1. What is this medicine and what is it used for?
This medicine contains: minoxidil (the active ingredient in Rogaine) which acts on the scalp to help stimulate hairs to return to the growth phase. It can be used for a variety of types of hair loss, including pattern baldness, telogen effluvium, CCCA and others.
2. How to use this medicine.
This medicine is for use on the scalp only. Do not apply it to other areas of the body. Make sure that the scalp is clean and dry before applying. Minoxidil can be applied once or twice a day.
If you use your fingertips to rub the solution into your scalp, make sure that you wash your hands afterwards.
4. How long does it take to see results?
The hair may take up to 6 months to see significant improvement / growth, and in some people may not grow at all. The new hair may be fine hair, similar to baby hair. This medicine is a treatment (not a cure) and needs to be continued for hair growth to be maintained. If you stop the treatment, the new hair will return to the pretreatment state in about 3 to 4 months
5. FEMALE: Why does the prescription contain Metformin and/or Spironolactone?
There have been reports of hair regrowth after 4 months of use of topical metformin. No systemic adverse effects were reported with topical use of Metformin.
Spironolactone works for hair loss by inhibiting an enzyme that helps make testosterone. In a study of 60 female patients with hair loss, topical spironolactone 1% was found to be effective in promoting hair growth. Spironolactone does have a strong chemical odor. If strong smells bother you, we can write your prescription without the spironolactone.
6. Common side effects
The most common side effect is itching and irritation of the scalp, at sites of application of the medication.
Another side effect is initial shedding of the hair in the first few weeks of using the medication. If you discontinue the minoxidil, the results will not be maintained, but your hair will NOT fall out more or worse than without using the medication at all.
7. Other side effects
There are many other possible, but less common side effects of topical minoxidil.
Topical Retinoids (Adapalene, Epiduo, Tretinoin, Retin-A, Fabior, Tazorac, Aklief)
Retinoids provide a number of benefits, such as unclogging the pores and fading dark spots (for acne patients) as well as helping to maintain younger, healthier-looking skin cells (for those seeking cosmetic improvement).
If you are prescribed one of these medications, there are a few things you need to know:
If just starting a retinoid on the face, you might want to consider using it only every other day or every third day for the first 2 weeks. The reason is that these medications are known for causing irritation (such as redness, peeling, dryness and burning). After the first week or two, you can gradually increase the frequency of use, until eventually your skin can tolerate using the medication every night.
Dryness of the skin is a normal reaction. Be sure to use a moisturizer with sunscreen (SPF 40 or higher) every morning as throughout the day as needed. When you apply the medication at night, do not apply any moisturizer on top of it.
Retinoids may increase your sensitivity to the sun. Be sure to use a moisturizer with SPF 30 in the morning. Brands we recommend include Neutrogena, Cetaphil, and Cerave.
Discontinue retinoid products 7-14 days before receiving any cosmetic procedures or facial waxing.
A ‘pea-sized’ amount should be enough to treat your entire face. Using more than this amount, or more frequently than once at bedtime, will increase the dryness and irritation of your skin.
Avoid highly sensitive areas such as the eyelids, corners of the mouth, and creases around the nose.
What is androgenetic alopecia?
Androgenetic alopecia is the most common type of progressive hair loss. It is also known as male-pattern baldness, female-pattern baldness, or just common baldness. It affects about 50% of men over the age of 50, and about 50% of women over the age of 65. In women the severity varies, it may present as widespread hair thinning but in some cases it can lead to complete baldness.
What causes androgenetic alopecia?
Androgenetic alopecia is caused by a combination of genetic and hormonal factors. Dihydrotestosterone (DHT) is the main hormone responsible for androgenetic alopecia. DHT causes scalp hair loss by inducing a change in the hair follicles on the scalp. The hairs produced by the affected follicles become progressively smaller in diameter, shorter in length and lighter in colour until eventually the follicles shrink completely and stop producing hair.
It is believed that genetic susceptibility to this condition can be inherited from either or both parents. On occasion, there may be no immediate family members with the condition.
What are the symptoms of androgenetic alopecia?
Androgenetic alopecia affects men earlier, and more commonly, than women. Males typically become aware of scalp hair loss or a receding hairline, beginning at any time after puberty. In women, the age of onset is later compared to men, usually occurring in the 50s or 60s. Occasionally, androgenetic alopecia in women may start earlier than this, in the 30s or 40s. In some women, it can be associated with an excess of male hormones such as in polycystic ovary syndrome (PCOS).
Can androgenetic alopecia be cured?
No, there is no cure for androgenetic alopecia. However, the progression of this condition in both men and women tends to be slow, spanning several years to decades. An earlier age of onset may predict a quicker rate of progression.
Treatment options include:
Topical minoxidil ( Rogaine) – In a solution, foam or ointment that will be applied to the scalp once a day. This medication should be used long term, and may initially result in temporary shedding of the hair.
For men, finasteride tablets reduce levels of dihydrotestosterone which may slow hair loss and possibly help regrowth of hair. Continuous use for 3 to 6 months is required before a benefit is usually seen.
In women, spironolactone tablets slow down the production of male hormones, and slow down the progression of hair loss caused by androgenic alopecia.
Platelet Rich Plasma (PRP) is a cutting-edge procedure where your blood is drawn in-office, the red blood cells are separated out, and the plasma containing platelets and growth factors are injected back into the scalp. We recommend a series of at least three treatments spaced a month apart.
Central centrifugal cicatricial alopecia (CCCA) is a very common cause of alopecia or hair loss in women of African descent. Hair loss from CCCA occurs primarily in the central (crown) part of the scalp. The hair loss radiates outward in a centrifugal or circular pattern and is usually gradual although some people experience a rapid progression of the hair loss. Symptoms of CCCA can vary and may include itching, burning, tingling, pain or no symptoms at all. CCCA causes destruction of the hair follicles and scarring leading to permanent hair loss. CCCA is the most common type of cicatricial (scarring) alopecia.
What is the cause of CCCA?
The exact cause of CCCA is unknown. Though previously thought to be solely related to the use of hot combs, excessive heat and hot oils on the scalp, chemical relaxers, and excessive tension from braids, tight hair rollers, weaves or extensions, the current thought also points to heredity (genetics or family history) playing a role. When scalp samples (biopsies) from people affected by CCCA are examined under a microscope, inflammation and scarring is typically present around the hair follicles.
What treatments are available for CCCA?
It is best to treat CCCA early before permanent hair loss develops. As the disease progresses, hair follicles may scar beyond the point of repair. Treatment options include:
Topical anti-inflammatory medication, like steroid ointments.
Oral anti-inflammatory agents, like antibiotic pills.
Corticosteroid scalp injections- These will be performed once a month for up to 6 months.
Topical minoxidil ( Rogaine) – In an ointment or solution that will be applied to the scalp once a day. This medication should be used long term, and may initially result in temporary shedding of the hair.
Platelet Rich Plasma (PRP)- is a cutting-edge procedure where your blood is drawn in office, the red blood cells are separated out, and the plasma containing platelets and growth factors are injected back into the scalp. Recommend at least a series of three treatments spaced a month apart.
Hair transplantation – may be considered in patients with permanent hair loss in whom scalp inflammation is absent or well controlled.
*Gentle hair grooming practices such as natural (chemical and heat-free) hair styles, reduced frequency of relaxers, and limited styling products, are also recommended in order to prevent inflammation and further hair breakage.
Melanoma is the most dangerous form of skin cancer. In its advanced stages, it can cause serious illness; if it spreads to the internal organs, it can even be life-threatening. Fortunately, melanoma rarely strikes without warning signs. Watch for them, because when melanoma is found early, it is almost always curable.
Moles, brown spots and growths on the skin are usually — but not always — harmless. Anyone who has more than 100 moles are at greater risk for melanoma. The first signs can appear in one or more of these moles. That’s why it’s so important to know your skin very well. Examine the skin all over your body once a month and have a physician check you over once a year.
DYSPLASTIC NEVI (atypical moles) are non cancerous moles that can look like melanomas. They usually have the following characteristics:
SHAPE: asymmetrical: A line drawn through the middle would not create matching halves.
BORDER: irregular and/or hazy—the mole fades into the surrounding skin. COLOR: variation and irregularity with shades of tan, brown, dark brown, red, blue, or black.
DIAMETER: generally larger than 6 mm (1/4 inch), the size of a pencil eraser, but may be smaller.
LOCATION: most commonly on the back, chest, abdomen and extremities; may also occur on areas such as the buttocks, groin, breasts, or scalp.
GROWTH: Enlargement of a previously stable mole or appearance of a new mole after ages 35-40 should raise suspicion.
SURFACE: Central portion often is raised, whereas the outer areas are usually flat, sometimes with tiny “pebbly” elevations.
APPEARANCE: greatly varied.
MELANOMA, the deadliest form of skin cancer, usually appears as an asymmetrical, irregularly bordered, multicolored or tan/ brown spot or lesion that grows over time. In rare instances, it may be clear.
1. Apply all topical medications and lotions to damp skin. Damp skin absorbs medication better and leaves skin moisturized.
2. Use mild soaps (ex. Unscented Dove White BAR, Cetaphil, Aveeno, Purpose, Neutrogena) when taking showers or baths.
3. Use lukewarm water (not hot) when taking baths or showers. Hot water strips moisture from the skin leaving it feeling dry and itchy.
4. Keep skin moisturized with lotions and creams (ex. La Roche-Posay, Elta cream, Eucerin Calming/Smoothing lotion or cream, Aveeno cleanser lotion, Cetaphil restoraderm lotion,vanicream, Lubriderm, Clinical therapy lotion, Vaseline or Aveeno daily moisturizing lotion). Remember to apply to DAMP skin.
5. When having problems with severe itching take Aveeno oatmeal baths one or two times a day.
6. DO NOT use fabric softener when laundering clothes, Fabric softeners contain perfume which can irritate the skin.
7. Use “free” detergents when laundering clothes such as ALL free or Cheer Free laundry detergent. These detergents are free from perfumes, lanolins, and ingredients that may irritate the skin.
8. Use a cool mist humidifier in rooms that are stuffy or hot, and in the bedroom when sleeping, Humidifiers help keep moisture in the air.
9. Try not to scratch. The more you scratch the more you itch. Try to break the cycle. For small babies or children putting socks on the hands may be beneficial. Older children or adults try frozen gel packs or frozen vegetable bags for 3 minutes on and off.
10.Use prescribed medications AS DIRECTED. Keep follow up appointments with your doctor or dermatologist
Keep the initial dressing dry and in place for 24 hours.
You may shower after the initial 24 hours.
Change dressing only once a day until the wound heals.
Clean biopsy site with gentle cleanser using Q-tips.
Dry the area and apply vaseline or aquaphor using Q-tips.
You may cover the area with a bandaid or gauze, especially if the area is irritated by clothing.
If you have stitches, return to our office in 7 days if on face or 14 days if on body.
If you have any questions or concerns, call the office at (301)679-5772
Keep the initial dressing in place and dry for 24 hours.
If the wound starts to bleed, apply continuous pressure on the area for 15 minutes without removing the bandage. Change the dressing when bleeding stops.
You may shower or bathe with the old bandage or dressing on after the initial 24 hours and then change the dressing.
Change the dressing once a day using the following methods:
Wash your hands before and after changing the dressing.
Clean the affected area gently with warm water and a gentle cleanser using Q-tips to remove any crusting on the wound or along the suture line.
Dry the area with gauze and apply vaseline or aquaphor using a Q-tip.
Cover with gauze or non-stick pad and paper tape. A bandaid can be used if the wound is small.
For pain, take extra strength Tylenol until stitches are removed. Do not take aspirin, aspirin containing products, advil, motrin or ibuprofen which may cause bleeding.
Return to our office in 7 days if on face or 14 days if on body or suture removal.
If your wound becomes increasingly red, warm, painful, begins to drain, or if you develop a fever of 101˚F or greater, please contact us.
If you have any questions or concerns, please call our office.
Actinic keratosis (AK), also known as solar keratosis, is a common skin precancer, affecting more than 58 million Americans. People with a fair complexion, blond or red hair, and blue, green or grey eyes have a high likelihood of developing one or more if they spend time in the sun and live long enough. Chronic sun exposure is the cause of almost all AKs.
SHOULD I BE CONCERNED? Actinic keratosis is called a “pre cancer” because it can be the first step leading to squamous cell carcinoma (SCC). Up to 10 percent of AKs may advance to SCC, and 40-60 percent of SCCs begin as untreated AKs. About 2 to 10 percent of these SCCs spread to internal organs and become life-threatening. Another form of AK, actinic cheilitis, develops on the lips and may evolve into SCC.
Your Smartest Move: PREVENTION: The best way to prevent actinic keratosis is to make sun safety part of your daily health care routine.
When outdoors, seek the shade, especially between 10AM and 4PM.
Wear sun-protective clothing,including a wide-brimmed hat and UV-blocking sunglasses. Use a high-SPF, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher every day. For extended outdoor activity, use a water resistant, broad spectrum sunscreen with an SPF of 45 or higher.
Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming or excessive sweating.
For more information: SkinCancer.org © 2013 The Skin Cancer Foundation. All Rights Reserved.
What to expect:
Liquid nitrogen is applied to the top of the skin lesion. Freezing occurs throughout the area which extends slightly to the surrounding tissue. Freezing can cause stinging, burning pain that peaks about 2 minutes after the treatment is performed. Within minutes after freezing, surrounding skin will become red and begin to swell. In most cases a blister will actually form within 3-6 hours. Often there is a small amount of bleeding into the blister which will turn it dark purple of black. This is expected and should not be cause for concern. The blister usually flattens in 2-3 days and sloughs off in 2-4 weeks.
How to care for the treated area:
As the blister may be tender for the first few days, you may want to protect it with a band-aid. However, most often it may be left to the air.
You should gently cleanse the treated area daily with mild soap and water.
If the area is excessively uncomfortable, you may take an over-the-counter pain reliever such as acetaminophen (Tylenol) or ibuprofen.
Protect the area from sun exposure while it is healing to help prevent scar formation.
Please be aware that warts, actinic keratoses, and seborrheic keratoses often require several treatments. If your skin lesion is still present after healing (usually 2 weeks), schedule a follow-up appointment; otherwise, return as instructed by Dr.Rodney.
Chemical Peel Aftercare Instructions For Face OR Body
1) Leave the peel on for 4-6 hours, then gently wash it off with warm water ONLY.
2) For the first 2 days, wash your face/body with warm water only, TWICE a day. Then apply moisturizer with sunscreen to face/body (AT LEAST SPF 44), as many times a day as needed.
3) From days 3-5, wash with a gentle cleanser (such as Cetaphil or Dove, no fragrance), followed by sunscreen.
4) From day 6-10 you may wash (with either a gentle cleanser or Eternal Clarifying Polish) TWICE a day, followed by sunscreen in the daytime.
5) Resume normal skin care routine on day 10 after your chemical peel, or when all the peeling has subsided.
***Call the office immediately if you have any issues after the procedure (301) 679-5772.
AFTER YOUR PEEL: It is crucial to the success of your peel that these guidelines be followed:
– Do not go swimming for at least 24 hours post-treatment.
– No exercise that causes sweating, Jacuzzi, sauna, or steam baths until the skin is healed.
– Do not use makeup for 24 hours post- treatment.
– If Retinoic Acid is used as part of your treatment, your skin will have a light yellow tinge immediately after the procedure. This is temporary and will fade in 1 to 2 hours. It is recommended to wait until the evening to wash your face, however if you should choose to wash it sooner, please wait at least 2 hours.
– It is important that you avoid direct sunlight for at least 1 week, and make using a sunscreen with at least SPF40 a long term part of your daily routine.
– Patients with sensitivity to the sun should take extra precautions to guard against sun exposure following the procedure as they may be more sensitive following the peel.
– Your skin may be more red than usual for 2-3 days.
-Approximately 24-48 hours after the treatment, your skin will start to peel. This peeling will generally last 2 to 7 days. DO NOT PICK OR PULL THE SKIN.
-Apply a light moisturizer with sunscreen as often as needed to relieve dryness and tightness.
-Do not have any other facial treatments for at least two weeks after your peel.
LACK OF PEELING: Although most people experience peeling of their facial skin, not every patient notices visibly peeling after a Chemical Peel procedure. Lack of peeling is NOT an indication that the peel was unsuccessful. If you do not notice actual peeling, please know that you are still receiving all the benefits of the peel, such as: unclogging of pores, stimulation of collagen production, increased cell turnover, improvement of skin tone and texture, and diminishment of fine lines, wrinkles and dark spots.
Microneedling Post-Procedure Instructions
1. A sunburn-like effect is normal for 1-3 days. Severity of redness will depend on how aggressive the treatment was performed. The skin may feel tight, dry, swollen, and sensitive to the touch. The skin may appear darker and this should flake off within 1 week. Avoid picking or exfoliating the area and allow old skin to flake off naturally.
2. After Care Regimen:
-Wash the treated area with lukewarm water only, twice a day for the first 2 days, starting in the morning after the procedure is done.
– On days 3-5 wash with a gentle cleanser, like cetaphil wash
– On days 6+, resume normal routine
– Do not go swimming for at least 24 hours post-treatment
– No exercise that causes sweating, Jacuzzi, sauna, or steam baths until the skin is healed
– DO not use makeup for 24 hours post- treatment
-As microneedling serves to stimulate collagen and growth, the skin benefits from higher amounts of collagen than normal to recover optimally. We recommend our Hyaluronic Acid Serum or Alastin Regenerating Skin Nectar, available for purchase. It is important to apply every 3 hours for the first 24 hours after the microneedling. These can also be continued twice a day for the first week.
-Do not use exfoliating medications, chemicals, or retinol products on the treated areas for at least 1 week, and until the skin appears completely healed.
3. Sun exposure must be minimized after your treatment. If you know you will get incidental sun exposure, we recommend using a protective hat or a scarf.
Do not use sunscreen for the first 24 hours after the procedure.
After 24 hours, use a bread spectrum physical sunscreen every morning, with reapplication throughout the day as needed.
Some redness and swelling is normal and may feel similar to a sunburn. This should go away in a few days. Some people may react more and have redness for up to 2 weeks.
During the 2 days after the laser treatment, hairs may shed. Please do not pick the hairs or skin.
Small blisters may occur if skin is burned. Please do not pick the blisters, and notify the clinic immediately if this happens.
Please read the labels on products before applying to your skin. Avoid irritants or any skin care products containing glycolic/glycolic acids, retinoids (such as Retin A) until all redness/skin irritation has resolved.
Clean the area twice daily with a gentle cleanser.
Apply broad spectrum sunscreen daily with reapplication as needed.
Shaving should be avoided until comfortable. Begin with light shaving.
Avoid strenuous exercise for the day as sweating may irritate the skin.
Make-up may be used as long as skin is not broken or irritated.
2. Avoid the use of alpha or beta hydroxy products, retinols, or Retin-A products for 24 hrs after your treatment as they could create additional irritation. After 24 hrs you may resume your prescribed skin care regimen.
3. Flaking and crusting may occur. Do not attempt to exfoliate or remove any crusting. Areas with heavy sun damage and brown spots will darken over the first 24 hrs after treatment. Some of the red areas may intensify as well. Do not pick or abrade the area. This is part of the normal response to treatment and will clear on its own in 3-7 days. If you experience any open wounds contact our office immediately.
4. Maintain hydration. Drink plenty of non-alcoholic, caffeine-free and sodium-free beverages and keep skin well hydrated.
5. Do not expose your skin to direct sunlight for a minimum of 3 days. Good sun protection is essential following treatment, and as part of your normal routine. If you are outdoors, apply a minimum SPF 40 and wear sun protective clothing and headwear. Following Laser therapy your skin is highly susceptible to sunburn or the formation of irregular, darkened pigmentation. Therefore, sun protection is required for life to maintain the results you have achieved.
6. Your treatment may require several treatments to achieve optimal results. Results may not be visible after each treatment but may develop gradually in the weeks that follow. It is essential that your progress is monitored throughout your treatment cycle. Keep your appointments as directed.
Laser treatments can be an effective way to remove hair, superficial blood vessels, and some dark spots as well as improve the appearance of various scars; however, there are things you should know before your first appointment
General laser requirements
Avoid excessive sun or UV exposure 1 week before your appointment – excessively tanned skin can absorb more of the laser energy leading to prolonged redness and darkening and even blistering of the skin
For the above reasons, patient’s with sunburns or those who use sunless tanning products will have their appointments rescheduled
Please make sure there are no products on the treatment area the day of your laser appointment
This includes make-up, tinted sunblock, or other products
Numbing cream and regular sunscreen are acceptable, but will be removed with alcohol wipes before your treatment
Please avoid chemical peels, facials, etc. to treatment area for two weeks before and after your appointment
Avoid all alpha and beta hydroxy products (AHA/BHA), Hydroquinone, Retinols/Retinoids, Tazorac, Tretinoin and Differin for 14 days (2 weeks) before treatment (unless otherwise stated by your provider)
Additionally, please tell your provider if you are Accutane as this will require your treatment to be rescheduled.
If a topical numbing aesthetic is provided, please apply to the treatment area 30 minutes to 1 hour before your appointment as it takes time for medication to take effect.
Laser hair reduction requirements
Please stop waxing or tweezing 3 weeks prior to treatment
Hair within the skin is required for laser reduction to be effective
Please shave the area to be treated the night before your scheduled appointment
Your appointment will be rescheduled if hair visible over skin
Visible hair can absorb more of the laser energy leading to prolonged redness and darkening and even blistering of the skin
Of note, only pigmented hairs can be treated with laser (very blonde, white, and gray hairs cannot be targeted by the laser)
PLEASE TELL YOUR PROVIDER IF YOU ARE PRONE TO COLD SORES, ARE PREGNANT, OR HAD AN ADVERSE REACTION TO PREVIOUS LASER TREATMENTS
Pre/Post Care for Fraxel Laser Treatment
Contraindications include use of medications that increase photosensitivity (such as certain antibiotics or Accutane), use of anticoagulants or have had chemotherapy in the past 6 months, history of bleeding disorders, pregnancy/breastfeeding, and seizure disorders. Prednisone and other steroids can cause excess swelling post treatment for up to 2 weeks.
PLEASE ADVISE YOUR LASER PROVIDER IF YOU HAVE ANY OF THESE CONDITIONS.
● Sun, tanning bed or the use of self tanning creams are not to be used 2 weeks prior to treatment.
● SPF 30 sunblock is the minimum required in the treatment areas 2 weeks prior to treatment
● Avoid skin care, cleansers and toners that contain Retinol A, glycols, salicylic acid, witch hazel,
benzoyl peroxide, alcohol, vitamin C, etc. If you have a question about your skincare or make-up please contact your technician prior to treating and understand that if you are using one of the listed ingredients it will postpone your treatment.
● Please do NOT take any steroids, anti-inflammatories (IBuprofen, or Aleve, etc.) 24 hours before treatment.
POST OP INSTRUCTIONS
● It is very important to ice when you are able, no more than 10 minutes every 4 hours for the first 2 days to reduce swelling for erbium skin resurfacing and vascular treatment
● NO Aleve/Ibuprofen 48 post treatment
● Showers can be taken, but please try to avoid hot water and direct shower spray to the treatment area for 48-72 hours following treatment. Avoid all saunas and hot tubs.
● Avoid strenuous exercise for 48 hours (this includes hot yoga).
● Sleep with 1-2 extra pillows at night to keep head raised for the first 2 nights if swelling is present
● Do not use any retinoid, RETIN-A or GLYCOLIC products for 1-2 weeks post-procedure. Do not use any non-prescription creams without discussing it with your provider first.
● Refrain from any chemical peel treatments or Microdermabrasion for 4 weeks post-procedure.
● Avoid scratching, rubbing the treated skin – do not put adhesive dressings over treated areas. Itching after a treatment is part of the healing process, taking a non drowsy over the counter antihistamine is recommended as needed.
● Men may shave 3 days post-treatment, but be gentle.
● Avoid direct sunlight for a minimum of 4 weeks after your treatment. Wear a provider approved physical sun protection for the next 4 weeks. If active outdoors, you should re-apply your sunscreen every 2 hours and wear a wide-brimmed hat.
Dr. Ife Rodney is double board-certified, highly rated, and takes a patient-centered and customized approach to care. She is a top acne expert and cosmetic dermatologist in Columbia and Howard County, MD. Contact us today to learn how Dr. Rodney can help you look and feel your best.