Treatment of folliculitis decalvans with photodynamic therapy

Photodynamic therapy for Folliculitis Decalvans

Dr Jeff Donovan, Canadian Hair Loss Foundation

Folliculitis decalvans is a type of scarring hair loss condition and can be challenging to treat. Hair loss is generally permanent once it occurs and the goal of treatment is to stop the disease from getting worse. A variety of treatments including antibiotics are often used. 

In a study from Spain, researchers evaluated the effectiveness of a treatment called photodynamic therapy  in the treatment of folliculitis decalvans. The group studied 10 patients, all who had previously been unsuccessfully treated with the antibiotic doxycycline. 9 of 10 patients benefitted from the photodynamic therapy. However, in 3 patients this benefit did not last long and other treatments were needed to maintain an improvement.  Most patients tolerated the procedure with side effects being pain, and local inflammatory type reactions. 

Overall this is an interesting study and calls for further larger studies of the role of photodynamic therapy in the treatment of folliculits decalvans.



Treatment of folliculitis decalvans with photodynamic therapy: Results in 10 patients.

Miguel-Gomez L, Vano-Galvan S, Perez-Garcia B, Carrillo-Gijon R, Jaen-Olasolo P. J Am Acad Dermatol. 2015 Jun;72(6):1085-7. 





Frontal fibrosing alopecia: Ridging in the forehead is a new sign

A New Observation in Patients with Frontal Fibrosing Alopecia

Dr Jeff Donovan, Canadian Hair Loss Foundation

Frontal fibrosing alopecia causes hair loss along the frontal hairline and temples and sometimes even extends around the back of the scalp as well. Many patients experience eyebrow, eyelash loss and even body hair loss. 

Researchers from Spain recently reported a new finding that we should all be on the lookout for - depression of the skin overlying the frontal vein (which is a vein that can often be seen in the middle of the forehead). The researchers reported 11 women who had a depression or ridge in the skin overlying the frontal vein and propose that this too is a feature of frontal fibrosing alopecia. 


Depression of the frontal veins: A new clinical sign of frontal fibrosing alopecia.

Vañó-Galván S, Rodrigues-Barata AR, Urech M, Jiménez-Gómez N, Saceda-Corralo D, Paoli J, Cuevas J, Jaén P. J Am Acad Dermatol. 2015 Jun;72(6):1087-8.

Rabbit syndrome from topical minoxidil foam

Mouth and lip tremors from high doses of minoxidil

Topical minoxidil is FDA approved for the treatment of genetic hair loss at concentrations of 2% and 5 %. Side effects including shedding in the first month of use, hair growth on the face, dizziness, rare heart palpitations, 

Dermatologists from India described a new side effect from minoxidil. 2 patients using 10 % minoxidil (higher than the FDA approved dose developed a vibration-like sensation/tremor over the lips and around the lips. The tongue was not involved.  This was rhythmic and regular and lasted up to 40 minutes after application. Given the similar to a rabbit, the findings have been previously referred to as  "Rabbit syndrome."

Interestingly, when the patients reduced the minoxidil to a lower dose of the standard concentration, the side effects ceased. 

It appears that the rabbit syndrome from minoxidil is rare. However, physicians and the public need to be aware of side effects of this over the counter medication, particularly in patients who use greater than the recommended amount. 


Nagar R. Rabbit syndrome because of topical minoxidil foam.Dermatol Ther. 2015 Mar 26. doi: 10.1111/dth.12227. [Epub ahead of print]

Does Deficiency of Vitamin D have a Role in Alopecia Areata?

Vitamin D and its Role in Alopecia Areata

By Dr. Jeff Donovan, Canadian Hair Loss Foundation 

Alopecia areata is an autoimmune hair loss condition. Vitamin D has an import role in the immune system and  low levels of vitamin D are thought to be a risk factor for some autoimmune diseases including type 1 diabetes, rheumatoid arthritis, and inflammatory bowel disease. Several recent studies have examined whether low vitamin D levels have role in alopecia areata.

A Study from Turkey published in the journal Vitamins and Trace Elements compared the levels of vitamin D in 42 individuals with alopecia areata and 42 individuals who did not have alopecia areata. Levels of vitamin D were reduced in those with alopecia areata compared to those without.

A study from Italy published in the journal Dermatoendocrinology showed a similar finding, namely that a vitamin D deficiency was present in 40 % of individuals with AA compared to 30 % of individuals without AA.

What are we to make of these vitamin D research findings?

It’s important to realize that these research studies inform us that individuals with alopecia areata are more likely to have low vitamin D levels. It does not mean that low vitamin D levels was a cause of the alopecia and it doesn’t mean that taking supplements will necessarily help with hair growth.  Additional research studies are going to be needed to determine if taking vitamin D pills will help with hair growth. However, because of the benefit of vitamin D in so many areas of health, and the safety of vitamin D supplements, it is important that all patients with alopecia areata to speak to their physicians to make sure their levels are normal and if not that they take vitamin D supplements.

Research Studies:

Yilmaz and Colleagues. Vitamin D Concentrations are Decreased in Patients with Alopecia Areata. Vitamins and Trace Elements 2012: 1: 3

d’Ovidio and Colleagues. Reduced level of 25- hydroxyvitamin D in chronic/relapsing alopecia areata. Dermatoendocrinol 2013; 5: 271-273

Minoxidil for men: Does it help in the front of the scalp or just the crown?

By Dr Jeff Donovan, Canadian Hair Loss Foundation

Minoxidil helps front and back

Early studies showed that minoxidil helps with hair loss in the crown (top) for men but may help hair loss in the front and temples in men as well.

Minoxidil is a topical medication that is FDA approved for treating genetic hair loss (sometimes referred to as androgenetic alopecia). If you look at a bottle of minoxidil it will state that it is to be used for hair loss in the crown in men and may not benefit other areas of hair loss. The original studies of minoxidil focused on the crown and did not address the benefit in the front of the scalp.

So an important question is:  

Does minoxidil help men with hair loss in the front of the scalp or not?

The answer is yes.   Many hair loss specialists around the world have witnessed benefit to minoxidil in the front of the scalp in balding men.  However, the companies which produce minoxidil are not setting out to formally prove the benefit in the front of the scalp and are not seeking approval from health regulatory authorities to be able to change the labelling on the bottles to indicate that it "works in the front and back."

New study shows 5 % minoxidil benefits men with hair loss in the temples

A study was presented by Dr. Blume Peytavi and colleagues from Berlin, Germany at the 2013 meeting of the World Congress of Dermatology. They studied 70 men with moderate genetic hair loss and studied whether minoxidil 5 % foam could help hair loss in the crown and in the front.  The German group showed that men using minoxidil 5 % foam did obtain benefit from using the medication in the front and in the crown.  This was one of the very first studies showing the minoxidil foam benefits hair loss in the front.


Minoxidil has long been understood to benefit men with hair loss in the crown. Accumulating evidence suggests it also benefits men with hair loss in the front (temples). More studies are needed to determine just 'how much' it helps men with hair loss in the front. In general, minoxidil seems to work better in the earliest stages of hair loss - as hairs are thinning and miniaturizing. 



Hillman K, Bartels GN, Stroux A, Canfield D, and Blume-Peytavi U. Investigator-initiated double blind, two-armed, placebo-controlled, randomized clinical trial with an open -label extension phase, to investigate efficacy of 5 % Minoxidil topical foam twice daily in men with androgenetic alopecia in the fronto-temporal and vertex region concerning hair volume over 24/52 weeks.  Poster at: World Congress of Hair Research, Edinburgh Scotland May 2013

Hillman K et al. A Single-Centre, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men. Skin Pharmacol Physiol. 2015;28:236-244.  


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