This transcript has been edited for readability.
Matthew Watto, MD: That is The Curbsiders.
Paul N. Williams, MD: We interviewed Dr Helena Pasieka about problems of the scalp and face. Dr Pasieka is an incredible dermatologist and a terrific educator who breaks issues down in a really sensible manner. We’re going to recap a few of the pearls we took away from that interview.
Watto: Beginning with the scalp. I knew subsequent to nothing concerning the scalp aside from to make use of some fluconazole shampoo from time to time.
Stuart Ok. Brigham, MD: Can we get this off of our chests first? We’re three White guys with good heads of hair speaking about hair loss.
Williams: I used to be listening to that androgenic alopecia stuff with rapt curiosity. Imagine me, I discovered it personally related and was very excited to listen to what she needed to say.
Watto: I had manner much less brow for many of my life, Paul, so I am proper there with you. She had some actually nice tips on alopecia. The 2 predominant buckets to separate it into are scarring alopecia and nonscarring alopecia.
Scarring alopecia is just not refined. You see complete destruction of the follicles. It is pretty unusual, however in the event you see it, ship the affected person proper to a dermatologist.
There are a few various kinds of nonscarring alopecia. Androgenic alopecia is the one everybody’s aware of: male sample baldness. Males get the temporal baldness and hair loss on the crown or again of the top. Girls have a barely completely different sample: hair loss extending throughout the entire prime of the top.
Apparently, sufferers herald a bag of hair and say, “I am shedding a lot hair.” Dr Pasieka tells them it is okay. Everybody loses as much as 200 hairs a day; that may be regular. During times of excessive stress — akin to a world pandemic — all of an individual’s hair can get pushed into the telogen section, which is when the hair falls out. You may have an entire bunch of hair falling out without delay. Usually it stops when the stress goes away, however it might final for a few months.
Williams: Given the current circumstances, I have been shedding hair for a few years.
Watto: The opposite widespread kind of nonscarring alopecia is alopecia areata, an autoimmune situation. These sufferers must be referred to a dermatologist. It may turn out to be generalized, with the lack of eyebrows and all different hair. It normally begins out with a coin-sized bald spot. For those who have a look at that bald spot and the affected person is beginning to regrow hair, the hair will probably be white as a result of the situation knocks out melanin as effectively.
Stuart, would you discuss remedy for alopecia?
Brigham: I believed it was attention-grabbing that minoxidil, which we have used as a mainstay of first-line remedy for alopecia, is available in a 2% formulation for ladies and 5% for males. I appeared up the costs. Minoxidil for males is about 10%-20% costlier. The advice is for ladies to make use of minoxidil for males as a result of it is more practical, which begs the query: Why even have 2% for ladies?
Watto: Give all people the good things, is mainly what she was saying. The opposite nice pearl about minoxidil is that you must coach sufferers about two essential issues. Primary is that there’s an upfront interval of hair loss. That freaks sufferers out, however they must push by means of it. Allow them to know that for the primary couple of days or perhaps weeks they may shed somewhat extra hair than they’re used to, however that may go away. They should attempt for not less than 16 weeks to know whether or not it is going to work. Sadly, in the event that they cease it, they are going to most likely lose any progress that they’ve made. However dermatologists produce other issues they’ll do, so ship sufferers to them if they’re actually upset about their hair loss.
Paul, you will have our remaining pearl, which isn’t associated to hair.
Williams: This was an episode that I had a egocentric curiosity in. I requested about “maskne” on this time of the coronavirus pandemic. Hopefully in the future this video will probably be terribly dated, however as we’re all strolling round carrying masks, individuals have been noticing outbreaks of pimples across the space of the masks. It has been known as maskne — an lovely identify — however the precise identify of it’s wonderful: pimples mechanica. It is precipitated classically in athletes by friction, warmth, sweat, and moisture. An space of pores and skin that rubs forwards and backwards and turns into sweaty is extra liable to pimples. It is a papulopustular eruption.
After the episode I appeared this up. There are some neat articles about it. It was additionally seen in troopers in Vietnam the place their backpack straps have been rubbing in opposition to their pores and skin. There are case reviews of turtleneck-induced pimples mechanica, and of individuals with a tic who rub their faces time and again, inflicting sufficient mechanical friction and warmth to trigger pimples in that spot.
Dr Pasieka recommends sulfur washes or benzoyl peroxide (4% or greater) in addition to ensuring that you’re washing the masks you’re utilizing regularly. Our personal Beth Garbitelli, who wrote the present notes, made a private advice for utilizing 100% tea tree oil for spot remedy, which she says is “straight-up magical.” Sensible recommendation throughout for these of us who must put on masks daily.
Thanks for watching.
The Curbsiders are a nationwide community of scholars, residents, and clinician educators from throughout the nation, representing 15 completely different establishments. They “curbside” consultants to deconstruct numerous matters on the planet of medication to offer listeners with medical pearls, practice-changing data, and dangerous puns. Study extra about their contributors and comply with them on Twitter.