Fiery reds and oranges enliven this ombre design.

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There's a hint of paisley in this cheerful design.

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Gold nails for glitter-loving clients.

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“How do I get a cover?” is a question I get asked nearly every day — so, dear readers, here is your chance. Before you go to https://ift.tt/2NpKLAD and share your work with us, here are my tips for entering a successful submission.

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CTE does not cause AGA but may Speed Up its Arrival in those Predisposed

I’m often asked if Chronic Telogen effluvium causes people to develop androgenetic alopecia. The answer is no - with the exception that CTE can speed up the arrival AGA if a person was predisposed to develop it anyways. The main point is that the person would likely have developed AGA at some point.

Chronic telogen effuvium is a hair shedding condition that typically develops in women age 35-70. Women report the condition to a much greater extent than men. Women develop increased hair shedding that can sometimes be quite profound yet at other times be quite minimal. The condition can go on for many years. In most cases, a trigger can’t be clearly found although there may be many best guesses. Patients with CTE may have a variety of symptoms including itching, tingling, burning and soreness when the hair is moved.

Sinclair Study of 2005

The Sinclair study is an important study which helps us provide patients with clearer answers as to whether or not CTE causes AGA. Professor Rodney SInclair studied five women diagnosed with chronic telogen effluvium and followed their photos for a minimum of 7 years. Four of the 5 women continued to shed year after year after year and shedding fluctuated in severity. However, serial photographs over time showed no visible reduction in hair density, and serial scalp biopsy specimen showed no follicular miniaturization. These 4 women showed no tendency toward development of female pattern hair loss or to spontaneous improvement. One woman however was diagnosed with female pattern hair loss.

Considering that 40 % of women in the general population develop AGA, this study has important implications. This study reminds us that CTE does not simply cause AGA and that CTE does not cause hair to thin and thin over time. For patients who have the correct genetics, CTE might speed up the arrival of AGA. Instead of developing AGA at age 47 a patient with CTE might, for example, develop visible AGA at 45. But it’s important to take note that this patient likely would have developed AGA anyways.

Articles on Chronic Telogen Effluvium (CTE)

Sinclair R. Chronic telogen effluvium: a study of 5 patients over 7 years. J Am Acad Dermatol. 2005 Feb;52(2 Suppl 1):12-6.

Those who are interested may wish to review these previous articles on CTE.

Differentiating CTE from DUPA

Do I have chronic telogen effluvium (CTE) ?

Chronic Telogen Effluvium 

Chronic Telogen Effluvium: Most patients don't develop AGA  

Chronic Telegen Effluvium

Acute and chronic telogen effluvium - what's the difference?  

Scalp symptoms (burning, tingling, pain) and chronic telogen effluvium  

Chronic telogen effluvium vs Genetic hair loss - Easily confused ! 

Acute vs Chronic Telogen Effluvium: A Closer Look

CTE: Misdiagnoses are Common

Oral Minoxidil for Chronic Telogen Effluvium

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Scalp Indents (Atrophy) from Steroid Injections: What should I be doing?

Steroid injections are generally well tolerated and have a good safety profile for most when the correct concentration and dose are used. Atrophy or small indentations or depressions in the skin are side effects that can sometimes occur with steroid injections. They are temporary in nature but it is important that one does not continue to inject in the area if atrophy is present. Injections need to be postponed in the area of atrophy if indentations are noted. Once the scalp improves back to normal in that area we can often continue the injections.

The presence of atrophy does not mean that injections need to be stopped altogether only but do indicate that injections need to be stopped in the area of atrophy. If there are only 1-2 indentations, then it may be possible to simply avoid injections and continue injections in other areas that require injections (at a lower dose). If there are 3 or more indentations, I recommend waiting 6-8 weeks to have the skin improve before attempting injections again. When injections are restarted, I recommend that a lower dose be used.

The Dose of Triamcinolone acetonide (Kenalog)

One must always consider the dose of steroid that was used. Some physicians use 10 mg per mL which has a higher chance of causing atrophy than 5 mg per mL. Some physicians use 2.5 mg per mL or 3.3 mg per ML which are both common doses that I use in many patients. A patient who gets atrophy from 10 mg per mL might still benefit from 2.5 mg per mL and so steroid injections need not necessarily be totally abandoned. Of course this is handled on a case by case basis.

For any patient with atrophy, one must also consider just how much topical steroid is being used. A patient who is using extremely large amounts of high potency topical steroids may be more likely to get atrophy if injections are then performed as well.

Below is a common algorithm for dealing with atrophy from steroid injections.

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The World Health Organization (WHO) is not a group to be looking towards for leadership in the matter of treating aging as a medical condition. This is unfortunate, as the WHO propagates the International Classification of Diseases (ICD) that medical regulators use as a list of conditions for which treatments are permitted, and further has a fair degree of influence over government policy. If there is to be a summary of the WHO position on aging, it is that people should be wealthier, exercise more, and smoke less. Also more should be spent on compensating for the harms done by aging. There is no mention of treating aging as a medical condition, or even of research and development in medical science.

Thus enormously expensive government-funded advocacy for lifestyle change is about the sum of the ambition on display at the WHO, despite the fair number of groups attempting to improve WHO programs through open comment and feedback processes. And this in an era of radical progress in biotechnology, and the advent of the first working rejuvenation therapies that clear senescent cells from old tissues! That efforts such as those of the International Longevity Alliance and others to influence the WHO, with the aim of getting the organization to pay more attention to medical research, inevitably produce very little movement is one of the reasons why I think it pointless to attempt to steer bureaucracies.

To my mind it is far better to build the first rejuvenation therapies, achieve success, and let the lumbering giants of human society then catch up to the reality on the ground. If you want the best possible chance to create meaningful change in the world, then work on building new technologies. If you want to waste most of your life, then try to change institutions from the inside.

Decade of Healthy Ageing 2020-2030

The Decade of Healthy Ageing (2020-2030) is an opportunity to bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector for ten years of concerted, catalytic and collaborative action to improve the lives of older people, their families, and the communities in which they live. Healthy ageing is the process of developing and maintaining the functional ability that enables wellbeing in older age. Functional ability is about having the capabilities that enable all people to be and do what they have reason to value.

Populations around the world are ageing at a faster pace than in the past and this demographic transition will have an impact on almost all aspects of society. The world has united around the 2030 Agenda for Sustainable Development: all countries and all stakeholders pledged that no one will be left behind and determined to ensure that every human being can fulfill their potential in dignity and equality and in a healthy environment. A decade of concerted global action on healthy ageing is urgently needed. Already, there are more than 1 billion people aged 60 years or older, with most living in low- and middle-income countries. Many do not have access to even the basic resources necessary for a life of meaning and of dignity. Many others confront multiple barriers that prevent their full participation in society.

Decade of Healthy Aging Zero Draft (PDF)

The extent of the beneficial opportunities that arise from increasing longevity will depend heavily on one key factor: health. If people are experiencing these extra years of life in good health, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by poor health, the implications for older people and for society are much more negative.

Poor health does not need to dominate older age. Most health problems confronting older people are associated with chronic conditions, particularly noncommunicable diseases. Many can be prevented or delayed by engaging in healthy behaviours such as not smoking and drinking, eating well and undertaking regular physical activity. Even for people with declines in capacity, supportive environments can ensure that they live lives of dignity and continued personal growth. Healthy ageing can be a reality for all.

Proposal of the International Longevity Alliance for the WHO's Decade of Healthy Ageing (2020-2030)

We certainly welcome WHO's vision of the world in which all people can live longer and healthier lives. However, the Zero draft does not address sufficiently "Strategic objective 5: Improving measurement, monitoring and research on Healthy Ageing" of the WHO's Global strategy and action plan on ageing and health. Regarding the Zero draft of the proposal for the Decade of Healthy Ageing from June 12, 2019, its section 4.4 "Fostering research and innovation" should be significantly strengthened with biomedical and clinical research agenda. In fact, a separate section should be developed on biomedical research and innovation on ageing.

Research and development in the areas of biological ageing and ageing-related disease is the major long-term strategy to improve health and the quality of life in older ages. Therefore, the work and cooperation in the area of biomedical and clinical research in ageing and ageing-related diseases by the WHO, the WHO parties, and non-governmental stakeholders' should be explicitly stated as an agenda item for the Decade of Healthy Ageing. There is a growing body of consensus about the need to include research and development for healthy longevity as a part of the global WHO agenda. Aging health and R&D for healthy longevity must be included into the WHO Work Program.

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Lavette Loves Black & White

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Fat transplants as a source of ‘Stem Cells’ in Folliculitis Decalvans

Folliculitis decalvans is an uncommon scarring alopecia. The cause is not entirely known although it is often associated with the presence of bacteria such as Staphylococcus aureus. Patients experience itching, burning and tenderness in the scalp and often have pustules. The hair loss that the patients experience is often permanent.

The mainstays of treatment to date are oral and topical antibiotics to eradicate the Staphylococcus aureus as well as treatments such as oral isotretinoin. A variety of other treatments have been reported with limited success. Fat transplantation involves the isolation of fat stem cells by liposuction type procedure form the thigh or abdomen. These procedures are not well established yet and have little in the way of good evidence. Some countries, including Canada, have banned these procedures altogether in order to protect the public until more evidence is available. Canadian physicians and other specialists face the possibility of losing their licenses were the to participate in these procedures. But the procedure continue in other countries and are flourishing - even without good evidence. I continue to follow the data and evidence on these procedures for hair growth in various types of hair loss.

I was interested in a 2018 paper citing use of autologous fat transplantation as a source of stem cell therapy for folliculitis decalvans. The patient in the study underwent two session of adipose transplantation 5 months apart. After treatments it was noted that the patient had no new pustules and no longer had pain or burning sensation in the affected area. There was some hair regrowth noted at the periphery of the area.

Conclusions

This is an interesting and potentially promising study. Many studies in scarring alopecia suffer greatly from lack of long term follow up. Folliculitis decalvans for example can undergo periods of relative quiet followed by increased activity. It is essential to know if this patient for example maintains a good response after 1, 2,3 and 4 years. In addition. a lack of pustules and reduction in symptoms is a very good sign but what matters most is the appearance of the scalp at various intervals following treatment. Nevertheless, this is an interesting paper and likely will fuel additional studies of these therapies in scarring alopecia.

Patients should be aware that these therapies for folliculitis decalvans (and other types of hair loss) are experimental at best and likely do not provide the same degree of benefits as do standard therapies. They do however offer a new means of treatment and provided these prove safe in the long run, a novel means of harvesting one’s own stem cells as anti-inflammatory and hair growth promoting agents.

REFERENCE

Tedesco M. Adipose tissue transplant in recurrent folliculitis decalvans. Int J Immunopathol Pharmacol. 2018 Mar-Dec.

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Delee Dennison, Simplicity By Design, Terrace, B.C., Canada

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They say you can get a transplant once you’ve stabilized your hairloss with Fin – but how reliable is it actually? I’m not sure how accurate this is, but I often read that Fin doesn’t really halt your hairloss, it slowns it down a lot but your hairline is still receding. And who’s to say that you get you a transplant and, 3 years later, Fin starts losing effectiveness and you end up looking even worse before? Do you just have to gamble on this, or am I missing something? Or is the transplant a commitment in the sense that you’ll eventually need more to “recorrect” everything?

What are you realistically getting in the long term with a hair transplant?

I have been doing hair transplants for 28 years and started the trend with small follicular units used for the hair transplants. Many of my patients from 28 years ago, come and visit me and a few came back for more hair transplants as they continued to lose hair. In good hands, hair transplants work and in 99% of people, the results are permanent. That is good and bad because if it is done well, you will look good, but it is done poorly, you will always look freaky.

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It takes about a year to get any reasonable results from either minoxidil or finasteride. Stick to it if you go that way

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