Difficult Cases Panel ISHRS Dr Alan Bauman - non-surgical hair regrowth

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Sometimes, "difficult cases" present as patients who are for whatever reason not great candidates for hair transplant surgery. In these instances, we bring to bear our 'toolbox' of medical treatment regimens that can help improve hair growth. These treatments may include Formula 82M minoxidil, LaserCap low level laser therapy, nutritional modification, platelet rich plasma, etc. Tracking compliance and results over time requires routine cross-sectional hair bundle measurements using the HairCheck device on a regular basis. Here are some of our 'difficult cases' successfully treated without hair transplantation using the most state-of-the-art medical therapies at Bauman Medical Group clinic in Boca Raton FL http://www.baumanmedical.com

Santé & Médecine Divertissement et humour

DIFFICULT CASES
Alan J. Bauman, M.D.
Bauman Medical Group – Boca Raton, FL
ISHRS Annual Scientific Meeting 2013

ALAN J. BAUMAN M.D., A.B.H.R.S.

DISCLOSURES
•

Shareholder – HairScience LLC

•

Consultant – P&G, MasterPharm
Please note: This presentation may contain information regarding the off-label use of
medications, devices and other products that have not been evaluated by the FDA.

ALAN J. BAUMAN M.D., A.B.H.R.S.

CASE1: 70 Y/O FEMALE “LAURA M.”
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Chief Complaint:
work.”

“I‟m losing hair all over for many years… My dermatologist‟s treatments did not

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Hair Loss Genetic Hx:

+ father, + mother, + paternal grandfather

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Allergies:

bacitracin, neo/polysporin,

•
•

Medical Hx:
Surgical Hx:

skin cancer, breast cancer, HPV, chronic eczema, anemia
appendectomy „62, R forearm hemangioma „72/‟86, bilateral mastectomy „79,
breast reconstruction ‟01, bladder suspension „10

•

Hair Loss Tx Hx:

Used OTC minox2% solution for 2-3wks, d/c‟d due to dermatitis
had >3 kenalog injections(.5mg/ml x 1cc) scalp
oral prednisone taper x 4 wks.
Referred by local derm, tx‟d for alopecia areata

•

Nutritionals:

ALAN J. BAUMAN M.D., A.B.H.R.S.

MVI, D, Omega3, Calcium

“LAURA M.” – 70F

ALAN J. BAUMAN M.D., A.B.H.R.S.

LABS / DIAGNOSTICS
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CBC & Chem20: wnl

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Ferritin: 84

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Thyroid panel: wnl

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CAG repeat: 25 (Low Androgen Sensitivity)

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HairCheck 10/2/12

Frontal 60x

Occiptial (tab#34):
50 HMI
Vertex (tab#20):
40 HMI
Frontal (tab#11):
30 HMI
L-temple (tab #10.5x6L):
19 HMI

ALAN J. BAUMAN M.D., A.B.H.R.S.

Vertex 60x

ASSESSMENT / PLAN
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Diffuse Hair Loss w/ Weak HMI & Poor Coverage in frontal, temples and vertex

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Weak occipital HMI – poor donor quality

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? Misdiagnosis / failed treatment with intradermal steroids and OTC minox

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Plan:

• Begin pulsed LLLT 2.8J/cm2 over 575 cm2 of scalp (frontal to vertex) every other day
• Start compounded Minoxidil Formula 82M; 30 drops (frontal to vertex) q12h

ALAN J. BAUMAN M.D., A.B.H.R.S.

LAURA M. – 60X DERMOSCOPY

Vertex

Frontal

T = 0 days (baseline)

ALAN J. BAUMAN M.D., A.B.H.R.S.

T = 90 days

MINOXIDIL “FORMULA 82M”
•

Minoxidil 5%

•

Retinoic Acid 0.01%

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Fluocinolone 0.001%

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Oleanolic Acid (olive leaf extract)

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Algae extract

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Phytantriol

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Vitamin E

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Propylene Glycol-free

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DOSAGE: apply 1ml (~30 drops) to scalp q12hr

ALAN J. BAUMAN M.D., A.B.H.R.S.

LOW LEVEL LASER THERAPY
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224 divergent / non-collimated / wide-angle laser diodes

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5mW / diode, 650 nm, 80% duty cycle

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30 min, every other day over 575cm 2

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Dosage

224 * 0.005 W * 1800 sec * .80 / 575cm 2 = 2.8 J/cm 2
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575cm2 = ½ area of a sphere with circumference of 60cm

ALAN J. BAUMAN M.D., A.B.H.R.S.

LASERCAP

HMI TRACKING
Bauman Medical Group - Hair Mass Index (HMI) Tracking Sheet

Patient Name: Mardyks, Linda

Date of Birth: 8/22/53

Hair Mass Index

110

Occipital Tab #34

85

Vertex Tab #17
60

Frontal Tab #8
Temple Tab #10.5x6L

35

10

Hair Mass Index Log
Exam Date

ALAN J. BAUMAN M.D., A.B.H.R.S.

Occipital Tab
#34

Vertex Tab
#17

Frontal Tab
#8

Temple Tab
#10.5x6L

Notes

Techs

0 DAYS

90 DAYS

180 DAYS

0 DAYS

90 DAYS

180 DAYS

OCT 2012

JAN 2013

APR 2013

OCT 2012

JAN 2013

APR 2013

ALAN J. BAUMAN M.D., A.B.H.R.S.

270 DAYS
JULY 2013

ALAN J. BAUMAN M.D., A.B.H.R.S.

270 DAYS
OCT 2012 – JULY 2013

ALAN J. BAUMAN M.D., A.B.H.R.S.

OTHER EXAMPLES

ALAN J. BAUMAN M.D., A.B.H.R.S.

ANA B. (68YO)

LaserCap qod, Formula 82M Minoxidil bid x 6mos
ALAN J. BAUMAN M.D., A.B.H.R.S.

ARLENE T. (68F)

LaserCap qod, Formula 82M Minoxidil bid, Biotin 2500mcg po bid

ALAN J. BAUMAN M.D., A.B.H.R.S.

ZACH (28M)

LaserCap qod, Formula 82M Minoxidil bid x 90 days
ALAN J. BAUMAN M.D., A.B.H.R.S.

MICHAEL K. (39M)

Formula 82M Minoxidil bid x 6mos
ALAN J. BAUMAN M.D., A.B.H.R.S.

VANSANTA S. (61F)

LaserCap qod, Formula 82M Minoxidil bid x 6mos
ALAN J. BAUMAN M.D., A.B.H.R.S.

CYNTHIA B. (65F)

LaserCap qod, Formula 82M Minoxidil bid, Biotin 2500mcg po bid x 6mos
ALAN J. BAUMAN M.D., A.B.H.R.S.

TAKE-HOME TEACHING POINT
Non-Surgical Treatment Options
• Medical Management Works

•

Formula 82M Minoxidil

• Diagnosis

•

Finasteride/Dutasteride

Follow-up

•

LaserCap

• Tracking

•

Platelet Rich Plasma

• Compliance

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Nutritionals

•

Thank You!!

ALAN J. BAUMAN M.D., A.B.H.R.S.

Follow @DrAlanBauman on Twitter
doctorb@baumanmedical.com

THANK YOU!

ALAN J. BAUMAN M.D., A.B.H.R.S.

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