For many women, hair loss can be very difficult to deal with.

“Hair loss is a very misunderstood condition, both in terms of how people see their own hair loss and how physicians who are not dermatologists approach hair loss,” said Dr. McMichael. “It is important for women to be evaluated by a dermatologist, who specializes in hair loss, at the first signs of a problem – whether she notices that her ponytail is smaller than it used to be, she sees more hair in the shower, or if her part is widening. Determining the cause of the hair loss is the first step in treating it and preventing future hair loss.”

Female-Pattern Hair Loss
The most common form of hair loss in women is female-pattern hair loss, which is a hereditary condition also referred to as androgenetic alopecia. While pattern hair loss affects both men and women, it is very different in women and does not display the classic receding hairline or bald spot on top of the scalp as it does in men. In women, the frontal hairline is usually maintained, but there is
visible thinning over the crown. Dr. McMichael explained that in both male- and female-pattern hair loss, the hair stays on the head for a shorter time due to a short growth phase, resulting in baby fine hairs that do not reach their full length or diameter.

Fortunately, several treatment options are effective for women with hair loss. Minoxidil 2% is the only topical medication approved by the U.S. Food and Drug Administration (FDA) for female-pattern hair loss. Minoxidil 5% is only FDA-approved for male-pattern hair loss, but it has been shown to be very effective in women as well. Both the 2% and 5% solutions are available over-the-counter. While minoxidil does not grow new hair, it works by prolonging the growth phase of hair – providing more time for hair to grow out to its full density.

“Minoxidil is a wonderful option for women with thinning hair, as it only treats the hair you want to keep that is not reaching its maximum growth and is an easy way to fill in hair density,” said Dr. McMichael. “Although minoxidil is an over-the-counter treatment, women should consult their dermatologist who is experienced with the product and can explain how it works and off-set any known side effects – such as irritation or fine facial hair that could develop along the cheeks and jaw line.”

In some cases, other medications may be used off-label to treat female hair loss, including finasteride (which is FDA-approved for male-pattern hair loss) for women of non-childbearing age only, and the anti-androgens spironolactone and flutamide that work by blocking the male hormone testosterone at the cellular level of the hair follicle. These oral medications also may be an option for women who may not want to spend time applying minoxidil every day. Dr. McMichael also noted that hair transplantation is an extremely effective procedure for women who want to fully restore their lost hair and works best in conjunction with topical or oral medications to prevent further hair loss.

Telogen Effluvium
Another common form of hair loss in both men and women, telogen effluvium, refers to an increase in the number of hairs in the telogen, or rest, phase of the hair cycle, which typically lasts three months in the normal growth
cycle. However, telogen effluvium occurs as a result of the body’s natural physiologic response to some form of stress, causing more hair to enter the rest phase than the normal 10 percent. For example, surgery, childbirth, dramatic weight loss (including gastric bypass surgery), the death of a loved one, starting
or stopping oral contraceptives, iron deficiency, and chronic thyroid diseases can trigger this type of hair loss.

“When I evaluate patients’ hair and their recent medical history, I am able to determine if their hair loss is a result of telogen effluvium. I always tell women to be patient and that their hair needs to grow back on its own,” said Dr. McMichael. “In these cases, I would only recommend minoxidil to less than 50 percent of women and oral medications would not be effective. Once the trigger is removed, the hair simply needs to return to normal – which could take anywhere from three to nine months. The key is determining the trigger and when it occurred in relation to the hair loss.”

Alopecia Areata
An autoimmune form of hair loss that can affect men and women, alopecia areata, occurs when the body’s white blood cells attack the hair follicles and put them to sleep. This results in either a small patch of complete hair loss on the scalp that may be easy to cover or complete hair loss on the scalp (similar to the effects of chemotherapy in cancer patients) and/or other areas of the body.

While not as common as other forms of hair loss, this condition can be very psychologically upsetting for women and its manifestations are unpredictable from person to person. For example, alopecia areata can happen overnight or occur gradually over the course of several years. Dr. McMichael noted that typically, alopecia areata is initially seen in children and young adults.

Although there are no FDA-approved treatments for alopecia areata, Dr. McMichael explained that dermatologists may use combination therapies off-label such as injectable steroids, topical steroids or minoxidil 5% to try to regrow hair in patches of bald spots. However, she cautioned that not all patients will experience hair regrowth even with treatment – which could have a significant negative impact on their quality of life.

“Studies examining quality of life issues show that women with hair loss are much more bothered by their condition than men,” said Dr. McMichael. “With men, it has become socially acceptable to be bald, but the same is not true for women. Many of my patients report not going to church because they don’t want
people in the pew behind them to see their thinning hair, or they stop exercising because they don’t want to mess up their hair that they’ve spent so much time styling to try to hide their hair loss. It really can affect many aspects of their lives.”

Dr. McMichael is optimistic that research in hair loss will continue to expand in the future. She also suggested that in addition to seeing their dermatologist for proper evaluation and treatment, women who are bothered by their hair loss can find help through the many support groups that are available to patients on the Internet.

Source: American Academy of Dermatology (AAD), July 29, 2009

Despite having access to some of the best health care in the world, many Americans with the most common form of eczema, known as atopic dermatitis, have sought relief from “alternative medicines.” However, dermatologists caution that patients seeking alternative treatments to alleviate symptoms of this common, chronic, inflammatory skin disease marked by red, itchy rashes, risk developing more severe symptoms by delaying treatment.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Peter A. Lio, MD, FAAD, assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, discussed why eczema patients try alternative therapies and how certain therapies used in conjunction with clinically tested medical treatments could hold promise in further improving the condition.

“Part of the difficulty in understanding why people seek alternative medicine lies in defining this term,” said Dr. Lio. “Broadly speaking, it encompasses treatments such as acupuncture, homeopathy and holistic medicine outside of the form of medicine taught in most U.S. medical schools. But people use the term for anything from chicken soup to any lotion or potion sold on the Internet to a new dietary supplement. Unfortunately, a great deal of snake oil can hide under the umbrella of alternative medicine.”

Dr. Lio believes there are two main reasons that patients try alternative therapies for eczema. The first reason is that since the cause of eczema is not fully understood nor why it occurs in some people and not others, treatments are
based on controlling the symptoms rather than fixing the root cause. Secondly, an increasing number of patients are looking for natural non-medical therapies that do not pose the known side effects of some of the traditional medications.

However, many non-medical therapies, especially herbal treatments, marketed for treating eczema are not governed by the U.S. Food and Drug Administration (FDA) or any agency, and contaminants could cause health problems or drug interactions could occur when used with other medications.

“The biggest risk posed by alternative medicines is worsening symptoms due to delayed treatment. In my practice, most of my patients have used some form of alternative therapy, but largely with little or no measurable improvement,” said Dr. Lio. “In fact, one large-scale study found more than half of the eczema patients participating reported using one or more forms of alternative medicine for their disease. The study concluded that the majority of patients reported no improvement or even worsening of their condition after using these alternative treatments.”

While topical corticosteroids (the mainstay in the treatment of eczema), antibacterial agents, topical calcineurin inhibitors and moisturizers are among the most effective medical treatments dermatologists prescribe to treat eczema, Dr. Lio suggested certain alternative therapies may be beneficial for some patients, perhaps by reducing stress.

For example, studies show that physical or emotional stress can worsen atopic dermatitis, and one study concluded that stress directly slows the healing of the skin barrier – or its protective outer layer. In another study, psychosocial stress and sleep deprivation were found to disrupt skin barrier function in healthy patients.

“It is possible that some forms of alternative medicine, such as hypnosis and acupuncture, may help eczema patients by reducing stress,” said Dr. Lio. “The areas of stress reduction and behavior modification are promising and deserve further exploration as a means to complement traditional medical therapies.”

In his practice, some of Dr. Lio’s patients report improvement in their condition with acupuncture, but there are no scientific studies examining this potential benefit. Currently, Dr. Lio is trying to initiate a study on the effects of acupuncture on eczema patients at his institution to examine why acupuncture reportedly benefits some patients but not others.

“I think it is important for patients to inform their dermatologist if they are using alternative therapies, as some could cause dangerous drug interactions with traditional medicine,” said Dr. Lio. “I always tell my patients that the fact that there are thousands of alternative treatments for eczema suggests that not one of them works really well. But if patients are committed to trying alternative medications, they should consult their dermatologist and not forgo their recommended medical regimen.”

Source: American Academy of Dermatology (AAD), July 29, 2009

Although acne traditionally has been considered a disease of teenagers, it is also extremely common in adult women. Studies show that acne affects more than 50 percent of women between the ages of 20-29 and more than 25 percent of women between the ages of 40-491. In fact, after age 20, women are far more likely to report having acne than men. While there is no cure for acne, dermatologists are finding that hormonal therapies can help some women fight bothersome acne that occurs in adulthood.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Bethanee J. Schlosser, MD, PhD, FAAD, assistant professor of dermatology and director of the Women’s Skin Health Program at Northwestern University Feinberg School of Medicine in Chicago, discussed the most widely used hormonal therapies available for women with acne and the best candidates for this type of treatment.

Factors that contribute to the formation of acne include excess oil gland production, skin inflammation, abnormal maturation of skin cells lining the hair follicle and an increased number of the acne-causing bacteria Propionibacterium acnes. However, hormones also influence both oil gland production and the maturation of skin cells thereby contributing to the formation of acne lesions. For example, when androgens (the male hormones present in both men and women) over-stimulate the oil glands and hair follicles in the skin, hormonal acne flares can occur.

“Women over the age of 20 may experience worsening of their acne or a change in the nature of their acne. This can include increased lesions on the lower one-third of the face (including the jaw line and upper neck), pre-menstrual flares, and resistance to oral antibiotics and other traditional acne therapies,” said
Dr. Schlosser. “For these women, hormonal therapy in the form of combination oral contraceptives and/or anti-androgen medications, such as spironolactone, flutamide and dutasteride that work by reducing the activity of the male hormone testosterone, may provide significant benefit.”

Dr. Schlosser noted that the use of hormonal therapies for acne, including combination oral contraceptives, requires careful screening of patients. For example, there are numerous contraindications (or factors that increase the risks of a particular medication) that must be considered before hormonal therapy is prescribed for treating acne. Such contraindications for combination oral contraceptives include a personal history of breast cancer, heart attack or stroke, uncontrolled high blood pressure, migraines with neurological symptoms, or abnormal vaginal bleeding, to name a few. Dermatologists will review these factors with patients to determine if hormonal acne therapy poses any potential risks for patients.

Based on a physical examination, a patient’s medical history and the success or failure of previously prescribed acne treatments, dermatologists may recommend hormonal therapy to enhance the results of acne treatment in women. Hormonal therapy in the form of combination oral contraceptive pills has been shown to help treat both inflammatory acne lesions (the papules, pustules and painful nodules under the skin), and non-inflammatory acne lesions (blackheads and whiteheads). Dr. Schlosser suggests that hormonal therapy should not be used in isolation but instead recommends that combination oral contraceptives or anti-androgen medications be used in conjunction with topical retinoids for optimal results.

While there are numerous types of oral contraceptives available that can be used to treat acne in women, three combination oral contraceptive pills have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of acne. All combination oral contraceptives contain an estrogen (ethinyl estradiol for most contraceptive pills) and a progestin. The estrogen component decreases the production of testosterone and other androgens by the ovaries and decreases the amount of active testosterone in the body.

Some progestins may actually mimic the activity of testosterone on the oil gland and thereby worsen acne. Therefore, Dr. Schlosser primarily recommends oral contraceptives that contain one of the following progestins: norgestimate, desogestrel, or drospirenone, all of which demonstrate low or no risk of increasing the activity of the testosterone receptor.

“Combination oral contraceptives can be very beneficial in the treatment of acne in appropriately selected women, and several different oral contraceptives have been shown to be effective in clinical studies,” said Dr. Schlosser. “But the treatment of acne with combination oral contraceptives needs to be targeted to each patient’s individual needs, and patients should be monitored regularly to ensure the safety and effectiveness of their particular therapy.”

Dr. Schlosser cautioned that improvement of acne with hormonal therapy does not occur overnight and requires at least three months of continuous use before a judgment about effectiveness should be made. In many cases, patients need to continue using oral contraceptives to sustain their results over time. However, some patients can stop hormonal therapy and maintain clear skin with the regular use of a topical retinoid.

“For many women with adult-onset acne, combination hormonal therapy can provide excellent results,” added Dr. Schlosser. “Women who think they might be good candidates should discuss their options with their dermatologist who can offer a customized treatment regimen and continual monitoring to ensure optimal results.”

Source: American Academy of Dermatology (AAD), July 29, 2009

According to the American Cancer Society, most of the more than 1 million cases of non-melanoma skin cancer diagnosed yearly in the United States are considered to be sun-related. Melanoma, the most serious type of skin cancer, accounts for about 8,110 of the 10,850 deaths due to skin cancer each year. Medical experts believe that too much exposure to the sun in childhood or adolescence is a major cause of skin cancer and premature skin aging later in life.

Marty Visscher, Ph.D., Director, Skin Sciences Institute at Cincinnati Children’s Hospital Medical Center, explains that some people do not understand the dangers of prolonged sun exposure. “During the summer months, it is critical that people use sunscreen and sun-protective clothing to reduce their risk of sun damage,” Dr. Visscher said. She said the best sunscreen protection will have an SPF number of at least 15 or higher and it should be applied liberally to the skin at least once every hour for maximum protection. “People can never be too careful about putting on sunscreen,” said Dr. Visscher. There are many products which higher SPF levels. You will get a little more protection from an SPF 30 than from SPF 15, but not twice the protection.

According to the federal trade commission (FTC), some of the dangerous effects of sun exposure on the skin include sunburn, photosensitive reactions (rashes), and cell and tissue damage. However, Dr. Visscher explains that there are several precautionary methods that people can take to make sure they don’t harm their skin from too much sun exposure.

Dr. Visscher, along with the FTC, advises the following ways for people to protect themselves from the sun:

• Use water-resistant sunscreens that help protect skin from both UVA and UVB rays and that have SPF numbers of at least 15. Dr. Visscher wants people to remember that that sunscreen will wash off in water and it should be reapplied frequently at a minimum of every hour and more often if a person is drying off and removing the sunscreen with the towel. Dr. Visscher also reminds people that the sun exposure is actually higher when they are around water, due to the reflection effects of the water.
• Apply the sunscreen 20-30 minutes before going out into the sun.
• The nose and lips get high exposure and often require use of sun blocks, containing zinc oxide or titanium oxide, so look for these ingredients on the label.
• Parents speak with camp counselors to make sure they apply and reapply their sunscreen on their child (or at least supervise the child when he or she is applying the sunscreen.
• Keep babies younger than six months out of the sun. Sunscreens may irritate baby skin, and an infant’s developing eyes are especially vulnerable to sunlight.
• Wear sun-protective clothing that lists the garment’s Ultraviolet Protection Factor (UPF) (the level of protection the garment provides from the sun’s harmful ultraviolet (UV) rays).
• Parents need to limit their child’s playtime during the hours when the sun is at its strongest peak, which is between 10 am and 3 pm, in the summer months. If a person is outside during these peak hours, he or she needs to remember to take breaks in the shade.

Source: Cincinnati Children’s Hospital Medical Center, July 7, 2009

Fat expansion in the eye socket is the reason baggy eyelids come with aging, according to a UCLA research team, who advise patients looking for a cure that fat excision should be the main target of treatment for this condition.

The study is the first to examine the anatomy of multiple subjects to determine what happens to the lower eyelid with age. The effects of age on the face were also measured using high-resolution magnetic resonance imaging.

“A common treatment performed in the past and present is surgical excision of fat to treat a ‘herniation of fat’ —meaning that the amount of fat in the eye socket does not change but the cover that holds the fat in place, the orbital septum, is weakened or broken and fat slips out,” said lead author Dr. Sean Darcy, a research associate in the division of plastic and reconstructive surgery at the David Geffen School of Medicine at UCLA and a plastic surgery resident at the University of California, Irvine.

“This orbital septum weakening or herniation-of-fat theory is what most plastic surgeons have been taught. However, our study showed there is actually an increase in fat with age, and it is more likely that the fat increase causes the baggy eyelids rather than a weakened ligament,” Darcy said. “There have been no studies to show that the orbital septum weakens.”

40 people participated in the study, (17 males, 23 females) between the ages of 12 and 80 years, and the evidence showed that the lower eyelid tissue increased with age and that the largest contributor to this size increase was fat increase. The American Society of Plastic Surgeons reported that in 2007 close to 241,000 Americans had eyelid surgery, one of the top four cosmetic procedures. Many plastic surgeons treating baggy eyelids do not remove fat but reposition it, or tighten the ligament holding the eyeball in place. Meanwhile, there is no data sowing that these structures change with age.

“Our findings may change the way some plastic surgeons treat baggy eyes,” said study co-author Dr. Timothy Miller, professor and chief of plastic surgery at the Geffen School. “Our study showed that a component of a patient’s blepharoplasty procedure should almost routinely involve fat excision rather than these procedures.”

Blepharoplasty refers to surgical rejuvenation of the upper or lower eyelids, or both, depending on the extent of aging or disease. The procedure is usually performed on the lower eyelid because the most common complaint patients have is that their eyes appear tired, puffy or baggy. The surgeon makes external incisions along the natural skin lines of the eyelid to remove the excess fat and improve the contour of the lower eyelid.

“Although baggy lower eyelids are a significant result of aging and fat expansion, there are other factors that can contribute too,” Miller said. “We recommend that surgeons evaluate each component and address them accordingly in an individualized approach to blepharoplasty.”

Source: Journal of Plastic and Reconstructive Surgery, September, 2008