Tracking the Success of Treatment

Prescribing an established hair loss treatment is just the first step.  The real challenge is determining how well the treatment is working.  Drugs and laser devices have a tendency to work “better” for some patients than they do for others.  Some patients will improve with a lower dose, or improve with a combination of multiple treatments instead of just one. What’s essential is that the measuring technology is sensitive enough to detect the slightest improvement or worsening… so that time is not wasted.  The follicles in patients with thinning, are getting smaller and smaller each month!

Any improvement (or worsening) must be significant in order to be detected with the naked eye.  It’s a medical fact — a patient must lose 50% of his/her hair mass before the loss can be visually detected by an objective observer.  That means that someone with thinning is “half bald” before he/she realizes that he/she is actually losing hair!

Translate that observation to the treatment of hair loss.  Before a patient can actually see if he/she is getting better… he/she must be 50% improved.  And under the very best of circumstances, that takes well over a year (hair grows at one half inch a month).  Clearly it makes sense to determine if improvement has occurred sooner, rather than later. Less time is wasted on a treatment that does not work.  Less time is wasted on a treatment that is giving marginal results.  In the earlier years of thinning, more follicles are still remaining viable. Early treatment equals better success.

Most clinics use photos and vague impressions to determine how well their patients are doing – but that requires a significant improvement in the before & after photos.  At the Hair Science Center, we can measure the smallest improvement (or worsening) – scientifically and precisely – so that your treatment can be promptly and effectively adjusted.

By using Cross section trichometry, we can detect changes in the range of 5%.  This kind of minimal improvement is impossible to see with the naked eye or photo.

MEASURING TREATMENT RESPONSE TO THINNING

The problem: A 37-year-old patient has moderate visible balding in the mid-frontal area. Cross section trichometry is performed in the affected area along the midline.

Result: The affected area has a baseline HMI of 32.

Treatment: The patient is started on MInoxidil 5% per day. Protocol would be the same for minoxidil, laser, biotin, or any hair growth treatment.

Follow up: The patient returns in 12 months. Cross section trichometry is performed at the same site. The HMI is now 40.

Summary: In one year, the patient has improved 20% (40-32/40 X 100) over baseline on minoxidil therapy.  If the improvement were only 5%, the strength of the minoxidil would be increased, or the dosage changed, or an additional ingredient added to increase the penetration.  A second drug, or perhaps laser might be added to the patient’s treatment regimen.  When the patient returns 3 months later, the measurement is repeated once again… and thus the treatment is maintained as maximally effective for the entire duration of the patient’s treatment.

TREATMENT OF THINNING IN THE PRESENCE OF MINIMAL LOSS

The problem: A 20-something year old woman, with a family history of loss thinks she might be losing her hair.   She has no visible hair loss, but suspects she has less hair in the mid-frontal area. Cross section trichometry is performed at one site in the area of suspected loss, and at one site in the permanent fringe — the back area where pattern balding does not occur.

Result: The suspected (mid-frontal) area has an HMI of 83. The posterior fringe has an HMI of 95. Ninety-five  becomes the patient’s control.

Treatment: The patient has a 13% loss in the suspected (mid-frontal) area. (95-83/95 X 100). The HMI reduction is due to early diameter reduction – too subtle to be seen with the naked eye or even appreciated by hair counts or video microscopy.

Follow up: The patient returns in 6-12 months. The frontal site of non-visible is re-measured. On this visit, the score has dropped from 83 to 79. The discussion might something like this.

“Your hair loss is still not visible. However the frontal area is 5% worse than it was last year (83-79/83 X 100). We can measure the site once or twice a year to see if it stabilizes, improves, or continues to worsen. Over time, we can even average your annual rate of loss. On the other hand, we can start minoxidil, enhanced minoxidil, or laser and see what effect they have on your loss. The treatment is maximally effective when started as early as possible.”

Summary: Certainly, an annual loss of 3% has different predictive implications than an annual loss of 23%. If she chooses to begin treatment, both the patient and physician will know exactly how well the treatment is working, and how well the loss has been stabilized.

THE DIAGNOSIS AND TREATMENT OF SHEDDING

Problem: A 35 year-old woman presents with complaints of shedding and hair loss. She’s convinced she has less hair than she had 2 years ago. There has been no fever, childbirth or hormonal changes in the past 3 years. On examination the loss appears distributed evenly over the scalp. A “pull test” is slightly positive. On video-microscopy, there are no miniaturized hairs.  This strongly suggests that she has shedding, rather than thinning. Cross section trichometry measurement is then performed on the top of the head and the posterior permanent fringe.

Results: HMI is 67 in the top of the head and 68 in the posterior permanent fringe. This confirms that the hair loss is NOT pattern.  Blood tests are ordered and thyroid functions return abnormally high. The patient is referred to an endocrinologist who prescribes medication for hyperactive thyroid disease. On the basis of the lab, HMI, and history, it appears that her shedding is due to an overactive thyroid… same scenario would be true if the lab work had revealed an iron deficiency (low serum ferritin) instead.

Follow up: The patient returns in 8 months. She reports that her shedding has decreased. Cross section trichometry is performed at the same sites. The HMI is now in the range of 80.

Summary: The patient’s shedding appears to have responded to the endocrinologist’s treatment. She has improved 16% over baseline (80-67/80 X 100).

MEASURING BREAKAGE SEVERITY AND ITS RESPONSE TO TREATMENT

The problem: A 35 year-old woman presents with complaints of hair loss. Her dark-rooted hair is straight, bleached and dyed light brown. The hair is 18 inches long hair and lacks luster. She uses a hot iron to straighten every other day. She was evaluated by a dermatologist and was told that all blood tests were “normal.” LINK TO BREAKAGE AND TREATMENT

Results: A Cross section trichometry breakage test is performed on a random-sized bundle of hair.(4) The 2 X 2 cm area does not need to be isolated. The hair is 16 inches long, so the bundle is measured proximally, then distally at 8 inches… at a site 50% along its length. The results are expressed as “percent breakage at 8 inches” The screen displays a Hair Breakage Index (HBI) of 36% at 8 inches. Conclusion: The woman has 16-inch long hair but 36% of the hairs are no longer than 8 inches.

Treatment:  The patient has significant breakage. She is instructed to discontinue the hot irons, eliminate the bleach, use wide tooth combs and brushes, use plenty of conditioners, gently handle the hair when wet, air dry rather than hot blower, etc. A deep protein conditioning treatment at the salon may be recommended as well.

Follow up: The patient returns in 4 months. The Cross section trichometer displays an HBI of 27%.

Summary: The patient has developed better hair care habits and her breakage has been reduced from 36% to 27%. She has improved 25% (36% – 27% / 36% x100). Each month the fullness improves, the length increases, and she literally, has more hair. No drugs or medical treatment were required.

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