Відео

Pentoxyfylline has not been well studied. i would guess it might be better than useless, yes, but I don’t see it as revolutionary. That said, that’s my opinion in the face of poor evidence. As far as question 2, yes, dutasteride is the most effective treatment for FFA. Nothing is more effective. as far as LPP goes, it has less benefit (except in clear cut cases of FAPD).

You'll find this helpful. AGA has largely lymphocytic inflammation. donovanmedical.com/hair-blog/aga-inflammation-2

@@donovanmedical9780 thank you! You also mentioned that he normal scalp can have some inflammation. What type of inflammation would that be?

if there is hair regrowth of any kind, there are stem cells alive. Now there are vast numbers of stem cells to begin with, but these diseases rapidly deplete them. SSRI are all that helpful. you'll want to see posts on the website about evidence based treatments for these diseases. As far as contraindications, you'll want to speak to your doctor and check a drug interaction checker online (free) to see if there are interactions. We have no good evidence yet for Regenera in these diseases but ongoing research will point us in new directions with many treatments.

@@donovanmedical9780 thankyou very much for the answer doctor.

Lots of possibilities actually and I would need to know a lot more information. A scalp biopsy (or two) will be important in many such cases. Be sure to see a patch testing expert if you think ACD is in the equation. There are many many causes of what you describe.

@donovanmedical9780 I had patch testing in Dec 2023 which found 5 allergens and a biopsy in March that said AGA and seb derm. Have been reacting to all meds, topicals etc w hair loss which is how I got to an immunologist since addressing the patch test and biopsy results made things worse. Now this diagnosis seems to overrule everything else so he wants to put me on a mast cell stabilizer. I had AA in 2017 so he thinks it could have reactivated the scalp issue.

@@pamedwards6522 Thanks so much for sharing. This is a complex situation and I would need to ask you another 77 questions in order to know where to go next! Be sure to keep close follow up with your doctors.

@donovanmedical9780 I actually think at this stage w all of the inflammation I've had I may now have something scarring. I know alot of loss has been from demodex as I also now have blepharitis, roasacea and eyelash/brow loss and I know it's worse on my scalp. He's looking at chromolyn sodium but I am wondering what else could help (Jak inhibitor, etc).

@@pamedwards6522thanks so much. the “what else” would require me to review all the details and ask you lots of questions and likely see the scalp up close. otherwise, it’s impossible for me to add much at this point. These sorts of situations require a really good trichoscopic assessment and thorough review of all the facts from the last few years. This requires digging and digging and good detective work.

@@HaeppyUnni Well, there are probably 35 causes of these symptoms you mention. Yes, finasteride could rarely cause but other issues need to be carefully ruled out. Be sure to see a dermatologist as well as your general physician for a complete examination.

Thanks and welcome! See you again sometime.

it depends on which of the 195 countries one lives in an which insurance policy a patient has and what the indication is for.

​@@donovanmedical9780I live in California and I want to use it on some bald spots I have due to lichen Planopilaris

@@soije4440 oh, I would need to know a lot more information and the opportunity to see your scalp up close. You are assuming that hair loss is quite straightforward! In addition to seeing your scalp, I would need to understand why really you made this switch. What really are the motivations to undertake this change? I would need to rule out other hair conditions that are present including any recent factors or triggers that might be driving a telogen effluvium. Blood work could be useful. I can’t say which ones you need without knowing your whole story. Of course, we would need to completely remove exclude comorbid or coexisting seborrheic dermatitis, alopecia areata, scarring alopecia which might be present - as well as any recent stress or recent COVID infections. We would also need to review the source of oral minoxidil and where exactly it’s coming from. We would also need to review any other prescription medications or supplements started or stopped in the last 2 years. Yes, it’s certainly possible that a shed like you describe is perfectly normal and part of a good growth response to oral minoxidil. But no, it’s not possible to assess hair loss without amassing all the facts and seeing the scalp up close. Be sure to follow up with your dermatologist or hair specialist.

You'll want to review with your doctor all of the many contraindications to spironolactone and all the many contraindications to finasteride. Provided you don't have any relative or absolute contraindications and provided you fully understand the risks and benefits and alternatives, then it may be possible. Be sure to sit down and review this important subject! For some women, the answer is yes and for some the answer is no way.

@@donovanmedical9780 Someone in her 20s with aggressive AGA and scarring alopecia, who has no other contraindications, would using spironolactone with finasteride help? Also, does taking finasteride increase testosterone and hence can it cause acne, hirsutism and other symptoms of high testosterone?

thank you! We've have another session in the future.

Thank you so much. We're so glad you to have you with us!

Thank you for sharing. You may want to review this with a dermatologist and consider a 4 mm punch biopsy. These issues can arise from many potential causes. Often a biopsy is helpful - but first and foremost a good history and examination is needed.

@donovanmedical9780 Thank you so much for responding. I just saw a dermatologist at Johns Hopkins last week and she wasn't concerned saying everyone has scalp irregularities but this is not normal for me. She said I had AGA and seb derm but my concern was an emerging FFA. I also have some eyelash and eyebrow loss. She would not do a biopsy saying it would only cause additional inflammation. Is it possible to send you the images from that visit? I know you can't make a diagnosis but if you were concerned I would seek a second opinion near me. Thanks again!

@@pamedwards6522 thanks. You might want to check out our volunteer program at the Donovan Hair Academy. We answer tough questions every week and use the questions to train the next generation of top hair specialists in the world. www.donovanhairacademy.com/qow

@donovanmedical9780 I will definitely do that. I have had alopecia areata in the past and was concerned about diffuse areata at first but then started to lose my frontal hairline. lThank you so much!

Thank you

Thank you. i am so glad

Thank you for your kind words!

Great question! Microneedling is not a first line treatment. Rather it is a third line treatment (see webinar) for one reason - studies are poor and we don't have all the answers. If studies were amazing and we had all the answers this treatment would be propelled from a third line position into a first line spot. It's not. So lots of answered questions in microneedling - and another 100 more than this one that you ask ! There is no evidence whatsoever of "cumulative fibrosis"although it is a very good thought and something that needs to be studied. This is more theoretical than anything. Many of the new treatment approaches to AGA and building on the concept that hair growth activating pathways may be 'woken up' with injury to the scalp. Thanks for the question and stay tuned as we learn more!

Thanks so much for the reply. What I was hoping was that wounding in general was understood well enough to reliably predict the consequences of microneedling, even in the absence of specific microneedling studies. But I guess microneedling produces a very unusual type of wound!

@@nathan87 yes, and also there are 205,000 microneedling protocols. You can buy lots of different sizes microneedles 0.25 mm, 0.35 mm, 0.4, 0.5 mm, 0.6 mm 0.7 mm, 0.8 mm etc etc all the way up to 2 mm. you can buy rollers and stamps and pens. You can do one pass two passes three passes of the needle. If using a stamp or roller, you can press hard or gingerly light. There are thousands upon thousands upon thousands upon thousands of protocols. The way a person might do microneedling is usually going to be different than the way his or her friend of neighbour does it. Even the way a person does microneedling this week is going to be different from the way they do it next week.

thank you so kindly.

I am so glad. Thank you!

@@churrochavez7020 No, it is not. But is is much much safer!

@@MA-me9hc yes! It can be alot of letters back and forth!! Yes, yes, yes!

Hello! thank you for telling us about your experience. Could you share with us what adverse effect you had with Hydroxychloroquine?

Well, of those 3 drugs, cyclosporine has the best long term data but they are all somewhat useful. All these drugs have different safety and cost and therefore need to be reviewed one by one. We don’t have data comparing topical tofa to topical ruxo but likely there a similar. But we just don’t have good data to say anything more than that.

@@donovanmedical9780 ​ @donovanmedical9780 thank you so much for your answer i was under the impression oral jak were safer than cyclo to use long term . sorry to bother you but would you say than otezla is less powerfull monotherapy in term of results than oral jak or cyclo in your experience?

Thank you so much doc. I know i'm harassing you under your videos and really appreciate your answer and learning on thos disease. As i'm french is there a way for me to get an opinion on my brows lpp or possible ffa through photos? I will pay whatever the cost is to have an opinion . I sent you a message on your instagram i know it's not how a patient should behave and i apologize but i don't think it's possible for me to reach your secretary on your online website

It can have mild benefits but for most patients with FD the credit would need to go to the clarithromycin/Bactrim. But yes, vitamin D analogues can benefit a variety of neutrophilic and acneiform based lesions - including acne and psoriasis.

@@donovanmedical9780 Thanks !

Yes, it’s possible. Granted it’s not the typical story but absolutely it can occur. Be sure to see an expert to exclude all the hair and scalp disorders that mimic male balding.

@@donovanmedical9780 Yes, that is exactly what I plan on doing. I’ve been having diffuse thinning and anisotrichosis all over my scalp, including the sides and back, since late September 2023. Back then, I thought it was telogen effluvium because I had COVID a month prior, but later realized that telogen effluvium should not cause individual hairs to become thinner. More recently, the corners of my hairline have started thinning out more aggressively, so I believe these are early signs of a receding hairline. I’ve been to a couple of dermatologists and have gotten mixed opinions from them, and have been told to wait a bit longer. Even though my hair thinning is not cosmetically visible to others yet, I can definitely feel and see a difference compared to how it was a year ago. If I do have a chronic hair loss condition, it is still in its early stages, which is why it might be hard for an accurate diagnosis right now. I would definitely start medical treatment soon (if that is required) to prevent further loss. If you were still accepting new patients, I would definitely visit you, but completely understand why this is not possible for you at this time. I will be moving to Seattle next month, so Whistler would not be too far away (I visited Whistler last summer and it is beautiful). Anyway, maybe I can see a good alopecia specialist soon and get an accurate diagnosis before my hair gets worse. I look forward to more videos on this channel Doctor, they are very informative.

Yes, I completely agree that an accurate diagnosis is crucial, especially in early stages of hair loss. The thing is I’ve been having diffuse thinning and anisotrichosis all over my scalp, including the sides and back, since late September 2023. At first, I thought this was telogen effluvium because I had COVID a month prior. However, I realized that telogen effluvium should not cause individual hairs to become thinner. More recently I started noticing more aggressive thinning at the corners of my hairline, which seem like the early signs of a receding hairline. I went to a couple of dermatologists, but have gotten mixed opinions from them and have been told to wait longer to see what happens. If I do have a chronic hair loss condition, it is definitely in its early stages, which is why an accurate diagnosis might be difficult right now. I would start treatment ASAP if it were required, because it is always better to prevent hair loss early on. I would visit you if you were still accepting new patients, but completely understand why this is impossible for you at this time. I will be moving to Seattle next month, so Whistler would not be too far away (I visited Whistler last summer and it was beautiful). Anyway, I hope I can get an accurate diagnosis from an alopecia specialist soon and see where I can proceed from there. I look forward to more videos on this channel Doctor, they are very informative.

@@donovanmedical9780 Yes, I completely agree that an accurate diagnosis is crucial, especially in early stages of hair loss. The thing is I’ve been having diffuse thinning and anisotrichosis all over my scalp, including the sides and back, since late September 2023. At first, I thought this was telogen effluvium because I had COVID a month prior. However, I realized that telogen effluvium should not cause individual hairs to become thinner. More recently I started noticing more aggressive thinning at the corners of my hairline, which look like the early signs of a receding hairline. I went to a couple of dermatologists, but have gotten mixed opinions from them and have been told to wait longer to see what happens. If I do have a chronic hair loss condition, it is definitely in its early stages, which is why an accurate diagnosis might be difficult right now. I would visit you if you were still accepting new patients, but completely understand this is impossible for you at this time. I will be moving to Seattle next month, so Whistler would not be too far away (I visited Whistler last summer and it was beautiful). Anyway, I hope I can get an accurate diagnosis from an alopecia specialist soon and see where I can proceed from there. I look forward to more videos on this channel Doctor, they are very informative.

@@donovanmedical9780 Yes, I completely agree that an accurate diagnosis is crucial, especially in early stages of hair loss. The thing is I’ve been having diffuse thinning and anisotrichosis all over my scalp, including the sides and back, since late September 2023. At first, I thought this was telogen effluvium because I had high fever (from the illness that starts with a C that I can’t write in youtube comments) a month prior. However, I realized that telogen effluvium should not cause individual hairs to become thinner. More recently I started noticing more aggressive thinning at the corners of my hairline, which look like the early signs of a receding hairline. I went to a couple of dermatologists, but have gotten mixed opinions from them and have been told to wait longer to see what happens. If I do have a chronic hair loss condition, it is definitely in its early stages, which is why an accurate diagnosis might be difficult right now. I would visit you if you were still accepting new patients, but completely understand this is impossible for you at this time. I will be moving to Seattle next month, so Whistler would not be too far away (I visited Whistler last summer and it was beautiful). Anyway, I hope I can get an accurate diagnosis from an alopecia specialist soon and see where I can proceed from there. I look forward to more videos on this channel Doctor, they are very informative.

Miniaturization can be seen in several different conditions. I’ll attach a helpful link here for you. donovanmedical.com/hair-blog/miniaturization

@@donovanmedical9780 Thank you Doctor, I’ll take a look at this.

Thanks for sharing. I hear your frustration. The JAK inhibitors are helpful for some - but don't help everyone. For patients with total hair loss (alopecia totalis and universalis), the JAK inhibitors help only a small proportion of patients to completely regrow hair. There will be more options in the future. ua-cam.com/video/WP74RvSYd0I/v-deo.html

There are actually four things that we must keep in mind at all times. They are safety, affordability, feasability and effectiveness. Cost is just one issue. Safety of oral minoxidil becomes an issue as the dose goes higher and higher and higher. At typical doses, it's reasonably safe. Long term safety is somewhat unknown. All four parameters need to be kept in mind. For many people, yes oral minoxidil has it's advantages. I agree with that. But a proportion of patients don't tolerate oral minoxidil very well.

This i great to hear and thanks for sharing. Keep taking photos and compare what things look like in 4-6 months too. It sure sounds encouraging!

Thank you for your comment. No, finasteride does not help alopecia areata. It is of no benefit for this autoimmune-mediated disease.

does not help everyone - but it's a reasonable second line approach. donovanmedical.com/qow-posts/topical-jaks-ffa

Yes. it works better. Many of these benefits are dose dependent. Side effects are dramatically increased by going up. I rarely ever prescribe such doses. Many men can’t even tolerate 5 mg. 10 mg dramatically increases cardiovascular side effects, hypertrichosis, headaches and other issues. Not a dose I recommend!

@@donovanmedical9780 I get no sides on 5mg after 2 years, you think I could up titrate the dose up from 5mg with 1mg a day so 6mg then keep working up to a max dose ?

thank you. Please contact my office.