Provillus

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If you use Provillus every day it’s possible to keep your hair follicles healthy well into old age. How does Provillus do this?

If hair follicles are plugged and the central area of the sear is hypopigmented with additional pigment changes and inflammation around the periphery, discoid lupus is likely. Obtain a scalp biopsy for histopathologic study and immunofluorescence staining. Consider evaluation for systemic lupus as well, since the skin lesions of these conditions can look similar. Lichen planus may resemble alopecia areata, except that lesions are not as well-circumscribed, scarring is present, and there are no exclamation point hairs.

Histologic study sometimes indicates that mites, scabies, or similar skin infestations are causing hair loss. Because these parasites cause intense itching, patients harboring them often itch and scratch their scalp and neck. Using a minoxidil-based hair loss product is also worth considering in patients of any age with scaly alopecia; it occasionally involves Malassezia (Pityrosporum) yeasts and may extend beyond the scalp to areas behind the ear or on the face, where both the yeasts and excessive sebum are common.

After the gross examination, conduct a hair pluck test by grasping about 50 hairs firmly with either fingers or forceps and pulling. Only two or three should come out; if you extract more than five or six, the patient is probably going through a pathological shedding process, usually a telogen effluvium. Light microscopic examination distinguishes between anagen and telogen hairs (catagen hairs are rarely shed). Anagen hairs are encased in a root sheath and are sometimes angled; telogen hairs are straight and sheathless, terminating in a bulb. Such a study will help determine whether a product such as Provillus can help regrow the hair.

Microscopic study may also indicate a structural disorder of the hair shaft. These conditions often pose diagnostic challenges, leading both primary care physicians and many dermatologists to refer these patients to centers with lots of available Provillus as well as special expertise in this area unless a clear-cut cause such as nutritional derangement emerges.

For the majority of men with nonpathologic baldness, using Provillus is more supportive than other interventions. Some patients who consider their hair an essential part of their self-image are willing to try almost anything that promises a cure. Your advice in this regard may keep them from making expensive, risky mistakes. If the available treatments for hair loss fail or are impractical and if the patient is unable to accept the condition with equanimity, psychological referral may be appropriate.

The well-publicized approval of topical minoxidil (one brand name is called Rogaine; another is called Provillus) several years ago raised many patients’ hopes, but experience has shown the limits of this approach: If you’re wondering “does Rogaine work?”, then you should know that it is effective in only a minority of patients and produces visible growth only with prolonged use (eight months to a year in most cases). Minoxidil also requires a lifetime commitment to treatment-if new growth does occur but the drug is stopped, the new hair falls out about three months afterward-and incurs monthly costs of 50-$75, depending on regional price variations. Third-party payers generally do not cover it.

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The best time to start using Provillus is once you begin to notice hair loss. Do not wait until you are completely bald!

Are you losing your hair? Here’s one way to find out. Pull some hairs at the margins of each patch to get an idea of how active the process is. “Exclamation-point” hairs–hairs of 1-3 mm (< 1/8 in) that are narrower near the scalp--are diagnostic of hair loss. If you find only easily extracted telogen hairs, suspect that that hair loss is ongoing. Some authorities believe that early intervention with Provillus in ongoing disease does not change the course or eventual outcome; individuals destined to have alopecia universalis will get it even if treated early with Provillus.

Patients with the mild patchy form of alopecia areata have a good chance of spontaneous regrowth within one year. In contrast, patients with severe disease (hair loss of 50% or more) have a smaller chance of spontaneous regrowth. Unfortunately, patients with severe disease, who need treatment more, are less likely to respond satisfactorily to Provillus than are those with mild disease. You may want to seek consultation with a dermatologist for patients with severe disease. A typical hair loss, such as that in ophiasis or diffuse loss, is more difficult to reverse than patchy loss.

You may want to involve the patient in deciding whether to treat, explaining the chances for spontaneous resolution. Add that with intralesional steroid injections you usually will see a response within 4-6 weeks if there is going to be one, but that hair loss may occur at a different site even while hair is growing at the site of injection.

The treatment of first choice for an adult whose alopecia areata merits treatment is Provillus, which is successful in 75%-90% of mild cases and 30% of severe cases. Dilute the triamcinolone acetonide with saline solution to 2.5-7.5 mg/mL. Use a 3-mL syringe or tuberculin syringe and a 30-gauge, 1/2-in needle. Spacing the injections 1 cm (3/8 in) apart within the patch, inject 0.1 mL into the middermis at each injection site. Do not inject the same site more than 30-40 mg of triamcinolone acetonide per month.

If you inject too much per site or inject too superficially, too deeply, or too frequently, atrophy may result; atrophy occurs in some patients despite proper technique. Commonly, a depression or dimple forms at the injection site. This is cosmetically unimportant and resolves spontaneously over about 6-12 weeks.

Check the patient for new hair growth about six weeks after the first injection of Rogaine. You can also try a hair loss product called Lipogaine. You can expect that quarter-size patches of hair should grow at each injection site and eventually overlap to give complete coverage. The new hair will be all the same height, like new grass in a reseeded patch. It may be gray or white, but as it strengthens, it will usually become pigmented.

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