J Investig Dermatol, Symp Proc 1999 December; for (3); 2~2-4; Authors: Whiting DA et al

The introduction of finasteride has had a tremendous impact in the approach to androgenetic alopecia and hair transplantation. The evidence over the past several years clearly shows the benefit of the medication in young to middle-aged men at earlier stages of hair loss in slowing down or reversing androgenetic alopecia. In this study, the effect of finasteride on postmenopausal women was evaluated as well. Women constitute the largest group of untreated patients with hair loss. The vast majority of women and physicians still do not recognize the value of medical treatment and surgical treatment for female pattern hair loss.

In this study, histologic analysis of hair follicles, serial 4mm punch biopsies taken at baseline and after 12 months, from zones of thinning hair between the unaffected posterior scalp and thinning vertex and frontal scalp in women were evaluated. Twenty-six men between the ages of 18 and 41 were in the study, and 94 postmenopausal women aged between 41 and 60 were placed in both placebo and finasteride groupings. In the male group, the ratio of terminal to vellus increased more in the finasteride group than the placebo group suggesting a reversal of miniaturization process with finasteride. In the female study group, there was no significant difference in follicular counts found between finasteride and placebo groups after 12 months of treatment. The follicular counts in horizontal sections fail to show any reversal in hair miniaturization in women. This study confirms the role of finasteride in the treatment of male pattern hair loss and strongly suggests that the positive effect in men is not found in postmenopausal women.

Anecdotally, in speaking with experienced dermatologists dealing with female pattern hair loss over many years, the majority reports no effect with finasteride in postmenopausal women although a minority of women does benefit from finasteride with improvement. I believe it is important to inform any postmenopausal women that the clinical trials failed to reveal a clear benefit in the majority of women for this medication. In addition, because it is a hormone blocking medication of unknown effect in women, the unknown long-term medical consequences of this medication need to be emphasized as well. In my clinical experience, a majority of women do not benefit from the medication and recent new clinical trials reflect my experience in the majority of women.

I would appreciate the feedback of other physicians regarding their experience with finasteride in postmenopausal women over a number of years.

REVIEW: Ahmet Seyhan, MD, Levent Yoleri, MD, Ali Barutcu, MD: Immediate hair transplantation into a newly closed wound to conceal the final scar on the hair-bearing skin. Plast Reconstr Surg, 105:5, 1866-1870, 2000.

The authors describe a technique of placing minigraft and micrograft hair transplants into the approximated wound edges of incisions of the scalp and other hair-bearing areas. While offering no controls (i.e., half of the incision not transplanted), the authors conclude that, in tension-free wound closures, the appearance of a linear scar is reduced.

REVIEW: Handbook of Diseases of the Hair and Scalp. By Rodney Sinclair, Cedrick Banfield and Rodney Dawber; 233 Pages. Published by Blackwell Science 1999.

The aim of this book, according to the authors, is “to act first as a text-atlas that can be used by the clinician to confirm a diagnosis and then as a source of concise, management oriented information for that condition.” This book has been written as a companion to the parent text, “Diseases of the Hair and Scalp” edited by Rodney Dawber (published by Blackwell Science 1998).

This 233-page book is organized into six sections, Hair Biology, Excess Hair, Non-Scarring Alopecias, Scarring Alopecias, Developmental Disorders, and Infectious and Inflammatory and Neoplastic Disorders. The book is extensively illustrated with color photographs and the index is very comprehensive.

As a hair transplant surgeon, I quickly checked out my areas of major interest—androgenetic alopecia of males and females, alopecia areata, Trichotillomania, the cicatricial alopecias, and my own particular favorite, triangular alopecia. In addition, I compared the book with its nearest rival, Whiting and Howsden's “Color Atlas of Differential Diagnosis of the Hair and Scalp,” (published in 1996 by Canfield Publishing).

On a topic such as “Drugs Causing Hairloss,” the atlas was more comprehensive, but on the other hand the Handbook devotes twice as much space to alopecia areata and androgenetic alopecia. With my own pet “hobby-horse,” the rarer condition of triangular alopecia, I was delighted to find 58 lines and a photograph in the Handbook compared with 5 lines and a photograph in the Atlas. This is more than in Dawber, Olsen, and Whiting combined.

If you want to sort out which of the critical alopecias might be the cause of your patient's distress, then both books are very informative although the Handbook devotes 30 pages to the subject compared with 10 in the Atlas. The Atlas is extensively referenced at the end of each section, whereas the reader of the Handbook is referred to the appropriate section of the parent textbook for further in-depth reading. This may be a problem if you do not have Dawber's book.

Another recurring problem in my practice is folliculitis decalvans. The Handbook has nearly three pages on this topic compared with a few lines in the Atlas.

My verdict? The Handbook has more than twice the number of pages than does the Atlas and there are marked differences in emphasis, but both are excellent publications. If you are truly interested in this fascinating field of hair and scalp, you unquestionably must have BOTH on your desk, together with Olsen and Dawber's textbooks.