Alopecia Areata

Have you noticed bald patches appearing on your scalp or just general thinning of the hair?? You may have Alopecia Areata, also known as autoimmune hair loss, where one or more round bald patches appear suddenly, most often on the scalp.

Image of man showing patches of hair missing as he suffers from alopecia areata
Alopecia Areata can affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. Lifetime risk is 1–2% and is independent of ethnicity.

What causes alopecia areata?
Alopecia areata is classified as an autoimmune disorder. It is characterised by immune cells flooding the area around the hair follicles. These immune cells then attack the hair and don’t allow the hair to grow. The exact mechanism is not yet understood.
The onset or recurrence of hair loss is sometimes triggered by:
• Viral infection
• Trauma
• Hormonal change
• Emotional/physical stressors
Alopecia areata can also be associated with nail changes such as pitting or ridging. Alopecia areata can be associated with other conditions such as eczema, urticaria (hives) and autoimmune thyroid issues.
Alopecia areata is clinically diagnosed by a qualified dermatologist.

The doctor may also assess the area by using a dermatoscope, if needed a biopsy may be taken to diagnose or confirm the condition.

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So what can you do for your Alopecia Areata?
There is not yet any reliable cure for Alopecia Areata and other forms of autoimmune hair loss, because spontaneous regrowth can occur.
Several topical treatments such as potent steroids used for Alopecia Areata are reported to result in temporary improvement in some people.
Another common treatment method is Intralesional injections – corticosteroid injections into patchy hair loss in the scalp, beard or eyebrows. We normally see patients every 6-8 weeks for follow up injections. Injections are easily tolerated by patients and takes no longer than a few minutes!
Oral medications may also be used but again it isn’t a cure, and ongoing treatment is key with this condition.

Say Goodbye To Hyperhidrosis (Excessive Sweating)

Do you suffer from excessive sweating, have to change your shirts multiple times a day or just from sitting doing nothing you get sweat patches? ….Then we could help you!
Hyperhidrosis also known as excessive sweating can be a very debilitating condition. It can affect people’s confidence, hygiene and also not to mention washing clothes more often!
Hyperhidrosis occurs when over-active sweat glands release a volume of sweat that is significantly more than the body’s normal requirements for cooling. There are two types of hyperhidrosis: Focal Hyperhidrosis (sweating confined to a particular area and Generalised hyperhidrosis (sweating all over the body).

Lucky we have an in clinic treatment that can help, a lot!

What can cause hyperhidrosis?
• Starts in childhood or adolescence
• May persist lifelong or improve with age
• There may be a family history
• Tends to involve armpits, palms and/or soles symmetrically
• Usually, sweating reduces at night and disappears during sleep
• Obesity
• Diabetes
• Menopause
• Overactive thyroid
• Cardiovascular disorders
• Respiratory failure

What can I do to help the condition?
General measures
• Wear loose-fitting, stain-resistant, sweat-proof garments.
• Change clothing and footwear when damp.
• Socks containing silver or copper reduce infection and odour.
• Use absorbent insoles in shoes and replace them frequently.
• Use a non-soap cleanser.
• Apply corn starch powder after bathing.
• Avoid caffeinated food and drink.
• Discontinue any drug that may be causing hyperhidrosis.
• Apply antiperspirant.
• Deodorants are fragrances or antiseptics to disguise unpleasant smells; on their own, they do not reduce perspiration.
• Antiperspirants contain 10–25% aluminium salts to reduce sweating; “clinical strength” aluminium zirconium salts are more effective than aluminium chloride.

In clinic treatment when these measures fail?
There are also some oral medications the dermatologist can prescribe. If all measures fail we can then look at anti sweating injections for under arm sweating! These types of injections are approved for hyperhidrosis affecting the armpits. It is a safe and effective treatment all done in clinic.
Unlike topical treatments, Anti Sweating Injections target sweating at its source. With a few tiny injections, Anti Sweating Injections enter the specific glands in the underarms responsible for excessive sweating. Once there, it blocks the release of a chemical that signals the perspiration.

Effectiveness has been found at 95% in Clinical studies, 1-week post treatment has shown a reduction at an average of 83%. Injection results generally last between 6 – 9 months; although some patients require re treatment after around 4 months (123 days) and others have had success for longer periods of time. An indication for another treatment is the return of symptoms.

How much does it cost???
The other great thing is because it is a medical condition Medicare will pay for some of the costs if the anti-sweating injections are performed by a dermatologist!
With such an easy treatment available it is becoming more and more common in our clinic.
With 95% improvement in sweating for around 6-9 months, what are you waiting for?!

Say goodbye to those sweat patches!

Biologics?! Hives? Psoriasis? Hidradenitis Suppurativa? There is an effective treatment!

Have you been suffering with the chronic itching of hives or are areas of your body covered in plaques of psoriasis? There is more that can be done than just topical steroids that you have probably been using for years and years with it only to really manage your condition. Topical steroids are good for acute attacks and for some do the job, but for others it just doesn’t seem to clear the psoriasis. That’s where biologics come in! Biologics can treat psoriasis but also hives or HS (Hidradenitis Suppurativa). YAY!

What are Biologic drugs?
Biologics, biologic therapies, or biological response modifiers, are drugs derived from living material (human, plant, animal, or micro-organism). They interfere with specific parts of the body’s immune system to treat and prevent immune-mediated inflammatory disorders and cancers. They are also called targeted therapies.
Biological agents work by interfering with specific components of the autoimmune response. Unlike general immunosuppressant’s that suppress the entire immune system, biological agents can fight more selectively and target only those chemicals involved in causing the specific disease.

How do I get onto a Biologic drug?
You will need to see a dermatologist to be prescribed this drug, the dermatologist will take a full history and determine if we should plan to put you on this drug.
Your skin condition will need to be fairly moderate or severe to be approved for this medication. It is also a bit of a process getting a patient on the drug, as patients must try lower strength medications and UVB therapy first and if your skin condition is still failing, then we can look to apply for the biologics! Biologics use to be very expensive but now some are on the PSB which is great; meaning it’s around $40 a script making it affordable for patients!

What to expect?
Biologics are administered through regular injections – the frequency depends on your skin condition. Patients normally find within 4-6 weeks an improvement in their skin, however this can sometimes take longer. Once treatment has kicked in people normally find around 90% clearance rate!


Once you are clear it doesn’t mean you can then stop treatment unfortunately. Normally you will need to be on this for a while, but the doctor may look to decrease the dose or frequency of the drug and slowly look to wean you off if you condition allows you to do this.

Biologics are not a new thing, it’s just many people don’t know that it is available and we need people to get to know about it! It is honestly life changing for people who have been suffering with chronic skin conditions for years and years. Book in with one of our dermatologists to start your path to clear skin! We can help you and you don’t have to live with these itchy debilitating conditions!

A DERMATOLOGIST’S GUIDE TO PREGNANCY SAFE SKINCARE INGREDIENTS

Our Principle Dermatologist Dr Hope Dinh recently shared her expert skincare tips for pregnant or breastfeeding mothers with beauty editor Joanna Fleming from Adore Beauty.


Just found out you’re expecting? Congratulations! Along with the excitement of falling pregnant comes a few lifestyle changes – so we asked Dr Hope Dinh, principle dermatologist and director of Hope Dermatology and mum of two, to give us her advice on pregnancy-safe skincare.

 

Which ingredients do you typically recommend women steer clear of while pregnant, and why?

If you are newly pregnant you may be noticing some big changes in your skin! Changes in hormones can result in an increase in oil, sweat, and increased circulation.  If you’re one of the lucky ones, this all results in the “pregnancy glow”. For the rest of us, increased oil and sweat = pimples and breakouts, and improved circulation = splotchy and red!  Pregnancy can also wreak havoc with your barrier protection, leading to dry, irritated or sensitive skin.

It’s important during pregnancy to review any prescription creams you may have been prescribed pre-pregnancy and check with your doctor if it is safe to continue their use.  As a hard and fast rule, ANY prescription Vitamin A product should preferably be stopped throughout pregnancy and breastfeeding. Rest assured though, studies have shown these products are often poorly absorbed through the skin and broken down quickly and have demonstrated no adverse effects to baby with accidental exposure.

Any prescription fading product containing ingredients such as Hydroquinone should also be stopped as these do have a higher rate of absorption through the skin.

Some women think they need to switch to completely natural skincare and body products during their pregnancy, is this true?

Absolutely not.  In most cases, you can continue your regular skincare regime and tweak it depending on the changes you experience and your skin’s needs.  Dry skin may require more hydration or barrier protection (hyaluronic acid, vitamin B) whilst conversely increased oil production with pregnancy may benefit from the addition of an AHA (alpha hydroxy acid such as lactic or glycolic) or BHA (salicylic acid).

Skin can become more sensitive during pregnancy and many “natural” skincare products contain plant-based ingredients which can feature quite high on the list of skin allergens and can actually irritate the skin further.

What’s the most common myth around pregnancy-safe skincare?

You’ll often hear that you should stop any skincare containing Salicylic acid (BHA, commonly found in acne or brightening serums or washes).  The rationale behind this is that regular use of these products can lead to a systemic build-up of salicylates, which can have a toxic metabolic effect.   Salicylic acid is chemically related to aspirin which when medically indicated, can be used in low doses. The amount of salicylate that is absorbed through the skin via topical skincare is negligible and risk during pregnancy is low.

Contrary to popular opinion in both the public and medical fields, over-the-counter Vitamin A products (retinol) can be used safely during pregnancy under the guidance of your doctor.  We know that oral isotretinoin medication does cause birth defects and so I advise patients using prescriptions topical tretinoin to cease use, however, widely available over-the-counter skincare containing the much less potent forms of Vitamin A such as Retinyl Palmitate, Retinol or Retinaldehyde pose very little risk when used during pregnancy.  These forms are significantly weaker, are poorly absorbed through the skin and are usually found in low concentration in skincare.

Care should certainly be taken to avoid skin irritation and I would generally recommend a low dose and titrate up in strength if well tolerated. Always consult your doctor if you have any concerns.

Pigmentation is a common skin concern that can arise during pregnancy, which ingredients are safe to use to help manage pigmentation while pregnant and breastfeeding?

Pigmentation can be such a tricky condition to treat and often requires the full arsenal of home care, prescription therapy and cosmetic procedures.  The most important thing you can do for your skin pre-pregnancy, during and post-pregnancy is to incorporate the use of a high quality, daily SPF 50+ into your skincare regime.

Pregnancy-safe products that can help reduce pigmentation include Vitamin B, antioxidants such as Vitamin C, Azelaic acid, and exfoliants like your AHA/BHA products. Some treatments, such as skin needling (without topical anaesthetic!) and lactic peels are safe both during pregnancy and breastfeeding and are an effective way to address both pigment and minor breakouts.

Tell us, what are your own skincare go-to’s when pregnant or breastfeeding?

Sunscreen. Sunscreen. Sunscreen.  And an active AHA/BHA serum to target breakouts, with a hydrating, non-occlusive moisturiser at night to prevent sensitivity.

I tend to switch my moisturiser during pregnancy as I find my skin becomes more oily. And I slow down with some of my active skincare (alternate nights) as I find I get slightly more sensitive.

Hope Dermatology Dr Hope Dinh

Dr Hope Dinh is the principle Dermatologist/ Director at a busy dermatologist practice, Hope Dermatology in South Melbourne

She has a 2-year-old and a four-year-old (and her skin breaks out with pregnancy every time!)