I have male pattern baldness with extreme hair fall. Please help.

Hello,

Welcome to icliniq.com.

I appreciate the details of the problem mentioned by you. This makes our diagnosis relatively easier; however, there are specific issues that need further clarification.

1. Have you ever noticed well-demarcated isolated clean patches of hair loss at some point of time? I mean, not the overall generalized hair loss, but appearance of absolutely bald patches within the scalp.

2. Have you noticed shedding of hair from eyebrows, eyelashes or other parts of the body?

3. Do you have any associated medical condition related to thyroid, kidneys, or liver?

The above questions are being asked, keeping the possibility of a condition called alopecia areata (AA). This condition typically presents absolutely distinctive clean bald patches surrounded by normal hair. But a special type of AA, known as generalized or diffuse AA, there may not be bald patches separately; instead, it presents with the diffuse episodic falling of hair, the way you have described it. Of course, you may be suffering from a combination of early stages of male pattern baldness (MPB) and generalized AA. There may be an additional contribution from nutritional deficiency or thyroid disorder, which is called chronic telogen effluvium. Now, to make a more accurate diagnosis and help you, optimally, I would need the following. It is ideal if you send us some close up well-focused photographs of the hair loss areas. Video conferencing would be ideal. I would advise you to get the following tests done as a part of blood evaluation: Complete Blood Count (CBC), serum TSH (thyroid stimulating hormone) levels, serum vitamin B12 levels, serum ferritin levels, anti-TPO (thyroid peroxidase) antibodies, anti-parietal cell antibodies. The eruption that you experienced over your face was definitely because of excessive dandruff. To control that, use Candid-B (Beclometasone and Clotrimazole) lotion as an overnight leave on-lotion over the scalp for ten nights and use 8X shampoo for alternate day scalp wash, with a five-minute leave-on time. Consult a specialist doctor, talk to them, and then take the medication. You may require a scalp skin biopsy to confirm the exact reason of your hair fall. I hope the discussion above may have helped you understand the complexity of the situation of your diagnosis.

I hope this will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

We have received the answers to my posted counter-queries and your serially arranged photographs (attachment removed to protect patient identity) to my satisfaction. The possibility of generalized alopecia areata with additional moderate male pattern baldness seem to be contributing to your overall and dramatic hair loss. The former condition (generalized AA) in your case would ideally require a skin biopsy from the central portion of the scalp by a dermatologist at the earliest opportunity for confirmation so that a strong treatment may be put in place. There is a little likelihood of you having something known as cicatricial alopecia, which is often irreversible in late stages. However, from the pictures, this looks pretty unlikely (although can be ruled out with 100 percent confidence only after a skin biopsy). So kindly ensure you get a biopsy done by a good dermatologist near you at the earliest. Pending the biopsy and its reports, I would suggest you the following protocol for getting the condition in some control. Remember, these treatments will take at least two months to show a good effect, as one needs to be really patient in hair treatment. And unless your condition is diagnosed to be what I am suspecting, with absolute certainty, these medications may not be able to help you completely. I hope you may have gauged the importance of skin biopsy by the above discussion.

I suggested the following treatment.

1. Follow the dandruff precautions with the lotion and shampoo as suggested earlier. Instead of using Candid-B (Beclometasone and Clotrimazole) lotion in the night, use it in the daytime over the dry scalp (after shampoo) and leave it on until night.

2. At night around 7 PM, without shampooing again, apply a lotion by the name of Hair-max-forte 1 ml over the entire balding area. The lotion will sting a little for few seconds, but that sensation will finish off. It is a combination of Minoxidil (5%) with additional components Tretinoin and Azelaic acid.

3. Use Grocapix gel (containing Capixyl A) around three hours after applying Hair-max-forte lotion. It is a blue gel, and you need to apply a small blob, sufficient to cover the scalp of the balding area.

4. Take capsule Adgain (Biotin, Iron, Zinc oxide) one capsule every day after breakfast.

Later after confirmation of diagnosis you may require intradermal injections of certain medicines to arrest further hair loss and promote hair regrowth. You may also require stronger medicines by mouth depending on the final diagnosis. So, start these medications and get a scalp skin biopsy done soon. Consult a specialist doctor, talk to them, and then take the medication.

I hope this helps you.

Thank you.

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

I hope this will help you.

Thank you.