed studies, 88% of women with this form of hair loss attained a positive outcome with treatment.

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Find out more about female hair loss, female pattern hair loss, androgenetic alopecia, hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

Male pattern baldness

We describe the cause of male pattern baldness as androgenetic alopeica. Actually, what is happening is a process of hair thinning or miniaturisation. The reason a man’s hair gets thin when he suffers from androgenetic alopecia is due to the process of miniaturisation. Each time selected hair follicles go through the hair cycle they become smaller and smaller and thus produces a smaller hair shaft. Eventually the hair shaft is so small that it does not protrude above the level of the skin of the scalp.

Men lose their hair or go bald in a very predictable pattern. Hair on the vertex (top of the head) begins to thin and there may be bilateral temporal recession (loss of hair at the corners of the frontal hair line). This gradually progresses with the hair in this region becoming thinner and thinner and in some people will eventually lead to complete baldness on the top of the scalp. The end-stage is hair like the stereotyped monk’s hair style. This is because the hairs at the back of the scalp are genetically preserved from this process of miniaturization.

Fortunately, there is treatment available today (including finasteride and topical minoxidil) which can either arrest or reverse the process of miniaturisation. This means the process of male pattern hair loss in most cases is stopped and in many patients (but not all patients) regrowth of hair can be achieved. A Dermatologist can advise the appropriate strength of treatment.  If minoxidil is appropriate for treatment, an over the counter preparation such as Regaine(R) (which is labelled Rogaine(R) in the United States) is appropriate at the strength recommended by your Dermatologist. (Please note I have no financial interest in these products or in recommending them). Many hair treatment businesses or Trichologists (not necessarily trained health professionals) may try to market hair regrowth products which may be essentially minoxidil sold at a much higher price. I would always recommend asking to see the clinic evidence or research behind such a product if it is offered to you. For example, research has now shown that a 12% preparation is not any more effective than a 5% preparation.

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Find out more about skin cancer, acne, hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

I was asked to provide some input into the article, as a Hair Specialist at The London Skin and Hair Clinic.

The reality is that Top football bosses are no more or less likely to go grey than any other male in their age group. The age at which men start to go grey, and the rate of going grey is genetically determined. Football Managers are typically at the age when men start to go grey. The average age of white hair developing on the scalp is 34, and at age 50, 50% of the population have 50% grey hairs on their scalp.

‘Going grey overnight’ is very rare and is due to diffuse alopecia areata, which causes the loss of pigmented hair and the retention of grey hair, giving the impression of sudden greying. Stress is one of the causes (but not the only cause) and the best treatment is to remove the cause of the stress. It may be that football fans experience similar levels of stress to Football Managers. There can be re-growth of the pigmented hair once the stress is removed if the cause, however the grey hairs will stay grey.

The only known treatment for dealing with grey hair is to dye one’s hair.

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Find out more about skin cancer, acne, hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.

1. hair loss, hair disorders and scalp conditions,
2. Skin cancer and melanoma, and
3. Acne

While the majority of my articles are likely to focus on these areas, I’ll also comment on general dermatology and skin and hair conditions, symptoms and signs, and treatment.

I hope to use this forum as a way to educate, raise awareness, and stimulate debate and discussion in these areas. If there are particular areas you would like me to write on, please feel free to email me at doctor@LSAH.co.uk.

Regards,

Dr Martin Wade

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Dr Martin Wade is a Consultant Dermatologist with the NHS and has a private clinic at The London Skin and Hair Clinic.  He consults on all General Dermatology and specialises in hair loss, hair disorders and scalp conditions. Dr Martin Wade is experienced in treating skin cancer and melanoma through his Dermatological experience in Australia which included working at one of the major melanoma units.

Find out more about skin cancer, acne, hair loss and general dermatology by visiting the websites of Dr Martin Wade and The London Skin and Hair Clinic.

This information is provided for educational purposes only and is not intended to be used for self-diagnosis and treatment. An accurate diagnosis can only be determined through a face to face consultation with a qualified Dermatologist.