••• Grand rounds 2015
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Transcript of ••• Grand rounds 2015
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
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.
www.howtomeasurehair.comwww.howtomeasurehair.com
BASICS of HAIR BASICS of HAIR Loss & GrowthLoss & Growth
A quick reviewA quick review
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
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
HAIR DIAMETERHAIR DIAMETER Fine = 60 micronsFine = 60 micronsAverage = 70 micronsAverage = 70 microns Coarse = 80 microns Coarse = 80 microns
NORMAL SCALPNORMAL SCALP
ALL HAIRS ARE THE SAME DIAMETERALL HAIRS ARE THE SAME DIAMETER
DIAMETERDIAMETERMEASUREMENTMEASUREMENT
NON-ASIAN HAIR HAS TWO NON-ASIAN HAIR HAS TWO DIAMETERSDIAMETERS
ASIANASIAN AFRICANCAUCASIAN
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
Length is determined by personal styling. Length is determined by personal styling.
Length changes with every haircut.Length changes with every haircut.
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
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
A full-sized hair falls out - EffluviumA full-sized hair falls out - EffluviumFollicle intact - activity out of syncFollicle intact - activity out of sync
SHEDDINGSHEDDING
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
HORSESHOE FRINGEHORSESHOE FRINGE
ALL HAIRS ARE THE SAME DIAMETERALL HAIRS ARE THE SAME DIAMETER
AREA AREA of of
THINNINGTHINNING
WIDE VARIATION IN WIDE VARIATION IN DIAMETERDIAMETER
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
FOLLICULAR UNITSFOLLICULAR UNITS
NORMAL GROUPING = 4, 3, 2, 1NORMAL GROUPING = 4, 3, 2, 1
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.
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
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
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
EVIDENCE BASEDEVIDENCE BASEDTREATMENT TREATMENT
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
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
FOUR POPULAR AGA TREATMENTSFOUR POPULAR AGA TREATMENTS
MINOXIDILMINOXIDILFINASTERIDEFINASTERIDE
LASERLASERPRPPRP
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
FDA-required EVIDENCEFDA-required EVIDENCE
DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT
GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION
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
Dry Hair Weight Dry Hair Weight AN AN
ACCURATE ACCURATE MEASUREMEASURE
OF HAIR MASSOF HAIR MASS(measures both density & diameter)(measures both density & diameter)
FDA required EVIDENCEFDA required EVIDENCE
DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT
GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION
DENSITY COUNTDENSITY COUNT
COUNT THE HAIRS PER SURFACE COUNT THE HAIRS PER SURFACE AREA OF SKINAREA OF SKIN
ANDROGENETIC ALOPECIA - diameter reduces in size
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
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
FDA-required EVIDENCEFDA-required EVIDENCE
DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT
GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION
GLOBAL PHOTOGRAPHY
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!
GLOBAL PHOTOGRAPHY
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
FDA-required EVIDENCEFDA-required EVIDENCE
DRY HAIR WEIGHTDRY HAIR WEIGHTSURFACE DENSITY COUNTSURFACE DENSITY COUNT
GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHYPATIENT SELF EVALUATIONPATIENT SELF EVALUATION
A A TOTALLY SUBJECTIVETOTALLY SUBJECTIVE
MEASUREMEASUREOF HAIR MASSOF HAIR MASS
(worthless?)(worthless?)
How does How does EVIDENCEEVIDENCE
required by the FDArequired by the FDA
compare withcompare withEVIDENCEEVIDENCE
obtained in the office?obtained in the office?
Clinical PhotographyClinical Photography
Random micro-image of scalpRandom micro-image of scalpwith untrimmed hairwith untrimmed hair
Patient self evaluationPatient self evaluation
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
CROSS SECTION TRICHOMETRYCROSS SECTION TRICHOMETRYPERFORMED IN THE OFFICEPERFORMED IN THE OFFICE
is equivalent tois equivalent to
DRY HAIR WEIGHT MEASUREMENTDRY HAIR WEIGHT MEASUREMENT
DEMARCATE A STANDARD-SIZEDDEMARCATE A STANDARD-SIZED AREA OF SCALP AREA OF SCALP
2 x 2 cm
• • 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
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
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
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
EARLY PROTOTYPEEARLY PROTOTYPE
HAIR CAPTURE ELEMENTHAIR CAPTURE ELEMENT(HOOK AND AVIL)(HOOK AND AVIL)
HAIR IS CAPTURED IN HAIR IS CAPTURED IN RECTANGULAR CHAMBERRECTANGULAR CHAMBER
TURN KNOB TO APPLY LOADTURN KNOB TO APPLY LOAD
BUNDLE ISBUNDLE ISCOMPRESSED & COMPACTEDCOMPRESSED & COMPACTED
CROSS-SECTIONAL AREACROSS-SECTIONAL AREA IS DISPLAYED ON LED SCREENIS DISPLAYED ON LED SCREEN
mm2 HAIR per 4 cm2 SCALP
FOUR CONSIDERATIONSFOUR CONSIDERATIONSBundle cross sectional areaBundle cross sectional area
DiameterDiameterDensityDensity
Hair weightHair weight
HOW WELL DOES HOW WELL DOES
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN
DIAMETER?DIAMETER?
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
HOW WELL DOES HOW WELL DOES BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN
DENSITY?DENSITY?
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
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
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
SAME STUDY USING SAME STUDY USING
HAIRHAIRINSTEAD OF INSTEAD OF
SILK FILAMENTSSILK FILAMENTS
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
HOW WELL DOESHOW WELL DOES
BUNDLE CROSS SECTION BUNDLE CROSS SECTION
CORRELATE WITH CORRELATE WITH
CLINICAL SEVERITY?CLINICAL SEVERITY?
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
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
EARLY PROTOTYPEEARLY PROTOTYPE
HairCheckHairCheckCROSS SCTION TRICHOMETERCROSS SCTION TRICHOMETER
CONCEPT B
CONCEPT B
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
LOCATOR STRIPLOCATOR STRIPENSURES RETURN TO SAMEENSURES RETURN TO SAME
NON-TATTOOED SITENON-TATTOOED SITE
3 STEP MEASUREMENT3 STEP MEASUREMENT
CLINICAL APPLICATIONSCLINICAL APPLICATIONSTracking the Hair Mass IndexTracking the Hair Mass Index
HMIHMI
BASELINEBASELINENo treatmentNo treatment
49497575 6161
18 MONTHS LATER18 MONTHS LATER
BASELINEBASELINESTART = FIN, MNX, LASERSTART = FIN, MNX, LASERIRON SUPPLEMENT, ETCIRON SUPPLEMENT, ETC..
49497575 8686
12 MONTHS LATER12 MONTHS LATER
BASELINEBASELINEREDUCE FINASTERIDEREDUCE FINASTERIDETO HALF DOSAGETO HALF DOSAGE
49497575 7575
8 MONTHS LATER8 MONTHS LATERWORKS JUST AS WELLWORKS JUST AS WELL
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
PRE OPPRE OPHAIR TRANSPLANTATION
49493333 6363
18 MONTHS LATER18 MONTHS LATER
6 MONTHS AFTER6 MONTHS AFTERCHILDBIRTHCHILDBIRTH
49495555 7777
18 MONTHS AFTER18 MONTHS AFTERCHILDBIRTHCHILDBIRTH
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
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
BASELINEBASELINE Start Start treatment treatment
49496565 7575
8 MONTHS LATER8 MONTHS LATER““Doc, thisDoc, this
treatment’s not working.”treatment’s not working.”
BASELINEBASELINE Start Start treatmenttreatment
49496565 6565
8 MONTHS LATER8 MONTHS LATER““Doc, thisDoc, this
treatment treatment reallyreally works!” works!”
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
ENDEND
NORWOOD SYSTEMNORWOOD SYSTEM
CAN THE DEVICECAN THE DEVICEBE USED TOBE USED TO
MEASUREMEASURE
HAIR DAMAGE?HAIR DAMAGE?
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.
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.
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
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
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.