I am 23 year old male and I have male pattern baldness, my telogen rate is at 44%. My dermatologist told me to use alpicort F (oestrogen based and on the label it says for women only). My doctor told me to disregard this as 2 weeks is nothing and he would review my condition. However so far i havent used this product as i am concerned with systemic side effects. Ive only found one journal on this product which looked promising. Ive sent Dr.Lee a question about it but havent heard from him so far. I was hoping someone would something about it. And is my doc crazy for giving a topical lotion based for women. Besides i have no idea what to start with revivogen, xandrox or minoxidil ? I want to start applying something as soon as possible.
Hi Dod and welcome,
I haven't heard of Alpicort F. I will pose your question to Dr. Lee for you again for you to see what he knows about it. I will also ask several other doctors and get back to you as soon as I get a response from them.
Sam i was wondering any news from Dr.Lee. By thw way information can be found about this lotion on google but its mainly in German and must be translated with Google translate.
Sorry Dod, not yet. He usually does get back within a few days. I'll let you know as soon as I hear back from him.
Here is the reply from Dr. Lee. I have just cut and pasted the reply email.
> I am 23 year old male and I have male pattern baldness, my telogen rate is
> at 44%.
I am assuming that you have had a scalp biopsy, which showed the very high
telogen:anagen ratio. A 44% telogen ratio would be diagnostic for a telogen
effluvium. However, the biopsy cannot tell you what the inciting factor was
that caused the massive shift of anagen hair follicles into the telogen
phase. I've included as an attachment an article I recently wrote in regards
to telogen effluvium.
> My dermatologist told me to use alpicort F (oestrogen based and on
> the label it says for women only). My doctor told me to disregard this as
> 2 weeks is nothing and he would review my condition. However so far i
> havent used this product as i am concerned with systemic side effects. Ive
> only found one journal on this product which looked promising.
Alpicort F is compounded with 5 mg estradiol benzoate, 0,2 g prednisolone and
0,4 g salicylic acid in 100mL of solution. When it is used topically for a
short period of time, it would not cause any systemic side effects. I've
included an abstract from an article regarding the use of Alpicort F at the
bottom of this message.
You should understand that the Alpicort F is being used to treat your MPB
(alopecia androgenetica) and not your telogen effluvium. The hair follicles
that are already in the telogen phase are going to shed regardless of any
> Ive sent
> Dr.Lee a question about it but havent heard from him so far.
I'm sorry, but I don't recall ever having received your question. I fairly
compulsive about replying to patients.
> I was hoping
> someone would something about it. And is my doc crazy for giving a topical
> lotion based for women. Besides i have no idea what to start with
> revivogen, xandrox or minoxidil ? I want to start applying something as
> soon as possible.
No, your doctor is not crazy for suggesting 'a topical lotion based for
women'. In fact, I often suggest topical spironolactone as a medications to
decrease the DHT in the scalp for patients with MPB. Oral spironolactone is
only prescribed to women, but applied topically, it has no systemic effects.
If you have reservations about the use of Alpicort F, it would be wise to use
a combination of topical minoxidil and an agent or agents to decrease the DHT
in the scalp. To date, this combination is the best available treatment for
Richard Lee, M.D.
> Best Regards,
The results of multi-center trial on application of local preparations with
estrogen, prednisolone and salicylic acid (Alpicort, Alpicort
F) in indications of alopetia diffusa and alopetia areata
Hana Zelenkova, MD, PhD(1) - J. Jautova, MD(2)
(1) Department of Dermatovenerology, Hospital Svidnk,
(2) Department of Dermatology, Faculty Hospital,
University of P. J. Safarik, Koaice
A multi-center study using local preparations with
estrogens, prednisolone and salicylic acid (Alpicort, Alpicort F Dr. August
Wolff) in indications Psoriasis
capillitii, Seborhoe capillitii, Alopetia diffusa,
alopetia areata and Alopetia androgenetica has been realized. The research
team consisted of 21
doctors/researchers. Therapeutic effect in the study
group of 400 patients has been evaluated. The study group included 122 males
and 278 females,
age average 34.4 yrs (there was more than 1 diagnosis in
10 patients). The study group consisted of following patients: psoriasis
with average duration of their disease 50.8 months,
alopetiae: 330 patients (alopetia androgenetica 101 patients, alopetia areata
120 pat., alopetia
diffusa 109 pat.). Average duration of the disease 23.1
months. Preparation applied: Alpicort solution - 113 patients in average for
6.2 weeks ad Alpicort
F - 287 patients in average for 7 weeks. Therapeutic
effect evaluation: excellent 209 patients (50,98%), good 133 (32,44%) pat.,
(11,22%) pat., minimal or no response 32 (11,22%) pat.
Eleven patients stopped the treatment or the therapeutic response was not
Preparations Alpicort WOLFF (combination of
glucocorticoids and keratolytics/0,2g (0,2%) prednisolone and 0,4g (0,4%)
salicylic acid) and Alpicort F
(active compounds 5 mg estradiol benzoate, 0,2 g
prednisolone and 0,4 g salicylic acid in 100 ml of the solution) have no known
equivalent. They are excellent medications, which
significantly enrich the spectrum of locally used dermatological preparations.
There is no rebound
phenomenon after completing therapy.
Here is the text of Dr. Lee's article on Telogen Effluvium:
Everything You Wanted to Know (Including Information You Probably Would Rather Not Know) About Telogen Effluvium
Effluvia? Effluviums? Even the name is confusing. According to Dorlands Medical Dictionary, telogen
is the resting phase of the hair growth cycle lasting approximately 100 days and effluvium:
is defined as an outflow, which may pertain to sudden, severe hair shedding.
To understand telogen effluvium, we need to have some knowledge of the hair growth cycle. On the human scalp, hair does not grow continuously. The anagen (growing) phase for terminal hair can extend 3 to 7 years. In this context, terminal has the connotation of ultimate or optimum, rather than finality. So, terminal is the word used to describe the thick, full, mature hair shaft. Catagen is the transitional portion of the hair growth cycle, between anagen and telogen and lasts only 1 to 2 weeks. During this time, there is a rapid involution and regression of the hair follicle. The hair follicle then enters the telogen phase, which is a relatively fixed period of time, approximately 100 days, regardless of the size of the hair follicle. There is no growth of the hair shaft during this phase. It is at the end of the telogen phase that the entire hair shaft, also often referred to as the club hair, because of its characteristic shape, will spontaneously shed, while a new hair shaft is forming within the hair canal. There is usually a collection of friable debris, consisting of dead cells and connective tissue at the scalp end of the shed hair. However, because the debris is unorganized and easily abraded off, it may be absent.
In the scalp of a healthy, young human adult, approximately 90% of the hair follicles will be in the anagen phase and approximately 10% will be in the telogen phase. Less than 1% will be in the catagen phase. The human scalp contains 100,000 hairs. At any one time, 10% or 10,000 of the hairs are in the telogen phase, which is approximately 100 days long. Statistically, 1% or 100 of those hairs will be at the end of the telogen phase and will shed spontaneously. This is the explanation of why it is normal to shed up to 100 hairs per day.
When excessive amounts of hair simultaneously switch from anagen into telogen and subsequently shed several months later, the phenomenon is referred to as a telogen effluvium. Statistically, about one half of all cases of telogen effluvium begin at 11 to 13 weeks after the inciting cause, but variations from 4 to 16 weeks have also been reported. Telogen effluviums can be acute or chronic. When the shedding lasts more than six months or persistently recurs, it is referred to as a chronic telogen effluvium. Chronic telogen effluvium has been reported mainly in women. No racial predilection exists. Although telogen effluvium can affect hair on all parts of the body, generally, only loss of scalp hair is symptomatic. The exact prevalence is not known and getting accurate statistics would be very difficult, but the condition is quite common. Telogen effluvium can occur at any age. It is likely that most adults have experienced an episode of telogen effluvium at some point in their lives and everybody has experienced the phenomenon early in life. In fact, mothers have been more aware of telogen effluviums in newborns and babies than most doctors have ever been. It is typical for hair follicles in the back of the head to enter the first telogen phase close to the time of birth and for these hairs to subsequently shed 2 to 3 months later. In the human infant, waves of synchronized hair growth occur before establishment of the mosaic pattern of hair growth, which is usually established by the end of the first postnatal year.
In order to cause a large number of hair follicles to simultaneously switch from the anagen (growing) phase into the telogen (resting) phase, the body has to undergo some systemic insult. The cells of the hair follicles on the scalp are the second most active group of cells in the body. Only the tissues producing red blood cells in the bone marrrow are more active. So, any significantly severe systemic insult can suddenly send a signal to many of the follicles to temporarily shut down, shifting from anagen to telogen. At the end of the telogen phase, those hairs will shed. But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified. A telogen effluvium is never caused by topical medications.
Among the most easily diagnosable causes of a telogen effluvium and the textbook prototype for a telogen effluvium would be the episodes of severe shedding of hair that may occur approximately 100 days after a woman has given birth. The inciting factor is probably the abrupt hormonal changes that occur at the end of pregnancy. All of the hair is regrown within a year.
Other causes of telogen effluvium include illness, major physical trauma, menopause, crash diets, severe psychological stress, major surgery (especially with general anesthesia), hypo or hyperthyroidism, anemias, acute and severe blood loss, heavy metal poisoning, etc. Chronic illness such as malignancy, and any chronic debilitating illness, such as systemic lupus erythematosus, end-stage renal disease, or liver disease can cause telogen effluvium. Immunizations also have been reported to cause acute hair shedding. Even jet lag and job changes have been reported to cause a telogen effluvium. In the United States, oral medications may very well be the most common cause of telogen effluviums. The list of medications associated with telogen effluviums includes retinoids, beta blockers, anticoagulants, SSRIs, non-steroidal anti-inflammatories, calcium channel blockers, etc. In any and all cases, the common factor is metabolic or physiologic stress several months before the start of the hair shedding
Making the diagnosis of a telogen effluvium is quite straightforward. A hair pull will determine whether or not a disproportionate number of hair follicles are in the telogen phase. And this is a test, which the patient can do himself or herself. Pinch a bunch of hair between your thumb and middle finger. You will have approximately 25 to 30 hairs within the pinch. Give the bunch of hair a sharp tug. Repeat this tug in several places over the scalp. It would be normal to dislodge one or two hairs with each pull, because approximately 10% of the hairs on the scalp are in the telogen phase. The hairs that are dislodged should have a small, friable, whitish bulb on the scalp end. If you pull out more than 4 or 5 hairs in each pull, its likely that you are having a period of telogen effluvium. Since a telogen effluvium is not limited to the hair follicles at risk for MPB or FPB, shedding can involve hair on any part of the scalp (and even body hair). The underlying scalp has a normal appearance without scarring or inflammation and there should not be any areas of complete alopecia. A close examination of the scalp may reveal a higher than expected number of short new hairs growing in.
If there is an obvious history of an inciting event and the time elapsed between the inciting event and the excessive shedding is consistent with the approximate length of a telogen phase, laboratory studies are of little use in making the diagnosis. Although a scalp biopsy can be performed to confirm the diagnosis, it would seldom be necessary if the history is characteristic and a hair pull produces numerous telogen hairs. There are no signs or symptoms, which allow you to expect the shedding from a telogen effluvium.
In reality, a telogen effluvium is simply an exaggeration of a normal process. The dilemma is that the process occurs prematurely and it occurs to a large number of hair follicles at the same time, so it provokes a lot of anxiety. In an uncomplicated telogen effluvium, the resolution is spontaneous and treatment can be limited to reassurance. Assuming there is no intervening pathological process, all of the hair will be replaced in six to twelve months and the replacement hair should be identical to the hair that was shed. If the inciting cause, whether it be some medication, stress, illness, etc., can be identified, then it should be avoided or discontinued or treated, whichever is appropriate.
Unfortunately, a telogen effluvium can be the harbinger of the onset of MPB or the initial event in a period of accelerated MPB. In these cases, which are fairly common, the hair also grows back, but the hair may be significantly finer and smaller, because the hair follicles affected have miniaturized. While 5% topical minoxidil is not proven to promote recovery of hair in telogen effluvium, this medication has a theoretical benefit because minoxidil acts directly on hair follicles promotes anagen growth. Patients who are eager to play an active role in their treatment may wish to use a 5% minoxidil solution. The use of DHT inhibitors is not recommended for the treatment of telogen effluvium.
Chronic telogen effluvium is more likely to be caused by a chronic metabolic abnormality and is less likely to resolve rapidly. The underlying cause or disorder should be avoided or discontinued or treated, whichever is appropriate, and the patient should have reassurances that the hair loss will not progress to baldness.
Hair transplantation is not a recommended treatment for telogen effluvium.
When hair is shed within days or a few weeks after an insult to the hair follicles, that would constitute an anagen effluvium and could be the subject of another article.
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Bertolino, A and Freedberg, I. M.: Disorders of Epidermal Appendages and Related Disorders. Fitzpatrick, T.B, et al: Dermatology in General Medicine. McGraw-Hill, 1993, 685-686
Brodin MB: Drug-related alopecia. Dermatol Clin 1987 Jul; 5(3): 571-9
Camacho F: Alopecias due to telogen effluvium. In: Camacho F, Montagna W, eds. Trichology: Diseases of the Pilosebaceous Follicle. Madrid: Aula Medica Group 1993: 403-410.
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Wise RP, Kiminyo KP, Salive ME: Hair loss after routine immunizations. JAMA 1997 Oct 8; 278(14): 1176-8
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