Hair Loss Treatment

FOR MEN

In the past few years, medicine has made tremendous strides in the treatment of men's hair loss. With the advent of 5-a-reductase inhibitors such as Propecia and the evolution of surgical hair restoration, for many, living with noticeable hair loss is no longer inevitable. For the first time in the history of mankind it is now possible to stop or slow the progression of hair loss and to replace lost hair through surgery with completely natural results. However, with that said the vast majority of hair loss treatments being marketed today are still nothing but "snake oils."

You've all seen the ads in the back of men's magazines, you've heard the commercials on the radio and you've seen the infomercials promoting miracle treatments for hair loss. The bottom line is that the vast majority of advertised "treatments" do not work for the prevention and treatment of hair loss. If a hair loss treatment is not approved by the FDA or recommended by The American Hair Loss Association, chances are you are wasting your precious time and money. Remember that successful treatment of hair loss is greatly dependent on early intervention. It is critical to begin treatment with an effective product as soon as you notice the onset of hair loss.

The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

Finasteride, Proscar/Propecia

Finasteride is the generic name for the brand name drugs Proscar and Propecia Finasteride was originally developed by Merck as a drug to treat enlarged prostate glands (Proscar). During the trials on men with prostate problems an intriguing side effect of hair growth was observed. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck and Company decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness.

On December 22, 1997 the FDA approved a 1mg dose of finasteride for the treatment of androgenic alopecia in men (male pattern baldness). Propecia is the first drug in history to effectively treat male pattern baldness in the vast majority of men who use it.

How Propeica/Finasteride Works:

Finasteride's hair-raising success is due to its ability to specifically inhibit Type II 5-alpha-reductace, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Propecia's 1 mg dose of finasteride can effectively lower DHT levels by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness .This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking it the drug during clinical trials. 65% of trial participants experienced what was considered a substantial increase of hair growth.

At this point, the only truly effective medically proven way to arrest the hair loss process is to lower DHT levels. The American Hair Loss Association recommends finasteride as the first line of attack for all men interested in treating their male pattern baldness.

Minoxidil (loniten)

Minoxidil (loniten) was the first drug approved by the FDA for the treatment of male pattern baldness. For many years, minoxidill, in pill form, was widely used to treat high blood pressure. Just like finasteride researchers discovered a very interesting side effect of the drug. People taking the medication were growing hair in unexpected places like on their cheeks and the back of their hands, some even grew hair on their foreheads.

Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. Well it did to varying digress depending on the extent of the hair loss, but at the time it was revolutionary.

While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair, most informed experts see it as a relatively marginally effective drug in the fight against hair loss. Since minoxidil has no effect on the hormonal process of hair loss it's positive effects are at best temporary and usually yield somewhat disappointing long-term results.

With the said, The American Hair Loss Association still recommends the drug for those who have not responded favorably to finasteride treatment or for those who would like to add another product to their regime. The AHLA does not recommend minoxidil as the first line of attract for men suffering with male pattern baldness, but does recognize it as an effective treatment for a small percentage of its users.

FOR WOMEN
Women are in a "Catch-22" position when it comes to drug treatments for androgenetic alopecia. While many drugs may work to some degree for some women, doctors are reluctant to prescribe them, and drug companies aren't exactly falling over themselves to test existing or new drugs specifically for their ability to prevent and treat female pattern baldness.

Physicians are reluctant to use systemic treatment (a pill or other form of internal treatment that affects your entire system) unless they know that the hair loss is due to an excess of androgen in the system or a sensitized "over-response" to the so-called "normal" amounts of androgen in the system. That's because these systemic treatments may lower the body's androgen levels. Therefore, physicians often choose topical treatments (those that are applied directly to the scalp).

The best results from treatment happen when you begin treatment as soon as possible after the hair loss begins because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will at least help prevent further hair loss and encourage some hair regrowth from those follicles that have been dormant but are still viable, Stopping treatment will result in the hair loss resuming if the androgens aren't kept in check in some other way. Maintaining your vitamin and mineral levels helps while you're on anti-androgen medications.

As always, treatments have the best chance of being effective if they are geared to the cause of the hair loss as well as to triggering hair growth.

Currently there is only one FDA approved treatment for female pattern hair loss.

Below you will find a list of treatments currently being used to treat hair loss in women. Some of these drugs have not been approved by the FDA for this particular application, however they have all been approved for other applications and are used “off label” to treat hair loss.

The effectiveness of these agents and methods vary from person to person, but many women have found that using these treatments have made a positive difference in their hair and their self-esteem.

Minoxidil 2% Topical Treatment

Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil experienced excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth. The amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.

Women with diffuse androgenetic alopecia can use minoxidil and it actually seems to be more effective for women compared to men. The makers of minoxidil recommend women only use the 2% concentration of minoxidil and not 5%. The makers of minoxidil have not received FDA approval for promoting 5% minoxidil or minoxidil extra strength for use by women. Many dermatologists do prescribe minoxidil 5% for women with androgenetic alopecia if used under their supervision. Some small clinical trials have been conducted on 5% minoxidil for androgenetic alopecia in women showing that indeed the 5% solution is significantly more effective in both retaining and regrowing hair than the 2 % solution.

In clinical studies of mostly white women aged 18-45 years with mild to moderate degrees of hair loss, the following response to minoxidil was reported: 19% of women reported moderate hair growth after using minoxidil for 8 months (19% had moderate regrowth; 40% had minimal regrowth). This compares with 7% of women reporting moderate hair regrowth after using the placebo, the liquid without the active ingredient in it, for 8 months (7% had moderate regrowth, 33% had minimal regrowth).

The American Hair Loss Association recognizes the limitations of topical minoxidil treatment in the fight against female androgenic alopecia (female pattern baldness) therefore we recommend that you seek out the advice of an informed hair loss specialist that can provide you with information on the potential treatments listed on this website.

Androgen Receptor Inhibitors.

Aldactone / Spironolactone

Spironolactone or the more popular brand name Aldactone is in a class of drugs called potassium-sparing diuretics (water pill). It is used to reduce the amount of fluid in your body without causing the loss of potassium. It is also used to treat hypertension (high blood pressure) and edema (swelling) and used to treat potassium deficiency and hyperaldosteronism (a hormonal disorder).

Spironolactone is an antiandrogen that works in two ways. Primarily it slows down the production of androgens in the adrenal glands and ovaries. Secondly it blocks the action of androgens in part by preventing dihydrotestosterone from binding to its androgenetic receptor.

Tagamet / Cimetidine

Cimetidine sold under the brand name Tagamet, belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block dehydrotestosterone form binding the follicle receptor sites.

Cimetidine has been used to treat hirsuitism in women (excess facial hair growth) and has been studied in women with androgenic alopecia showing promising results. Because of the high doses needed to achieve it’s hair raising results, men should not take cimettidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.

Cyproterone Acetate

Cyproterone Acetate is used to reduce sex drive in men which have excessive sex drive and for the treatment of pronounced sexual aggression. It is also prescribed to treat severe hirsuitism in woman of childbearing age and also androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of DHT dihydrotestosterone to its receptors.

Cyproterone acetate is not available in the US and is thought of as one of the last resorts for treating female pattern hair loss because of its possible toxicity and long term side effects.

As with any drug side effects other than those listed may occur, contact your doctor if you are experiencing a side effect that is unusual or particularly bothersome

Estrogen/Progesterone

Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for androgenetic alopecia for women in menopause or whose estrogen and/or progesterone are lacking for other reasons.

Oral Contraceptives

Since birth control pills decrease the production of ovarian androgens, they can be used to treat women's androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers over thirty-five who take "the pill" are at higher risk for blood clots and other serious conditions. Discuss your medical and lifestyle history thoroughly with your doctor. Contraceptive pills come in various hormonal formulations, and your doctor can determine which is right for your specific needs, switching pills if necessary until you are physically and emotionally comfortable with the formulation. Note: Only low androgen index birth control pills should be used to treat hair loss. High androgen index birth control pills actually contribute to hair loss by triggering it or enabling it once it's been triggered by something else.

Nizoral/Ketoconazole

Available as a topical treatment by prescription, Ketoconazole is currently used as an antifungal agent in the treatment of fungal infections. It also has anti-androgenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs (in women, the ovaries). Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1 percent version is now available over-the-counter, but it may not be as effective as the 2 percent prescription strength. There are no significant side effects.

Propecia/Proscar

The drug finasteride inhibits the enzyme 5-alpha reductase, thereby inhibiting the production of prostate-harming, follicle killing DHT. It was first marketed to treat the prostate under the brand name Proscar in 5 mg pills. In 1998, a 1 mg version with the brand name Propecia entered the market as the first pill approved by the FDA for men's hair loss. It works quite well for most men in both preventing hair loss and triggering regrowth, and it may work for some women, although women must not take it if they are pregnant and must not get pregnant while on the drug because of the risk of birth defects in a male fetus. Less than 2 percent of men experience transient sexual side effects including erectile and libido difficulties. In women these side effects do not occur.

Cyproterone Acetate with Ethinyloestradiol

Sold under the brand name Diane 35 and Diane 50, this contraceptive tablet is prescribed in Europe for women's androgenetic alopecia. The drug works by blocking some of the actions of male hormones commonly present in women. Although it's possible for the drug to stop further hair loss and trigger regrowth of hair within about a year, it needs to be used on an ongoing basis in order to maintain regrowth and eliminate hair loss. Possible side effects include breast tenderness, headaches, and decreased libido. It does have one good side effect- it helps prevent osteoporosis. The drug is a combination of cyproterone and estradiol, an estrogen. Both Diane 35 and Diane 50 contain 2 mg of cyproterone. Diane 35 contains 0.035 mg of estradiol. Diane 50 contains 0.050 mg of estradiol. The drug is as effective as, if not more than, spironolactone. Currently this drug is not available in the US

Chronic myelogenous leukemia (CML)

Chronic myelogenous leukemia is a disease in which the bone marrow makes too many white blood cells.

Chronic myelogenous leukemia (also called CML or chronic granulocytic leukemia) is a slowly progressing blood and bone marrow disease that usually occurs during or after middle age, and rarely occurs in children.

Normally, the bone marrow makes blood stem cells (immature cells) that develop into mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. The lymphoid stem cell develops into a white blood cell. The myeloid stem cell develops into one of three types of mature blood cells:

• Red blood cells that carry oxygen and other materials to all tissues of the body.
• Platelets that help prevent bleeding by causing blood clots to form.
• Granulocytes (white blood cells) that fight infection and disease

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Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell.

In CML, too many blood stem cells develop into a type of white blood cell called granulocytes. These granulocytes are abnormal and do not become healthy white blood cells. They may also be called leukemic cells. The leukemic cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur.

This summary is about chronic myelogenous leukemia. See the following PDQ summaries for more information about leukemia:

• Adult Acute Lymphoblastic Leukemia Treatment
• Childhood Acute Lymphoblastic Leukemia Treatment
• Adult Acute Myeloid Leukemia Treatment
• Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment
• Chronic Lymphocytic Leukemia Treatment
• Hairy Cell Leukemia Treatment

Possible signs of chronic myelogenous leukemia include tiredness, night sweats, and fever.

These and other symptoms may be caused by CML. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Feeling very tired.
• Weight loss for no known reason.
• Night sweats.
• Fever.
• Pain or a feeling of fullness below the ribs on the left side.

Sometimes CML does not cause any symptoms at all.

Most people with CML have a gene mutation (change) called the Philadelphia chromosome.

Every cell in the body contains DNA (genetic material) that determines how the cell looks and acts. DNA is contained inside chromosomes. In CML, part of the DNA from one chromosome moves to another chromosome. This change is called the “ Philadelphia chromosome.” It results in the bone marrow making an enzyme, called tyrosine kinase, that causes too many stem cells to develop into white blood cells (granulocytes or blasts).

The Philadelphia chromosome is not passed from parent to child.

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Philadelphia chromosome. A piece of chromosome 9 and a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on chromosome 22 where the piece of chromosome 9 attaches. The changed chromosome 22 is called the Philadelphia chromosome.

Tests that examine the blood and bone marrow are used to detect (find) and diagnose chronic myelogenous leukemia.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease such as an enlarged spleen. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the sample made up of red blood cells.

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  Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.

• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
• Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes, such as the Philadelphia chromosome.
• Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.

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  Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The patient’s age.
• The phase of CML.
• The amount of blasts in the blood or bone marrow.
• The size of the spleen at diagnosis.
• The patient’s general health.

Six types of standard treatment are used:

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors are targeted therapy drugs used to treat chronic myelogenous leukemia.

A tyrosine kinase inhibitor called imatinib mesylate is used as initial treatment for certain types of chronic myelogenous leukemia in newly diagnosed patients. It blocks an enzyme called tyrosine kinase that causes stem cells to develop into more white blood cells (granulocytes or blasts) than the body needs. Another tyrosine kinase inhibitor called dasatinib is used to treat patients with certain types of CML that have progressed, and is being studied as an initial treatment.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Donor lymphocyte infusion (DLI)

Donor lymphocyte infusion (DLI) is a cancer treatment that may be used after stem cell transplant. Lymphocytes (a type of white blood cell) from the stem cell transplant donor are removed from the donor’s blood and may be frozen for storage. The donor’s lymphocytes are thawed if they were frozen and then given to the patient through one or more infusions. The lymphocytes see the patient’s cancer cells as not belonging to the body and attack them.

Surgery

Splenectomy is surgery to remove the spleen.

Avian Influenza (Bird Flu)

Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These influenza viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Infected birds shed influenza virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated secretions or excretions or with surfaces that are contaminated with secretions or excretions from infected birds. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

Infection with avian influenza viruses in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production). However, the highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100% often within 48 hours.

Human infection with avian influenza viruses

There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Many different combinations of HA and NA proteins are possible. Each combination represents a different subtype. All known subtypes of influenza A viruses can be found in birds.

Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds, but infections with these viruses can occur in humans. The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997. Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and has been limited, inefficient and unsustained.

“Human influenza virus” usually refers to those subtypes that spread widely among humans. There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. It is likely that some genetic parts of current human influenza A viruses came from birds originally. Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans.

During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds.

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which virus caused the infection.

Studies done in laboratories suggest that some of the prescription medicines approved in the United States for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to demonstrate the effectiveness of these medicines.

Avian Influenza A (H5N1)

Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them. H5N1 virus does not usually infect people, but infections with these viruses have occurred in humans. Most of these cases have resulted from people having direct or close contact with H5N1-infected poultry or H5N1-contaminated surfaces.

Avian influenza A (H5N1) outbreaks

For current information about avian influenza A (H5N1) outbreaks, see our Outbreaks page.

Human health risks during the H5N1 outbreak

Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of detected cases of severe disease and death in humans. However, it is possible that those cases in the most severely ill people are more likely to be diagnosed and reported, while milder cases go unreported. For the most current information about avian influenza and cumulative case numbers, see the World Health Organization (WHO) avian influenza website.

Of the human cases associated with the ongoing H5N1 outbreaks in poultry and wild birds in Asia and parts of Europe, the Near East and Africa, more than half of those people reported infected with the virus have died. Most cases have occurred in previously healthy children and young adults and have resulted from direct or close contact with H5N1-infected poultry or H5N1-contaminated surfaces. In general, H5N1 remains a very rare disease in people. The H5N1 virus does not infect humans easily, and if a person is infected, it is very difficult for the virus to spread to another person.

While there has been some human-to-human spread of H5N1, it has been limited, inefficient and unsustained. For example, in 2004 in Thailand, probable human-to-human spread in a family resulting from prolonged and very close contact between an ill child and her mother was reported. In June 2006, WHO reported evidence of human-to-human spread in Indonesia. In this situation, 8 people in one family were infected. The first family member is thought to have become ill through contact with infected poultry. This person then infected six family members. One of those six people (a child) then infected another family member (his father). No further spread outside of the exposed family was documented or suspected.

Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population. If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. For more information about influenza pandemics, see PandemicFlu.gov.

No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.

Treatment and vaccination for H5N1 virus in humans

The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamivir and zanamivir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness.

Breast Implant

Over the past few years, much attention has been focused on the safety of silicone-gel-filled breast implants. Some women who have them have complained of chronic low-grade fever, fatigue, and joint pain and have attributed these discomforts to their implants.

This raised concerns about a possible connection between silicone leaking into the body and the occurrence of connective-tissue and immune-related (autoimmune) disorders such as scleroderma or rheumatoid arthritis.

Because of these and other concerns, a FDA Advisory Council panel met to review the issues. On April 16, 1992, the FDA concluded its investigation. Although the panel did not find silicone-gel-filled implants to pose a health risk, it concluded that implant manufacturers had not provided adequate data to confirm the absolute safety of the devices.

The panel announced that silicone-gel-filled implants would continue to be available, but only if saline-filled implants are not an option. For this reason, most plastic surgeons are using saline-filled implants almost exclusively.

When silicone-gel implants are used, it is only under a strict set of criteria. Patients who have silicone-gel-filled devices implanted must agree to participate in a study designed to monitor their health for five years or more after surgery. These and other research studies are now underway to answer questions regarding the safety and long-term effects of these devices.

Saline-filled implants are still available without restriction for reconstruction. However, the FDA is also expected to require manufacturers of these devices to submit safety and effectiveness information in the near future.

Conflicting Evidence on Breast Implants

In 1999, the Department of Health and Human Services commissioned the Institute of Medicine (IOM) to conduct an independent review of all past and ongoing scientific research regarding the safety of silicone breast implants.

Following are the most prominent points of the report:

Positive Findings

• Silicone implants do not cause major disease
• Breast implants have improved
• Radiation doesn't harm implants and vice versa
• In general, silicone is safe

Negative Findings

• Most problems with silicone implants are local
• Breast implants do not last forever

Since the 1999 IOM report, there have been other studies published with conflicting results.

A 2001 NCI study reported that women who had breast implants (both saline- and silicone-filled) were two to three times as likely to die of brain cancer and three times as likely to die of lung cancer, compared to other plastic surgery patients.

However, a follow-up study of this report showed that the excess risk of death from brain cancer in patients with breast implants was not as high as previously believed. The researchers also showed the rates of death from this cancer may not be significantly different than in other plastic surgery patients.

And that same year, FDA scientists published a study with findings of more autoimmune disease among women with leaking breast implants compared to women with intact breast implants.

More recently reported, in 2004, scientists at the National Cancer Institute (NCI) found an increase in reported connective-tissue diseases among those with breast implants, but also found that many of the women made errors in their self-reported diagnoses. They concluded that this area needed further study.

Talk To Your Doctor About Breast Implants

While the topic of breast implants remains controversial, both types (saline- and silicone-filled) are still currently available. If you have questions about the safety of implants, talk to your plastic surgeon.

Breast Reduction Surgery

If you've got disproportionately large breasts that are causing neck pain, back pain, or other physical symptoms, you may want to consider breast reduction surgery.

According to the American Society of Plastic Surgeons, more than 88,732 women had breast reduction surgery in 2008. The procedure carries tremendous psychological effects and most women who undergo breast reduction are very satisfied with the results.

It is also important to note that this surgery isn't just for women, either. Men who have conditions such as gynecomastia (where male breasts are enlarged abnormally) also may seek a breast reduction.

Your Consultation About Breast Reduction Surgery

Before getting breast reduction surgery, you will go in for a consultation, during which time your surgeon will take a detailed medical history, including whether or not you've ever had a lump removed from your breast or any other medical conditions affecting your breasts. He or she also will take a detailed family history. You should be in good physical and mental shape in order to undergo this surgery.

It's important that you are completely honest during this consultation. That includes being completely open with your medical history. It also means being very open as to why you're seeking a breast reduction. You should expect to discuss the emotional issues you've dealt with; that is, how have you felt dealing with your breast size? How has it made you feel, physically? What types of physical conditions have you experienced?

Your surgeon may take photos of your breasts and measure them. During this time, he or she also will discuss how much breast tissue should be removed to achieve the desired results. You also will learn about how to prepare for the surgery and how to plan for your recovery. Your surgeon may prepare you for this procedure by performing a mammogram and breast exam.

How Breast Reduction Surgery Is Done

Depending on your personal situation, breast reduction surgery can be performed in an outpatient facility or you may have to stay at least one night in the hospital. In either case, you will be given general anesthesia, which means you will be put to sleep for the procedure. It's important to have someone with you who can drive you home and stay with you at least the first night if you're not staying in the hospital.

Breast reduction surgery itself will take about two to five hours, sometimes longer. Your surgeon will make an incision around your nipple, then downward on the breast, in a keyhole form. The excess skin, tissue and fat are removed and your nipple is relocated for cosmetic purposes. Your surgeon may use drainage tubes and the incision site is then stitched up. Your breasts will be wrapped in special gauze. If required, you may also wear a surgical bra.

How To Prepare for Breast Reduction Surgery

You need to be in good physical shape to ensure proper healing, so follow your surgeon's instructions on vitamins you can take before and after breast reduction surgery. Likewise, it's very important to eat well-balanced meals. This is no time for a diet!

During your preoperative consultation, your surgeon will ask about your habits, including whether you smoke or what medications you take. You may have to quit smoking for a period before and after surgery to ensure proper healing.

Likewise, you also may have to cease taking certain medications, such as aspirin or certain anti-inflammatory drugs such as Motrin or Aleve. Your surgeon will instruct you on this.

Before you undergo surgery, you'll need to get your home ready for your recovery. This should include:

• Plenty of ice
• Gauze and clean washcloths and towels
• Loose, comfortable T-shirts and blouses
• Special ointments or creams as recommended by your surgeon for the incision sites
• Telephone within reaching distance of your primary rest area
• Magazines, movies, etc.

Recovery From Breast Reduction Surgery

You will need to take at least one week off from work or school for breast reduction surgery. Some patients require two weeks, but each situation varies. Your surgeon will instruct you on follow-up appointments to remove bandages and stitches.

If you are a physically active person, you will not be able to resume your activity for at least one month after surgery. It's very important that you realize the emotional impact of surgery: a lot of people experience depression, but this is normal! Make sure you communicate with your doctor about all your concerns.

Breast Reduction Surgery Complications and Side Effects

After breast reduction surgery, you should expect to feel tired and have breast pain. This is normal!

Your surgeon will give you an oral painkiller to ease you through the first few days after surgery. You should avoid heavy lifting at all costs.

It's important to note that breast reduction surgery will cause scars as a normal side effect. These scars will fade over time but will never completely disappear. Scars can be made worse if you lift heavy objects prematurely. Though they are rare, some people may experience certain complications such as inadequate healing of the nipple area, which may require a skin graft.

After Breast Reduction Surgery, Contact Your Doctor Immediately:

• At the first sign of infection, including fever
• If you have any unusual discharge from the incision site (including pus)
• If any of the stitches come out before you are due to have them removed

Does Insurance Cover Breast Reduction Surgery?

The good news is yes, in most cases insurance covers breast reduction surgery. Because breast reduction is considered reconstructive, your chances of getting insurance coverage are good. But you must be sure to follow all the procedures set forth by your carrier's policy.

Your surgeon can take photos of your breasts, detailing your physical symptoms caused by enlarged breasts in a letter. But begin communicating early with your carrier and make sure you understand exactly what the carrier will cover, such as lab costs, anesthesiologist fees, etc. This will save you a headache in the long run, when you have more important things to do, like focus on your recovery.

Cosmetic Fillers and Wrinkles

Wrinkles may be proof of wisdom. But do you ever wish you didn't have to look quite so wise?

Cosmetic fillers are materials injected underneath the skin to make it fuller. After an injection, the plumper skin shows fewer wrinkles and looks younger.

Injectable cosmetic fillers have been around for decades. In recent years, medical advances have brought new versions of this wrinkle treatment to the marketplace. Newer cosmetic fillers are longer lasting, even permanent -- but do your homework before heading to the cosmetic surgeon.

The Birth of a Wrinkle

Skin is held tight and smooth by three critical components: collagen, hyaluronic acid, and elastin. These chemicals combine to create a firm, spongy meshwork under the skin surface. This elastic structure keeps the skin surface smooth and firm.

We slowly lose the integrity of the meshwork as we age. With weakness in the underlying support structure, the skin's surface loses its perfect baby-skin smoothness.

Injecting cosmetic fillers helps fill the thinned-out meshwork. They plump up the tissue underneath skin, shrinking wrinkles. The skin becomes firmer, smoother, and younger-looking.

Collagen is the oldest and best-known cosmetic filler. Newer natural and synthetic products are available, each with its own advantages and disadvantages.

Bovine Collagen Fillers

Bovine collagen is processed from the skin of cows. Approved in the 1980s as a wrinkle treatment, bovine collagen is still in wide use as a cosmetic filler.

Bovine collagen is effective and less expensive than other treatments. It can cause allergic reactions, so allergy skin testing is generally done before beginning the injections.

Collagen injections are broken down naturally by the body. Injections need to be repeated two to four times per year to maintain results.

Human Collagen Fillers

Human collagen, mass-produced from cultures of human cells, became available in 2002. Human collagen causes dramatically fewer allergic reactions, so skin testing is usually not needed. It is more expensive than bovine collagen, and injections also need to be repeated every three to six months.

Hyaluronic Acid Fillers

Hyaluronic acid is a naturally occurring polysaccharide (chain of sugars). It's a normal part of the support structure under the skin. Age depletes hyaluronic acid in the skin, but injections can replace it.

Various natural and synthetic hyaluronic acid (HA) products are available. In the newest products, the HA molecule is modified to break down more slowly. Cosmetic results can last nine months or longer. Allergic reactions are very rare.

Fat Injection Fillers

Ever wish you could move that fat from your thighs to somewhere it might look a little better? Fat injections involve removing small amounts of fat from the thighs, belly, or buttocks and injecting it under the skin of the face. The fat expands the skin, shrinking wrinkles. Because it is the patient's own tissue, there can be no allergic reaction. Results are variable, and are sometimes permanent.

Poly-L lactic Acid (Sculptra) Fillers

When injected under the skin, poly-L lactic acid (PLLA) stimulates skin cells to make collagen. Poly-L lactic acid is nontoxic, and has been widely used as a component of suture material for years.

PLLA is FDA-approved for cosmetic treatment of certain skin conditions in HIV patients. It is often legally used "off-label" to treat wrinkles in otherwise healthy people. It's considered "semi-permanent," meaning results can last for months to years.

Calcium Hydroxyapatite (Radiesse) Fillers

In 2006, the FDA approved calcium hydroxyapatite for cosmetic injection. This cosmetic filler is made of the minerals that give bone its strength and texture. These minerals are ground into tiny particles and suspended in water solution, which is injected under the skin.

In the trial that led to its approval, calcium hydroxyapatite worked significantly better and lasted longer than collagen injections to reduce severe wrinkles.

Polymethyl methacrylate (PMMA) Fillers

Polymethyl methacrylate is a new, permanent cosmetic filler. PMMA has been used for decades as a cement for bone surgery, and was recently FDA-approved as an injectable cosmetic filler.

You heard right -- we said "cement." Polymethyl methacrylate is a non-biodegradable chemical. Unlike biological products, PMMA produces permanent cosmetic results.

Botox

Botox is the brand name of a toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin can cause botulism, which you probably associate with food poisoning. Despite the fact that one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted amounts can be directly injected into specific muscles causing controlled weakening of the muscles.

The FDA approved such usage in the late 1980s upon the discovery that Botox could stop ailments like blepharospasm (uncontrolled blinking) and strabismus (lazy eye). Doctors have been using Botox for years to successfully treat wrinkles and facial creases. In April 2002, Botox gained FDA approval for treatment of moderate-to-severe frown lines between the eyebrows -- called glabellar lines. However, Botox is often used for other areas of the face as well.

How Does Botox Work?

Botox blocks signals from the nerves to the muscles. The injected muscle can no longer contract, which causes the wrinkles to relax and soften.

It is most often used on forehead lines, crow's feet (lines around the eye) and frown lines. Wrinkles caused by sun damage and gravity will not respond to Botox.

How Is a Botox Procedure Performed?

Getting Botox takes only a few minutes and no anesthesia is required. Botox is injected with a fine needle into specific muscles with only minor discomfort. It generally takes three to seven days to take full effect and it is best to avoid alcohol at least one week prior to treatment. Aspirin and anti-inflammatory medications should be stopped two weeks before treatment as well in order to reduce bruising.

How Long Does a Botox Injection Last?

The effects from Botox will last four to six months. As muscle action gradually returns, the lines and wrinkles begin to re-appear and wrinkles need to be re-treated. The lines and wrinkles often appear less severe with time because the muscles are being trained to relax.

What Are the Side Effects of Botox?

Temporary bruising is the most common side effect of Botox. Headaches, which resolve in 24-48 hours, can occur, but this is rare. A small percentage of patients may develop eyelid drooping. This usually resolves in three weeks. This usually happens when the Botox moves around so you shouldn't rub the treated area for 12 hours after injection or lay down for three to four hours.

Who Should Not Receive Botox?

Patients who are pregnant, breastfeeding, or have a neurological disease should not use Botox. Since Botox doesn't work for all wrinkles, a consultation with a doctor is recommended.

Will Health Insurance Pay for Botox?

Insurance coverage varies for Botox injections, depending largely on the medical necessity of your condition. Botox is not generally covered by insurance when used for cosmetic purposes. Check with your insurance carrier for coverage details.

Acne Treatment

Over-the-counter medications

Name of medication (click for info)	Commonly used brand names	Example product
Benzoyl Peroxide Acne.org Treatment, Neutrogena On-the-Spot, Clearasil, Oxy-10 Fostex, Clear by Design, Persa-Gel link
Salicylic Acid Stri-dex, Clearasil Clearstick, Oxy Night Watch Stri-dex Triple Action Pads with Salicylic Acid link
Sulfur Clearasil Adult Care Clearasil Adult Care Acne Fighting Cream, Tinted link
Resorcinol Clearasil Adult Care Clearasil Adult Care Acne Fighting Cream, Tinted link

Prescription treatments for acne

Name of medication (click for info)	Commonly used brand names	Cost (at drugstore.com as of 3/26/08, closest to 60g or 60ml or 60 capsule size available, rounded off to nearest dollar, generic when available)
Adapalene Differin 45g tube = $132.97 (gel) link Azelaic Acid Azelex 50g tube = $139.89 link Benzoyl Peroxide Benzac AC, Brevoxyl, Triaz, Benzaclin (benzoyl peroxide + clindamycin) 60g tube 2.5% gel = $23.99 (generic) link Clindamycin Cleocin T, Clinda-derm, Clindets, Benzaclin (clindamycin + benzoyl peroxide) 60ml bottle (1% solution) = $16.79 (generic) link
Erythromycin Akne-Mycin, A/T/S, Emgel Erycette, Eryderm, Erygel, Erymax, Ery-Sol, Erythra-Derm, ETS, Staticin, Theramycin Z, T-Stat, Benzamycin (erythromycin + benzoyl peroxide) 60g tube 2% gel = $38.65 (generic) link
Isotretinoin Accutane, Accutane Roche 60 capsules 20mg
Oral Antibiotics (Tetracycline, Minocycline, Doxycycline, Bactrim/Septra) Vibramycin (doxycycline), Minocin (minocycline), Bactrim, Septra (sulfamethoxazole-trimethoprim) 90 capsules Tetracycline 250mg = $14.99 (generic) link 90 capsules Minocycline 50mg = $36.97 (generic) link 60 capsules Doxycycline 50mg = 31.97 (generic) link 90 tablets Sulfamethoxazole-Trimethoprim (Bactrim, Septra) 80mg = $30.97 (generic) link
Oral Contraceptives Ortho Tri-Cyclen 1 month supply = $27.99 (generic: TriNessa) link
Sodium Sulfacetamide Klaron, Novacet, Sulfacet-R 118mL bottle Klaron 10% lotion = $130.79
Tazarotene Tazorac 30g tube .05% gel = $116.72 link
Tretinoin Retin-A, Retin-A Micro, Avita, Renova 45g tube .025% cream = $59.19 (generic) link
Spironolactone Spironolactone, Aldactone 90 capsules 50mg = $46.97 link

Acne myths

• Myth:

  Washing your face more often will help clear up acne

  Reality:

  Facial blemishes are not caused by dirt. Contrary to what you may have seen in commercials, pores do not get blocked from the top down due to "impurities". Rather, the walls of a pore stick together deep within the skin, starting acne formation. Far from preventing acne, frequent washing may actually irritate pores and cause them to become clogged. A washcloth can add even more irritation. The best bet is to wash very gently with bare hands, and only wash twice a day.

• Myth:

  Stress causes acne

  Reality:

  Stress may have an effect on hormones and theoretically can promote acne. However, an effective acne system is more powerful than a bout of stress any day. Some psychiatric medications may have acne as a side effect, but stress itself is no big deal. Your time is better spent determining the right course of acne treatment rather than feeling guilt about stress.

• Myth:

  Masturbation or sex causes acne

  Reality:

  This antiquated notion, originating as early as the 17th century to dissuade young people from having premarital sex, is not based on scientific evidence. A more plausible explanation may be that higher levels of androgens (male sex hormones) can cause increased sex drive. We also know that high levels of androgens can be related to more severe cases of acne. So it may be the higher androgen levels and not the associated increase in desire for sexual activity that is related to acne.

• Myth:

  The sun will help get rid of acne

  Reality:

  The sun may work in the short-term to hasten the clearing of existing acne while reddening your skin, thus blending your skin tone with red acne marks. However, a sun burn is actually skin damage. It's important to prevent damage to your skin while trying to get rid of acne. Sun exposure causes irritation which can make acne worse. People will often notice their skin breaking out as it heals from sun damage. The sun is a short-term band-aid which will often bite back with more acne in the weeks following exposure. Having said that, I don't want to give the impression that the sun is evil. It is not. We get our vitamin D from the sun for instance. Limiting sun exposure on acne prone areas of your body is most likely prudent, but some exposure from time to time is not only unavoidable, but is perfectly okay.

• Myth:

  Diet and acne are related

  Reality:

  The bottom line is we need more research. We do know that people in some indigenous societies do not experience acne whatsoever across the entire population. This is in stark contrast to the widespread presence of acne throughout all modern society. It leaves us to ponder the question of whether the indigenous people's diet contributes to their acne-free skin. Discovering a dietary way of preventing acne may be a future reality, however, we may live so differently from our hunter/gatherer ancestors that it has become close to impossible to replicate our ancestral diet. But, let's see if we can work together to come to some concensus from our own experiences. If you feel that you have cleared your acne using a particular diet, or if you are planning on attempting a diet of some kind, please post your method on the Nutrition & Holistic health message board.

Milia

Milia are tiny white bumps that occur when normally sloughed skin cells get trapped in small pockets on the surface of the skin. They are common in newborns across the nose and upper cheeks and can also be seen on adult skin. The bumps disappear as the surface is worn away and the dead skin is sloughed. In newborns, the bumps usually disappear within the first few weeks of life. However, for adults milia may persist indefinitely.

Treatment is usually not indicated in children. Adults can have them removed by a physician for cosmetic improvement.

Acne

A normal follicle looks like this:

For reasons no one completely understands, follicles, often called pores, sometimes get blocked. Sebum (oil) which normally drains to the surface gets blocked and bacteria begins to grow. Both whiteheads and blackheads start out as a microcomedone. The picture below is a microcomedone:

There are two types of acne

1. Non-inflammatory acne

Microcomedones become non-inflamed skin blemishes called comedones--either a whitehead or a blackhead:

1.a. Whitehead

When the trapped sebum and bacteria stay below the skin surface, a whitehead is formed. Whiteheads may show up as tiny white spots, or they may be so small that they are invisible to the naked eye.

1.b. Blackhead

A blackhead occurs when the pore opens to the surface, and the sebum, which contains the skin pigment melanin, oxidizes and turns a brown/black color. It is not dirt and can not be washed away. Blackheads can last for a long time because the contents very slowly drain to the surface.

A blackhead or whitehead can release its contents to the surface and heal. Or, the follicle wall can rupture and inflammatory acne can ensue (see below). This rupture can be caused by random occurrence or by picking or touching the skin. This is why it is important to leave acne prone skin relatively untouched.

2. Inflammatory acne

2.a. Papule

A papule occurs when there is a break in the follicular wall. White blood cells rush in and the pore becomes inflamed.

2.b. Pustule

A pustule forms several days later when white blood cells make their way to the surface of the skin. This is what people usually refer to as a "zit" or a "pimple".

An inflamed lesion can sometimes completely collapse or explode, severely inflaming the surrounding skin, and sometimes engulfing neighboring follicles. These lesions are called nodules or cysts:

2.c. Nodule

When a follicle breaks along the bottom, total collapse can occur, causing a large, inflamed bump that can be sore to the touch.

2.d. Cyst

Sometimes a severe inflammatory reaction can result in very large pus filled lesions.