••• Grand rounds 2015

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EVIDENCE BASED EVIDENCE BASED HAIR LOSS MANAGEMENT HAIR LOSS MANAGEMENT Bernard Cohen, MD Bernard Cohen, MD VOLUNTARY CLINICAL PROFESSOR VOLUNTARY CLINICAL PROFESSOR UNIVERSITY OF MIAMI SCHOOL OF MEDICINE UNIVERSITY OF MIAMI SCHOOL OF MEDICINE DECEMBER 16, 2015 DECEMBER 16, 2015 GRAND ROUNDS GRAND ROUNDS

Transcript of ••• Grand rounds 2015

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EVIDENCE BASEDEVIDENCE BASEDHAIR LOSS MANAGEMENTHAIR LOSS MANAGEMENT

Bernard Cohen, MDBernard Cohen, MD VOLUNTARY CLINICAL PROFESSORVOLUNTARY CLINICAL PROFESSOR

UNIVERSITY OF MIAMI SCHOOL OF MEDICINE UNIVERSITY OF MIAMI SCHOOL OF MEDICINE

DECEMBER 16, 2015DECEMBER 16, 2015GRAND ROUNDSGRAND ROUNDS

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DISCLOSUREDISCLOSURE

Dr. Cohen owns the patent, and receives royalties Dr. Cohen owns the patent, and receives royalties on the technology featured in thison the technology featured in this

presentation.presentation.

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www.howtomeasurehair.comwww.howtomeasurehair.com

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BASICS of HAIR BASICS of HAIR Loss & GrowthLoss & Growth

A quick reviewA quick review

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230 hairs per square cm.230 hairs per square cm.Anagen telogen duration and percentileAnagen telogen duration and percentile

Hair growth rateHair growth rateHair diameter and cross section Hair diameter and cross section

Shedding v. thinningShedding v. thinningFollicular units and their behaviorFollicular units and their behavior

Effect of treatmentEffect of treatmentEffect of treatment discontinuationEffect of treatment discontinuation

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230 hairs per square cm.230 hairs per square cm.Anagen telogen duration and percentileAnagen telogen duration and percentile

Hair growth rateHair growth rateHair diameter and cross sectionHair diameter and cross section

Shedding v. thinningShedding v. thinningFollicular units and their behaviorFollicular units and their behavior

Effect of treatmentEffect of treatmentEffect of treatment discontinuationEffect of treatment discontinuation

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HAIR DIAMETERHAIR DIAMETER Fine = 60 micronsFine = 60 micronsAverage = 70 micronsAverage = 70 microns Coarse = 80 microns Coarse = 80 microns

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NORMAL SCALPNORMAL SCALP

ALL HAIRS ARE THE SAME DIAMETERALL HAIRS ARE THE SAME DIAMETER

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DIAMETERDIAMETERMEASUREMENTMEASUREMENT

NON-ASIAN HAIR HAS TWO NON-ASIAN HAIR HAS TWO DIAMETERSDIAMETERS

ASIANASIAN AFRICANCAUCASIAN

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HOW MUCH HAIRHOW MUCH HAIRMASS - QUANTITY – VOLUMEMASS - QUANTITY – VOLUME

IS DETERMINED BYIS DETERMINED BY

DENSITYDENSITY - number of hairs per cm- number of hairs per cm22

DIAMETERDIAMETER - coarse - average - fine - coarse - average - fine

LENGTH LENGTH - not considered - not considered

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Length is determined by personal styling. Length is determined by personal styling.

Length changes with every haircut.Length changes with every haircut.

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rr22 = = CROSS SECTIONAL AREACROSS SECTIONAL AREA••••••••••••••••••••••••••••••••••••••

CHANGING THECHANGING THE HAIR DENSITY HAIR DENSITY 10%10%

CHANGES THE HAIR MASS CHANGES THE HAIR MASS 10%10%

CHANGING THECHANGING THE HAIR DIAMETERHAIR DIAMETER 10%10%CHANGES THE HAIR MASS CHANGES THE HAIR MASS 20%20%

DIAMETERDIAMETER IS MORE INFLUENTIAL THAN IS MORE INFLUENTIAL THAN DENSITYDENSITY

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230 hairs per square cm.230 hairs per square cm.Anagen telogen duration and percentileAnagen telogen duration and percentile

Hair growth rateHair growth rateHair diameter and cross sectionHair diameter and cross section

Shedding v. thinningShedding v. thinningFollicular units and their behaviorFollicular units and their behavior

Effect of treatmentEffect of treatmentEffect of treatment discontinuationEffect of treatment discontinuation

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A full-sized hair falls out - EffluviumA full-sized hair falls out - EffluviumFollicle intact - activity out of syncFollicle intact - activity out of sync

SHEDDINGSHEDDING

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FOLLICLE – smaller & smallerFOLLICLE – smaller & smallerDIAMETER -- smaller & smallerDIAMETER -- smaller & smaller

ANAGEN -- shorter & shorterANAGEN -- shorter & shorterMINIATURIZED HAIR GROWS ONLY 3, 2, OR 1 YEARMINIATURIZED HAIR GROWS ONLY 3, 2, OR 1 YEAR

OF ITS 4 YEAR ANAGEN CYCLEOF ITS 4 YEAR ANAGEN CYCLE

THINNINGTHINNING

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HORSESHOE FRINGEHORSESHOE FRINGE

ALL HAIRS ARE THE SAME DIAMETERALL HAIRS ARE THE SAME DIAMETER

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AREA AREA of of

THINNINGTHINNING

WIDE VARIATION IN WIDE VARIATION IN DIAMETERDIAMETER

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230 hairs per square cm.230 hairs per square cm.Anagen telogen duration and percentileAnagen telogen duration and percentile

Hair growth rateHair growth rateHair diameter and cross sectionHair diameter and cross section

Shedding v. thinningShedding v. thinningFollicular units and their behaviorFollicular units and their behavior

Effect of treatmentEffect of treatmentEffect of treatment discontinuationEffect of treatment discontinuation

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FOLLICULAR UNITSFOLLICULAR UNITS

NORMAL GROUPING = 4, 3, 2, 1NORMAL GROUPING = 4, 3, 2, 1

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FOLLICULAR UNIT REDUCTIONFOLLICULAR UNIT REDUCTION

4 HAIR become 3 HAIR, 4 HAIR become 3 HAIR, 3 HAIR become 2 HAIR, etc.3 HAIR become 2 HAIR, etc.

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230 hairs per square cm.230 hairs per square cm.Anagen telogen duration and percentileAnagen telogen duration and percentile

Hair growth rateHair growth rateHair diameter and cross sectionHair diameter and cross section

Shedding v. thinningShedding v. thinningFollicular units and their behaviorFollicular units and their behavior

Effect of treatmentEffect of treatmentEffect of treatment discontinuationEffect of treatment discontinuation

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HAIR “GROWTH” DRUGS/DEVICESHAIR “GROWTH” DRUGS/DEVICESTelogen hairs converted to anagen hairsTelogen hairs converted to anagen hairs

Hairs are maintained in anagenHairs are maintained in anagenMiniaturized hairs continue to growMiniaturized hairs continue to growFurther miniaturization preventedFurther miniaturization prevented

Hair diameter eventually increases Hair diameter eventually increases Work best in early stages before the folliclesWork best in early stages before the follicles

have vanishedhave vanished

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230 hairs per square cm.230 hairs per square cm.Anagen telogen duration and percentileAnagen telogen duration and percentile

Hair growth rateHair growth rateHair diameter and cross sectionHair diameter and cross section

Shedding v. thinningShedding v. thinningFollicular units and their behaviorFollicular units and their behavior

Effect of treatmentEffect of treatmentEffect of treatment discontinuationEffect of treatment discontinuation

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EVIDENCE BASEDEVIDENCE BASEDTREATMENT TREATMENT

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The FDA requires The FDA requires evidenceevidence of efficacy of efficacy before approving a new drug-device.before approving a new drug-device.

The physician looks at the The physician looks at the evidenceevidenceand decides to prescribe the drug-device.and decides to prescribe the drug-device.

Then, he/she looks for Then, he/she looks for evidenceevidencethat the drug-device is actually working, asthat the drug-device is actually working, as

it should, in each individual patientit should, in each individual patient

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Evidence = A measurable effect Evidence = A measurable effect

If it can’t be measured,If it can’t be measured,It can’t be managed!It can’t be managed!

Medicine uses a language of numbersMedicine uses a language of numbersBP, GLUCOSE, WEIGHT, CHOLESTEROL, ETCBP, GLUCOSE, WEIGHT, CHOLESTEROL, ETC

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FOUR POPULAR AGA TREATMENTSFOUR POPULAR AGA TREATMENTS

MINOXIDILMINOXIDILFINASTERIDEFINASTERIDE

LASERLASERPRPPRP

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WHAT DOES THE FDA REQUIRE? WHAT DOES THE FDA REQUIRE?

1. EVIDENCE of efficacy1. EVIDENCE of efficacy(Choose 3 out of 4)(Choose 3 out of 4)

DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT

GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION

2. EV2. EVIDENCE of safetyIDENCE of safety

Journals generally require less evidence than FDA Journals generally require less evidence than FDA

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FDA-required EVIDENCEFDA-required EVIDENCE

DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT

GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION

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DRY HAIR WEIGHTDRY HAIR WEIGHTTHE GOLD STANDARDTHE GOLD STANDARD

Weigh hair bundle from a demarcated areaWeigh hair bundle from a demarcated area““before and after” treatmentbefore and after” treatment

Change reflects density & diameter changesChange reflects density & diameter changesRarely performedRarely performed

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Dry Hair Weight Dry Hair Weight AN AN

ACCURATE ACCURATE MEASUREMEASURE

OF HAIR MASSOF HAIR MASS(measures both density & diameter)(measures both density & diameter)

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FDA required EVIDENCEFDA required EVIDENCE

DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT

GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION

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DENSITY COUNTDENSITY COUNT

COUNT THE HAIRS PER SURFACE COUNT THE HAIRS PER SURFACE AREA OF SKINAREA OF SKIN

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ANDROGENETIC ALOPECIA - diameter reduces in size

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BALDING IS A MIXTURE OFBALDING IS A MIXTURE OF

FULL SIZEFULL SIZE&&

INTERMEDIATEINTERMEDIATEHAIRSHAIRS

ANY HAIR LARGER THANANY HAIR LARGER THAN30 MICRONS IS 30 MICRONS IS COUNTED ASCOUNTED AS

ONE HAIRONE HAIR

HAIR DENSITY COUNTHAIR DENSITY COUNT

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Hair Density CountHair Density Count

ANAN INCOMPLETE INCOMPLETE

MEASUREMEASUREOF HAIR MASSOF HAIR MASS

measures variations in measures variations in density but not diameter density but not diameter

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FDA-required EVIDENCEFDA-required EVIDENCE

DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT

GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION

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GLOBAL PHOTOGRAPHY

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1999 - E. Marritt The 2 Box Study1999 - E. Marritt The 2 Box Study

In HT surgery, only half the hairIn HT surgery, only half the hairneeds to be replaced in order toneeds to be replaced in order to

achieve a normal density appearance.achieve a normal density appearance.

50% of the hair mass must be lost before50% of the hair mass must be lost beforethe underlying skin becomes visible.the underlying skin becomes visible.

When a man discovers for the first time When a man discovers for the first time that hethat he’’s balding… he has already s balding… he has already

lost 50% of his hair! lost 50% of his hair!

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GLOBAL PHOTOGRAPHY

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PhotographyPhotography

AN INCOMPLETEAN INCOMPLETEMEASURE OF HAIR MASSMEASURE OF HAIR MASS

(does not detect loss if its less than 50%)(does not detect loss if its less than 50%)

DIFFICULT TO QUANTIFY CHANGEDIFFICULT TO QUANTIFY CHANGE

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FDA-required EVIDENCEFDA-required EVIDENCE

DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT

GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION

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A A TOTALLY SUBJECTIVETOTALLY SUBJECTIVE

MEASUREMEASUREOF HAIR MASSOF HAIR MASS

(worthless?)(worthless?)

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How does How does EVIDENCEEVIDENCE

required by the FDArequired by the FDA

compare withcompare withEVIDENCEEVIDENCE

obtained in the office?obtained in the office?

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Clinical PhotographyClinical Photography

Random micro-image of scalpRandom micro-image of scalpwith untrimmed hairwith untrimmed hair

Patient self evaluationPatient self evaluation

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Cohen, B H, The Cross-section Trichometer: A New Cohen, B H, The Cross-section Trichometer: A New Device for Measuring Hair Quantity, Hair Loss, and Hair Device for Measuring Hair Quantity, Hair Loss, and Hair Growth, Dermatologic Surgery 2008, 34:1-12Growth, Dermatologic Surgery 2008, 34:1-12

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CROSS SECTION TRICHOMETRYCROSS SECTION TRICHOMETRYPERFORMED IN THE OFFICEPERFORMED IN THE OFFICE

is equivalent tois equivalent to

DRY HAIR WEIGHT MEASUREMENTDRY HAIR WEIGHT MEASUREMENT

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DEMARCATE A STANDARD-SIZEDDEMARCATE A STANDARD-SIZED AREA OF SCALP AREA OF SCALP

2 x 2 cm

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• • Isolate and gather the hairs into a Isolate and gather the hairs into a bundlebundle

• • Measure the cross sectional area of Measure the cross sectional area of the bundlethe bundle

2 x 2 cm

1 x 2 mm

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CROSS SECTIONAL AREACROSS SECTIONAL AREAwill fluctuate ifwill fluctuate if

Diameter increasesDiameter increasesDiameter decreasesDiameter decreases

A hair falls outA hair falls outNew hair emergesNew hair emerges

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DESIGN A DEVICE THAT WILLDESIGN A DEVICE THAT WILLCAPTURE - COMPRESS – COMPACTCAPTURE - COMPRESS – COMPACT

AND THENAND THENMEASUREMEASURE

THE CROSS SECTIONAL AREA OF THE BUNDLETHE CROSS SECTIONAL AREA OF THE BUNDLE

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THE IDEAL DEVICE THE IDEAL DEVICE shouldshould

1.1. Always compress the bundle with the same exact load…Always compress the bundle with the same exact load… regardless of the bundle size regardless of the bundle size

2.2. Compact the bundle completely …but not damageCompact the bundle completely …but not damage the hair the hair

3.3. Apply the load with incremental mechanical precisionApply the load with incremental mechanical precision

4.4. Include a precise scientific measuring elementInclude a precise scientific measuring element

5.5. Be easy-to-use and widely availableBe easy-to-use and widely available

6.6. Not require hair be cutNot require hair be cut

7.7. Not require a physician operatorNot require a physician operator

8.8. Generate results in less than 5 minutesGenerate results in less than 5 minutes

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EARLY PROTOTYPEEARLY PROTOTYPE

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HAIR CAPTURE ELEMENTHAIR CAPTURE ELEMENT(HOOK AND AVIL)(HOOK AND AVIL)

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HAIR IS CAPTURED IN HAIR IS CAPTURED IN RECTANGULAR CHAMBERRECTANGULAR CHAMBER

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TURN KNOB TO APPLY LOADTURN KNOB TO APPLY LOAD

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BUNDLE ISBUNDLE ISCOMPRESSED & COMPACTEDCOMPRESSED & COMPACTED

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CROSS-SECTIONAL AREACROSS-SECTIONAL AREA IS DISPLAYED ON LED SCREENIS DISPLAYED ON LED SCREEN

mm2 HAIR per 4 cm2 SCALP

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FOUR CONSIDERATIONSFOUR CONSIDERATIONSBundle cross sectional areaBundle cross sectional area

DiameterDiameterDensityDensity

Hair weightHair weight

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HOW WELL DOES HOW WELL DOES

BUNDLE CROSS SECTIONBUNDLE CROSS SECTION

CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN

DIAMETER?DIAMETER?

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3-0 80 60 40 20

4-0 20 40 60 80 60 40 20

5-0 20 40 60 80 60 40 20

6-0 20 40 60 80

3.813.81 3.633.63 3.073.07 2.702.70 2.362.36 2.142.14 2.032.03 1.651.65 1.371.37 1.261.26 1.091.09 .82.82 .66.66

STRANDS OF SILK SUTURE MATERIAL

BUNDLE CROSS SECTIONBUNDLE CROSS SECTION PRECISELY CORRELATES WITH PRECISELY CORRELATES WITH

FILAMENT DIAMETERFILAMENT DIAMETER

BUNDLE CROSS SECTION

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HOW WELL DOES HOW WELL DOES BUNDLE CROSS SECTIONBUNDLE CROSS SECTION

CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN

DENSITY?DENSITY?

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STRANDS of SILK 20 40 60 80 100 120 140 160

BUNDLE CROSS SECTION .36 .75 1.17 1.58 1.93 2.36 2.75 3.14

RATIO BUNDLE CROSS SECTION :: STRANDS

.018 .019 .020 .020 .019 .020 .020 .020

BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES TO THEPRECISELY CORRELATES TO THE

NUMBER OF STRANDSNUMBER OF STRANDS

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HOW WELL DOESHOW WELL DOES

BUNDLE CROSS SECTION BUNDLE CROSS SECTION

CORRELATE WITH CORRELATE WITH

DRY WEIGHT?DRY WEIGHT?(using silk filaments)(using silk filaments)

THE INDUSTRY GOLD STANDARDTHE INDUSTRY GOLD STANDARD

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STRANDS ofSILK

150150 148148 146146 144144 142142 140140 138138

GRAMS .2754.2754 .2728.2728 .2705.2705 .2672.2672 .2546.2546 .2590.2590 .2565.2565

BUNDLE CROSSSECTION

2.742.74 2.722.72 2.712.71 2.652.65 2.622.62 2.522.52 2.482.48

RATIO GRAMS :: BUNDLE CROSS

SECTION

.101.101 .100.100 .100.100 .101.101 .101.101 .103.103 .103.103

BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE

WEIGHT OF BUNDLEWEIGHT OF BUNDLE

RATIO STRANDS :: BUNDLE CROSS

SECTION

5555 5454 5454 5454 5454 5656 5656

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SAME STUDY USING SAME STUDY USING

HAIRHAIRINSTEAD OF INSTEAD OF

SILK FILAMENTSSILK FILAMENTS

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NUMBER OF HAIRS

xx X X MINUSMINUS

22

X X MINUSMINUS

44

X X MINUSMINUS

88

X X MINUSMINUS

1010

X X MINUSMINUS

1212

X X MINUSMINUS

1414

X X MINUSMINUS

1616

X X MINUSMINUS

2020

GRAMS .5536.5536 .5528.5528 .5519.5519 .5511.5511 .5506.5506 .5494.5494 .5480.5480 .5467.5467 .5434.5434

BUNDLE CROSSSECTION mm2

2.082.08 2.042.04 1.981.98 1.951.95 1.941.94 1.921.92 1.891.89 1.871.87 1.821.82

BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE

WEIGHT OF BUNDLEWEIGHT OF BUNDLE

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HOW WELL DOESHOW WELL DOES

BUNDLE CROSS SECTION BUNDLE CROSS SECTION

CORRELATE WITH CORRELATE WITH

CLINICAL SEVERITY?CLINICAL SEVERITY?

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THE COHEN SEVERITY SCALETHE COHEN SEVERITY SCALE MINIMALMINIMAL MILDMILD Much more hair than skin More hair than skinMuch more hair than skin More hair than skin

MODERATE SEVERE MODERATE SEVERE More skin than hair Much more skin than hairMore skin than hair Much more skin than hair

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SEVERITY SCORESEVERITY SCORE HAIR MASS INDEXHAIR MASS INDEX

Patient #1Patient #1 minimalminimal 4747

Patient #2Patient #2 minimalminimal 4444

Patient #3Patient #3 minimalminimal 4444

Patient #4Patient #4 mildmild 3636

Patient #5Patient #5 mildmild 3333

Patient #6Patient #6 mildmild 3333

Patient #7Patient #7 moderatemoderate 2525

Patient #8Patient #8 moderatemoderate 2828

Patient #9Patient #9 moderatemoderate 2626

Patient #10Patient #10 severesevere 2222

Patient #11Patient #11 severesevere 2020

Patient #12Patient #12 severesevere 2121

Severity Score and Hair Mass IndexNo hair loss: HMI = 75 to 100

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EARLY PROTOTYPEEARLY PROTOTYPE

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HairCheckHairCheckCROSS SCTION TRICHOMETERCROSS SCTION TRICHOMETER

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CONCEPT B

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CONCEPT B

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DISPLAYS HAIR MASS INDEX DISPLAYS HAIR MASS INDEX mmmm22 hair / cm hair / cm22 scalp x 100 scalp x 100

Normal rangeNormal rangeHMI = HMI = 75 to 100 75 to 100

(FINE to COARSE HAIR)(FINE to COARSE HAIR)

SensitivitySensitivityDevice will detect the difference of 3 hairsDevice will detect the difference of 3 hairs

in a 600 hair bundlein a 600 hair bundle

LimitationLimitationHair must be at least 1” longHair must be at least 1” long

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LOCATOR STRIPLOCATOR STRIPENSURES RETURN TO SAMEENSURES RETURN TO SAME

NON-TATTOOED SITENON-TATTOOED SITE

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3 STEP MEASUREMENT3 STEP MEASUREMENT

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CLINICAL APPLICATIONSCLINICAL APPLICATIONSTracking the Hair Mass IndexTracking the Hair Mass Index

HMIHMI

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BASELINEBASELINENo treatmentNo treatment

49497575 6161

18 MONTHS LATER18 MONTHS LATER

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BASELINEBASELINESTART = FIN, MNX, LASERSTART = FIN, MNX, LASERIRON SUPPLEMENT, ETCIRON SUPPLEMENT, ETC..

49497575 8686

12 MONTHS LATER12 MONTHS LATER

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BASELINEBASELINEREDUCE FINASTERIDEREDUCE FINASTERIDETO HALF DOSAGETO HALF DOSAGE

49497575 7575

8 MONTHS LATER8 MONTHS LATERWORKS JUST AS WELLWORKS JUST AS WELL

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BASELINEBASELINENEW DRUG,NEW DRUG,

UNKNOWN SIDE EFFECTSUNKNOWN SIDE EFFECTS

4949

7575 6060

18 MONTHS LATER18 MONTHS LATERNEW DRUG,NEW DRUG,

MIGHT CAUSE HAIR LOSSMIGHT CAUSE HAIR LOSS

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PRE OPPRE OPHAIR TRANSPLANTATION

49493333 6363

18 MONTHS LATER18 MONTHS LATER

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6 MONTHS AFTER6 MONTHS AFTERCHILDBIRTHCHILDBIRTH

49495555 7777

18 MONTHS AFTER18 MONTHS AFTERCHILDBIRTHCHILDBIRTH

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MALE with EARLY BALDINGMALE with EARLY BALDINGVertex = 50% LOSS = VISIBLEVertex = 50% LOSS = VISIBLE

Mid scalp = 12% LOSS = NOT VISIBLEMid scalp = 12% LOSS = NOT VISIBLE(86/98 X 100 = 88%)(86/98 X 100 = 88%)

8686 9898

4949

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FEMALE with HAIR LOSSFEMALE with HAIR LOSS(occiput & mid scalp are about equal)(occiput & mid scalp are about equal)

CONCLUSION = Hair Loss is DIFFUSE not PATTERNCONCLUSION = Hair Loss is DIFFUSE not PATTERN

7474

7777

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BASELINEBASELINE Start Start treatment treatment

49496565 7575

8 MONTHS LATER8 MONTHS LATER““Doc, thisDoc, this

treatment’s not working.”treatment’s not working.”

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BASELINEBASELINE Start Start treatmenttreatment

49496565 6565

8 MONTHS LATER8 MONTHS LATER““Doc, thisDoc, this

treatment treatment reallyreally works!” works!”

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CROSS SECTION TRICHOMETRYCROSS SECTION TRICHOMETRY

• Measure the amount of hair in an area of scalpMeasure the amount of hair in an area of scalp• Measure and track shedding (effluvium) Measure and track shedding (effluvium) • Measure and track thinning (pattern balding) Measure and track thinning (pattern balding) • Measure the efficacy of a device or drugMeasure the efficacy of a device or drug• Measure response to iron Rx, thyroid, etc.Measure response to iron Rx, thyroid, etc.• Measure HT resultsMeasure HT results• Determine if a drug causes hair lossDetermine if a drug causes hair loss• Detect balding many years in advanceDetect balding many years in advance• Technology was developed at UM Derm Technology was developed at UM Derm • Used by approximately 300 physicians internationallyUsed by approximately 300 physicians internationally

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ENDEND

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NORWOOD SYSTEMNORWOOD SYSTEM

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CAN THE DEVICECAN THE DEVICEBE USED TOBE USED TO

MEASUREMEASURE

HAIR DAMAGE?HAIR DAMAGE?

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If you If you PERM, DYE, HEAT DRY & SUN EXPOSEPERM, DYE, HEAT DRY & SUN EXPOSEactively growing hair over a period of timeactively growing hair over a period of time

TheThe DISTAL DISTAL shaft will receive more insults shaft will receive more insults thanthan thethe PROXIMAL PROXIMAL shaft, andshaft, and

BREAKAGEBREAKAGE will occur in will occur in DISTALDISTAL shaft. shaft.

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THEREFORETHEREFORE

We can incrementally measure We can incrementally measure the bundlethe bundle’’s X-section along its length s X-section along its length

to detect the absence of to detect the absence of DISTALDISTAL hair shafts. hair shafts.

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BUNDLE OF BROKEN HAIRBUNDLE OF BROKEN HAIR

X-sect = 1.73 sq mmX-sect = 1.73 sq mm

X-sect = 2.06 sq mmX-sect = 2.06 sq mm

X-sect = 3.89 sq mmX-sect = 3.89 sq mm

X-sect = 4.54 sq mmX-sect = 4.54 sq mm

Skin surface

2 cm

5 cm

7 cm

10 cm

Unbroken hairs

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If the X-section is 1.73 mmIf the X-section is 1.73 mm2 2 at 10 cm at 10 cm

and 4.54 mmand 4.54 mm2 2 at the skin surface…at the skin surface…

1.73 divided by 4.54 = .381.73 divided by 4.54 = .38

WE CAN CONCLUDEWE CAN CONCLUDE

THERE IS 38% HAIR BREAKAGETHERE IS 38% HAIR BREAKAGE

@ 10 CM FROM THE SCALP@ 10 CM FROM THE SCALP

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The size of the bundle has no relevance. No scalp The size of the bundle has no relevance. No scalp demarcating measurement is required.demarcating measurement is required.

Performance of aPerformance of a HAIR DAMAGE HAIR DAMAGE measurement measurement takes about 2 minutes. takes about 2 minutes.

Hair may be wet or dry.Hair may be wet or dry.

No training or experience is required.No training or experience is required.

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