Female Alopecia: Guide to Successful Management

213 Pages·2013·12.22 MB·English

by  Ralph M. Trüeb (auth.)

Female Alopecia

Ralph M. Trüeb
Female Alopecia
Guide to Successful Management
Ralph M. Trüeb
Center for Dermatology
and Hair Diseases
Wallisellen
Switzerland
ISBN 978-3-642-35502-8 ISBN 978-3-642-35503-5 (eBook)
DOI 10.1007/978-3-642-35503-5
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2013932339
© Springer-Verlag Berlin Heidelberg 2013
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material
supplied speci fi cally for the purpose of being entered and executed on a computer system, for
exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is
permitted only under the provisions of the Copyright Law of the Publisher’s location, in its
current version, and permission for use must always be obtained from Springer. Permissions for
use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable
to prosecution under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a speci fi c statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or
implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Preface
My heart thought of my love of you,
When half of my hair was braided;
Skull of Anhapu I came at a run to fi nd you,
And neglected my hairdo.
Now if you let me braid my hair,
I shall be ready in a moment.
Papyrus Harris 500 (Ramesside Period)
Old Myths and New Insights into Female Hair Loss
Few dermatologic problems carry as much emotional overtones as the com-
plaint of hair loss in women. In general, the best way to alleviate the emo-
tional distress related to hair loss is to effectively treat it. In fact, one of the
oldest medical professions, according to Greek historian Herodotus (484–425
BC), was the Egyptian P hysician of the Head who specialized in disorders of
the scalp. Even if the complaint of hair loss may at times seem disproportion-
ate to the extent of recognizable hair loss, the proportion of women suffering
of truly imaginary hair loss is negligible.
A detailed patient history focusing on chronology of events, examination
of the pattern of hair loss and the scalp, few simple diagnostic techniques,
dermoscopy of the hair and scalp (trichoscopy), pertinent screening blood
tests, and a scalp biopsy in selected cases will usually establish a speci fi c
diagnosis.
Once the diagnosis is certain, treatment appropriate for that diagnosis is
likely to control the problem.
Ultimately, patients need to be educated about the basics of the hair cycle
and why considerable patience is required for effective cosmetic recovery.
Success relies on patient compliance that, on its part, relies on con fi dence in
the physician and treatment. Rather than being a failure of the patient, patient
noncompliance results from failure of the physician to build up that con fi dence.
Adding to the patient’s worry may be prior frustrating experiences with phy-
sicians, who tend to trivialize complaints of hair loss or dismiss them com-
pletely. This attitude on the part of physicians may result from lack of
knowledge or from o ld myths regarding hair loss in women.
Prerequisite for delivering appropriate patient care is an understanding of
the pathologic dynamics of hair loss and the multitude of cause relationships.
vv
vi Preface
New insights focus on the role of internal and external factors on hair loss in
women, such as nutrition (proteins, energy, vitamins, and trace metals), hor-
mones, aging, seasonality of hair growth and shedding, cigarette smoking,
UV radiation, and hair care. It must be borne in mind that hair loss often does
not result from a single cause effect but from a combination of factors that all
need to be addressed simultaneously in an individualized manner for
success.
The aim of this monograph is to deliver to specialists as well as to primary
care physicians with interest in hair the practical know-how to successful
management of hair loss in female patients of all ages.
Wallisellen, Switzerland Prof. Ralph M. Trüeb
Author

Ralph M. Trüeb is a Professor of Dermatology. He received his MD and
Swiss Board Certi fi cation for Dermatology and Venereology as well as for
Allergology and Clinical Immunology from the University of Zurich,
Switzerland. In 1994–1995, he spent a year at the University of Texas
Southwestern Medical Center at Dallas with Rick Sontheimer and at the
Howard Hughes Medical Institute in Dallas with Bruce Beutler to complete
his Fellowship in Immunodermatology. After a 20-year tenure at the
Department of Dermatology, University Hospital of Zurich, where he estab-
lished and was head of the Hair Consultation Clinic, he established in 2010
his private Center for Dermatology and Hair Diseases in Wallisellen, Zurich.
He is past President of the European Hair Research Society (2008–2011)
and founding President of the Swiss Skin and Hair Foundation (2011). His
clinical research interests focus on hair loss in women, in fl ammatory phe-
nomena, hair aging and antiaging, and patient expectation management. He is
currently author of 166 peer-reviewed scienti fi c publications and author and
editor of 4 textbooks on hair.
vii

Acknowledgements
A thankful heart is not only the greatest virtue,
but the parent of all other virtues.
Cicero (106–43 BC)
With great respect and thankfulness, I would like to acknowledge my interna-
tional fellow colleagues who have either inspired me or have been compan-
ions and friends over the years in the quest for excellence in the management
of female alopecia (in alphabetical order): Bruno Bernard, Ulrike Blume-
Peytavi, Pierre Bouhanna, Francisco Camacho, Zoe Draelos, Juan Ferrando,
Tobias Fischer, Ramon Grimalt, Marcella Guarrera, Rudolf Happle, Rolf
Hoffmann, Maria Hordinsky, Daisy Kopera, Steven Kossard, Won-Soo Lee,
Andrew Messenger, Sundaram Murugusundram, Elise Olsen, Ralf Paus,
Gérald Piérard, Bianca-Maria Piraccini, Vera Price, Valerie Randall, Pascal
Reygagne, Lidia Rudnicka, Hugh Rushton, Jolanta Schmidt, Jerry Shapiro,
Rodney Sinclair, Kurt Stenn, Antonella Tosti, Dominique van Neste, David
Whiting, Hans Wolff, Xingqi Zhang, and Abraham Zlotogorski.
Without the support of the pharmaceutical and hair cosmetic industry, we
would have not had the many opportunities to meet and share our knowledge
all over the globe: Johnson & Johnson, Merz Pharmaceuticals, MSD, L’Oréal,
and Procter & Gamble.
Furthermore, I would like to acknowledge:
• Maria Barraud-Klenovsek, Amadé Bregy, Nadja Galliker, Marguerite
Krasovec, Michael Kunz, Nadine Lengg, Alexander Navarini, Patrick
Oberholzer, Marcus Pericin, Stefan Trachsler, Barbara Willimann, and
Martin Zinkernagel (in alphabetical order) who have performed the stud-
ies referred to in the book
• Simon Koch, my coworker at the Center for Dermatology and Hair
Diseases, with whom I share many experiences with female hair loss
patients
• My mother, Mrs. Helen Trüeb Michaelides, who at the age of 87 years has
proven to me that 5 % topical minoxidil is safe and also (very) effective
• My Parson Jack Russell Terrier L autrec for having drawn my attention to
seasonal growth and shedding of hair in women, since my female patients
tend to come in complaining of increased hair shedding whenever my pet
dog is molting
• Finally, the holy Patron Saint Agnes of Rome, who’s icon stands in my
of fi ce
ix