••• Grand rounds 2015

EVIDENCE BASEDEVIDENCE BASED
HAIR LOSS MANAGEMENTHAIR LOSS MANAGEMENT
Bernard Cohen, MDBernard Cohen, MD
VOLUNTARY CLINICAL PROFESSORVOLUNTARY CLINICAL PROFESSOR
UNIVERSITY OF MIAMI SCHOOL OF MEDICINEUNIVERSITY OF MIAMI SCHOOL OF MEDICINE
DECEMBER 16, 2015DECEMBER 16, 2015
GRAND ROUNDSGRAND ROUNDS

DISCLOSUREDISCLOSURE
Dr. Cohen owns the patent, and receives royaltiesDr. Cohen owns the patent, and receives royalties
on the technology featured in thison the technology featured in this
presentation.presentation.

www.howtomeasurehair.comwww.howtomeasurehair.com

BASICS of HAIRBASICS of HAIR
Loss & GrowthLoss & Growth
A quick reviewA quick review

230 hairs per square cm.230 hairs per square cm.
Anagen telogen duration and percentileAnagen telogen duration and percentile
Hair growth rateHair growth rate
Hair diameter and cross sectionHair diameter and cross section
Shedding v. thinningShedding v. thinning
Follicular units and their behaviorFollicular units and their behavior
Effect of treatmentEffect of treatment
Effect of treatment discontinuationEffect of treatment discontinuation

HAIR DIAMETERHAIR DIAMETER
Fine = 60 micronsFine = 60 microns
Average = 70 micronsAverage = 70 microns
Coarse = 80 micronsCoarse = 80 microns

NORMAL SCALPNORMAL SCALP
ALL HAIRS ARE THE SAME DIAMETERALL HAIRS ARE THE SAME DIAMETER

DIAMETERDIAMETER
MEASUREMENTMEASUREMENT
NON-ASIAN HAIR HAS TWONON-ASIAN HAIR HAS TWO
DIAMETERSDIAMETERS
ASIANASIAN AFRICAN
CAUCASIAN

HOW MUCH HAIRHOW MUCH HAIR
MASS - QUANTITY – VOLUMEMASS - QUANTITY – VOLUME
IS DETERMINED BYIS DETERMINED BY
DENSITYDENSITY - number of hairs per cm- number of hairs per cm22
DIAMETERDIAMETER - coarse - average - fine- coarse - average - fine
LENGTHLENGTH - not considered- not considered

Length is determined by personal styling.Length is determined by personal styling.
Length changes with every haircut.Length changes with every haircut.

Πrr22
== CROSS SECTIONAL AREACROSS SECTIONAL AREA
••••••••••••••••••••••••••••••••••••••
CHANGING THECHANGING THE HAIR DENSITYHAIR DENSITY 10%10%
CHANGES THE HAIR MASSCHANGES THE HAIR MASS 10%10%
CHANGING THECHANGING THE HAIR DIAMETERHAIR DIAMETER 10%10%
CHANGES THE HAIR MASSCHANGES THE HAIR MASS 20%20%
DIAMETERDIAMETER IS MORE INFLUENTIAL THANIS MORE INFLUENTIAL THAN DENSITYDENSITY

A full-sized hair falls out - EffluviumA full-sized hair falls out - Effluvium
Follicle intact - activity out of syncFollicle intact - activity out of sync
SHEDDINGSHEDDING

FOLLICLE – smaller & smallerFOLLICLE – smaller & smaller
DIAMETER -- smaller & smallerDIAMETER -- smaller & smaller
ANAGEN -- shorter & shorterANAGEN -- shorter & shorter
MINIATURIZED HAIR GROWS ONLY 3, 2, OR 1 YEARMINIATURIZED HAIR GROWS ONLY 3, 2, OR 1 YEAR
OF ITS 4 YEAR ANAGEN CYCLEOF ITS 4 YEAR ANAGEN CYCLE
THINNINGTHINNING

HORSESHOE FRINGEHORSESHOE FRINGE
ALL HAIRS ARE THE SAME DIAMETERALL HAIRS ARE THE SAME DIAMETER

AREAAREA
ofof
THINNINGTHINNING
WIDE VARIATION INWIDE VARIATION IN
DIAMETERDIAMETER

FOLLICULAR UNITSFOLLICULAR UNITS
NORMAL GROUPING = 4, 3, 2, 1NORMAL GROUPING = 4, 3, 2, 1

FOLLICULAR UNIT REDUCTIONFOLLICULAR UNIT REDUCTION
4 HAIR become 3 HAIR,4 HAIR become 3 HAIR,
3 HAIR become 2 HAIR, etc.3 HAIR become 2 HAIR, etc.

HAIR “GROWTH” DRUGS/DEVICESHAIR “GROWTH” DRUGS/DEVICES
Telogen hairs converted to anagen hairsTelogen hairs converted to anagen hairs
Hairs are maintained in anagenHairs are maintained in anagen
Miniaturized hairs continue to growMiniaturized hairs continue to grow
Further miniaturization preventedFurther miniaturization prevented
Hair diameter eventually increasesHair diameter eventually increases
Work best in early stages before the folliclesWork best in early stages before the follicles
have vanishedhave vanished

EVIDENCE BASEDEVIDENCE BASED
TREATMENTTREATMENT

The FDA requiresThe FDA requires evidenceevidence of efficacyof efficacy
before approving a new drug-device.before approving a new drug-device.
The physician looks at theThe physician looks at the evidenceevidence
and decides to prescribe the drug-device.and decides to prescribe the drug-device.
Then, he/she looks forThen, he/she looks for evidenceevidence
that the drug-device is actually working, asthat the drug-device is actually working, as
it should, in each individual patientit should, in each individual patient

Evidence = A measurable effectEvidence = A measurable effect
If it can’t be measured,If it can’t be measured,
It can’t be managed!It can’t be managed!
Medicine uses a language of numbersMedicine uses a language of numbers
BP, GLUCOSE, WEIGHT, CHOLESTEROL, ETCBP, GLUCOSE, WEIGHT, CHOLESTEROL, ETC

FOUR POPULAR AGA TREATMENTSFOUR POPULAR AGA TREATMENTS
MINOXIDILMINOXIDIL
FINASTERIDEFINASTERIDE
LASERLASER
PRPPRP

WHAT DOES THE FDA REQUIRE?WHAT DOES THE FDA REQUIRE?
1. EVIDENCE of efficacy1. EVIDENCE of efficacy
(Choose 3 out of 4)(Choose 3 out of 4)
DRY HAIR WEIGHTDRY HAIR WEIGHT
SURFACE DENSITY COUNTSURFACE DENSITY COUNT
GLOBAL PHOTOGRAPHYGLOBAL PHOTOGRAPHY
PATIENT SELF EVALUATIONPATIENT SELF EVALUATION
2. EV2. EVIDENCE of safetyIDENCE of safety
Journals generally require less evidence than FDAJournals generally require less evidence than FDA

FDA-required EVIDENCEFDA-required EVIDENCE

THE GOLD STANDARDTHE GOLD STANDARD
Weigh hair bundle from a demarcated areaWeigh hair bundle from a demarcated area
““before and after” treatmentbefore and after” treatment
Change reflects density & diameter changesChange reflects density & diameter changes
Rarely performedRarely performed

Dry Hair WeightDry Hair Weight
ANAN
ACCURATEACCURATE
MEASUREMEASURE
OF HAIR MASSOF HAIR MASS
(measures both density & diameter)(measures both density & diameter)

FDA required EVIDENCEFDA required EVIDENCE

DENSITY COUNTDENSITY COUNT
COUNT THE HAIRS PER SURFACECOUNT THE HAIRS PER SURFACE
AREA OF SKINAREA OF SKIN

ANDROGENETIC ALOPECIA - diameter reduces in size

BALDING IS A MIXTURE OFBALDING IS A MIXTURE OF
FULL SIZEFULL SIZE
&&
INTERMEDIATEINTERMEDIATE
HAIRSHAIRS
ANY HAIR LARGER THANANY HAIR LARGER THAN
30 MICRONS IS30 MICRONS IS
COUNTED ASCOUNTED AS
ONE HAIRONE HAIR
HAIR DENSITY COUNTHAIR DENSITY COUNT

Hair Density CountHair Density Count
ANAN
INCOMPLETEINCOMPLETE
MEASUREMEASURE
measures variations inmeasures variations in
density but not diameterdensity but not diameter

1999 - E. Marritt The 2 Box Study1999 - E. Marritt The 2 Box Study
In HT surgery, only half the hairIn HT surgery, only half the hair
needs to be replaced in order toneeds to be replaced in order to
achieve a normal density appearance.achieve a normal density appearance.
50% of the hair mass must be lost before50% of the hair mass must be lost before
the underlying skin becomes visible.the underlying skin becomes visible.
When a man discovers for the first timeWhen a man discovers for the first time
that hethat he’s balding… he has already’s balding… he has already
lost 50% of his hair!lost 50% of his hair!

PhotographyPhotography
AN INCOMPLETEAN INCOMPLETE
MEASURE OF HAIR MASSMEASURE OF HAIR MASS
(does not detect loss if its less than 50%)(does not detect loss if its less than 50%)
DIFFICULT TO QUANTIFY CHANGEDIFFICULT TO QUANTIFY CHANGE

AA
TOTALLY SUBJECTIVETOTALLY SUBJECTIVE
MEASUREMEASURE
(worthless?)(worthless?)

How doesHow does
EVIDENCEEVIDENCE
required by the FDArequired by the FDA
compare withcompare with
EVIDENCEEVIDENCE
obtained in the office?obtained in the office?

Clinical PhotographyClinical Photography
Random micro-image of scalpRandom micro-image of scalp
with untrimmed hairwith untrimmed hair
Patient self evaluationPatient self evaluation

Cohen, B H, The Cross-section Trichometer: A NewCohen, B H, The Cross-section Trichometer: A New
Device for Measuring Hair Quantity, Hair Loss, and HairDevice for Measuring Hair Quantity, Hair Loss, and Hair
Growth, Dermatologic Surgery 2008, 34:1-12Growth, Dermatologic Surgery 2008, 34:1-12

CROSS SECTION TRICHOMETRYCROSS SECTION TRICHOMETRY
PERFORMED IN THE OFFICEPERFORMED IN THE OFFICE
is equivalent tois equivalent to
DRY HAIR WEIGHT MEASUREMENTDRY HAIR WEIGHT MEASUREMENT

DEMARCATE A STANDARD-SIZEDDEMARCATE A STANDARD-SIZED
AREA OF SCALPAREA OF SCALP
2 x 2 cm

•• Isolate and gather the hairs into a bundleIsolate and gather the hairs into a bundle
•• Measure the cross sectional area of the bundleMeasure the cross sectional area of the bundle
2 x 2 cm
1 x 2 mm

CROSS SECTIONAL AREACROSS SECTIONAL AREA
will fluctuate ifwill fluctuate if
Diameter increasesDiameter increases
Diameter decreasesDiameter decreases
A hair falls outA hair falls out
New hair emergesNew hair emerges

DESIGN A DEVICE THAT WILLDESIGN A DEVICE THAT WILL
CAPTURE - COMPRESS – COMPACTCAPTURE - COMPRESS – COMPACT
AND THENAND THEN
MEASUREMEASURE
THE CROSS SECTIONAL AREA OF THE BUNDLETHE CROSS SECTIONAL AREA OF THE BUNDLE

THE IDEAL DEVICETHE IDEAL DEVICE shouldshould
1.1. Always compress the bundle with the same exact load…Always compress the bundle with the same exact load…
regardless of the bundle sizeregardless of the bundle size
2.2. Compact the bundle completely …but not damageCompact the bundle completely …but not damage
the hairthe hair
3.3. Apply the load with incremental mechanical precisionApply the load with incremental mechanical precision
4.4. Include a precise scientific measuring elementInclude a precise scientific measuring element
5.5. Be easy-to-use and widely availableBe easy-to-use and widely available
6.6. Not require hair be cutNot require hair be cut
7.7. Not require a physician operatorNot require a physician operator
8.8. Generate results in less than 5 minutesGenerate results in less than 5 minutes

EARLY PROTOTYPEEARLY PROTOTYPE

HAIR CAPTURE ELEMENTHAIR CAPTURE ELEMENT
(HOOK AND AVIL)(HOOK AND AVIL)

HAIR IS CAPTURED INHAIR IS CAPTURED IN
RECTANGULAR CHAMBERRECTANGULAR CHAMBER

TURN KNOB TO APPLY LOADTURN KNOB TO APPLY LOAD

BUNDLE ISBUNDLE IS
COMPRESSED & COMPACTEDCOMPRESSED & COMPACTED

CROSS-SECTIONAL AREACROSS-SECTIONAL AREA
IS DISPLAYED ON LED SCREENIS DISPLAYED ON LED SCREEN
mm2
HAIR per 4 cm2
SCALP

FOUR CONSIDERATIONSFOUR CONSIDERATIONS
Bundle cross sectional areaBundle cross sectional area
DiameterDiameter
DensityDensity
Hair weightHair weight

HOW WELL DOESHOW WELL DOES
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES INCORRELATE WITH CHANGES IN
DIAMETER?DIAMETER?

3-0 80 60 40 20
4-0 20 40 60 80 60 40 20
5-0 20 40 60 80 60 40 20
6-0 20 40 60 80
3.813.81 3.633.63 3.073.07 2.702.70 2.362.36 2.142.14 2.032.03 1.651.65 1.371.37 1.261.26 1.091.09 .82.82 .66.66
STRANDS OF SILK SUTURE MATERIAL
PRECISELY CORRELATES WITHPRECISELY CORRELATES WITH
FILAMENT DIAMETERFILAMENT DIAMETER
BUNDLE CROSS SECTION

CORRELATE WITH CHANGES INCORRELATE WITH CHANGES IN
DENSITY?DENSITY?

STRANDS of SILK 20 40 60 80 100 120 140 160
BUNDLE CROSS SECTION .36 .75 1.17 1.58 1.93 2.36 2.75 3.14
RATIO BUNDLE CROSS
SECTION :: STRANDS
.018 .019 .020 .020 .019 .020 .020 .020
PRECISELY CORRELATES TO THEPRECISELY CORRELATES TO THE
NUMBER OF STRANDSNUMBER OF STRANDS

CORRELATE WITHCORRELATE WITH
DRY WEIGHT?DRY WEIGHT?
(using silk filaments)(using silk filaments)
THE INDUSTRY GOLD STANDARDTHE INDUSTRY GOLD STANDARD

STRANDS of
SILK
150150 148148 146146 144144 142142 140140 138138
GRAMS .2754.2754 .2728.2728 .2705.2705 .2672.2672 .2546.2546 .2590.2590 .2565.2565
BUNDLE CROSS
SECTION
2.742.74 2.722.72 2.712.71 2.652.65 2.622.62 2.522.52 2.482.48
RATIO GRAMS ::
BUNDLE CROSS
SECTION
.101.101 .100.100 .100.100 .101.101 .101.101 .103.103 .103.103
PRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE
WEIGHT OF BUNDLEWEIGHT OF BUNDLE
RATIO STRANDS ::
BUNDLE CROSS
SECTION
5555 5454 5454 5454 5454 5656 5656

SAME STUDY USINGSAME STUDY USING
HAIRHAIR
INSTEAD OFINSTEAD OF
SILK FILAMENTSSILK FILAMENTS

NUMBER OF
HAIRS
xx XX
MINUSMINUS
22
XX
MINUSMINUS
44
XX
MINUSMINUS
88
XX
MINUSMINUS
1010
XX
MINUSMINUS
1212
XX
MINUSMINUS
1414
XX
MINUSMINUS
1616
XX
MINUSMINUS
2020
GRAMS .5536.5536 .5528.5528 .5519.5519 .5511.5511 .5506.5506 .5494.5494 .5480.5480 .5467.5467 .5434.5434
BUNDLE CROSS
SECTION mm2
2.082.08 2.042.04 1.981.98 1.951.95 1.941.94 1.921.92 1.891.89 1.871.87 1.821.82
PRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE
WEIGHT OF BUNDLEWEIGHT OF BUNDLE

CORRELATE WITHCORRELATE WITH
CLINICAL SEVERITY?CLINICAL SEVERITY?

THE COHEN SEVERITY SCALETHE COHEN SEVERITY SCALE
MINIMALMINIMAL MILDMILD
Much more hair than skin More hair than skinMuch more hair than skin More hair than skin
MODERATE SEVEREMODERATE SEVERE
More skin than hair Much more skin than hairMore skin than hair Much more skin than hair

SEVERITY SCORESEVERITY SCORE HAIR MASS INDEXHAIR MASS INDEX
Patient #1Patient #1 minimalminimal 4747
Patient #4Patient #4 mildmild 3636
Patient #7Patient #7 moderatemoderate 2525
Patient #10Patient #10 severesevere 2222
Severity Score and Hair Mass Index
No hair loss: HMI = 75 to 100

HairCheckHairCheck
CROSS SCTION TRICHOMETERCROSS SCTION TRICHOMETER

DISPLAYS HAIR MASS INDEXDISPLAYS HAIR MASS INDEX
mmmm22
hair / cmhair / cm22
scalp x 100scalp x 100
Normal rangeNormal range
HMI =HMI = 75 to 10075 to 100
(FINE to COARSE HAIR)(FINE to COARSE HAIR)
SensitivitySensitivity
Device will detect the difference of 3 hairsDevice will detect the difference of 3 hairs
in a 600 hair bundlein a 600 hair bundle
LimitationLimitation
Hair must be at least 1” longHair must be at least 1” long

LOCATOR STRIPLOCATOR STRIP
ENSURES RETURN TO SAMEENSURES RETURN TO SAME
NON-TATTOOED SITENON-TATTOOED SITE

3 STEP MEASUREMENT3 STEP MEASUREMENT

ABSTRACT
Background: Hair loss affects millions worldwide. At
present, most dermatologists use simple, non-
quantitative methods to monitor hair loss progression
and response to treatment, with an emphasis on density
alone. However, the diameter of the hair fibers also
contributes greatly to the appearance of hair.
Objective: Evaluate the accuracy and sensitivity of a
cross-section trichometer (the HairCheck® device), a
simple, hand-held device that measures hair mass
influenced by both density and diameter.
Materials and Methods: Using surgical silk and cut
human hair, we analyzed the correlations between the
HairCheck® readings, the number and diameter of
strands, and the bundle dry weight.
Results: Direct correlations were observed between a
bundle’s cross-sectional area, displayed as the Hair
Mass Index (HMI), the number of strands, fiber diameter,
and bundle dry weight.
Conclusion: Cross-Section Trichometry (CST), the
HairCheck® System and its methodology to determine
the HMI, may provide a quick and accurate tool to
assess progressive alopecia and treatment response in
the clinic.
CONCLUSIONS
• Direct correlations were observed between the
bundle’s cross-sectional area, displayed as the Hair
Mass Index (HMI), the number of strands, the silk/hair
diameter, and the bundle dry weight. Therefore, HMI is a
meaningful measure of the hair mass.
• We have given the name Cross-Section Trichometry
(CST) to the trichometer system and its methodology.
CST is a simple modality that can quickly and accurately
measure the cross-sectional area of a bundle of hair, and
converts it to HMI for display.
REFERENCES
ACKNOWLEDGMENTS
• Arnold J. Hair mass index. 4th Annual Congress European
Society of Hair Restoration Surgery Barcelona 2001.
• Cohen B. The cross-section trichometer: a new device for
measuring hair quantity, hair loss, and hair growth. Dermatol
Surg 2008;34:900-10; discussion 10-1.
• Hendriks MA, Geerts PA, Dercksen MW, van den Hurk CJ ,
Breed WP. Evaluation of Cohen's Cross-Section Trichometer
for Measuring Hair Quantity. Dermatol Surg 2012. [Epub]
Cross-Section Trichometry, A Clinical Tool
for Assessing the Progression and Treatment Response of Alopecia
Joaquin J. Jimenez, Tongyu Cao Wikramanayake, Lucia M. Mauro, Irene A. Tabas,
Anne L. Chen, Isabel C. Llanes, Lawrence A. Schachner
Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
EXPERIMENTAL PROCEDURES
TCW is the recipient
of a Career
Development Award
from NIH/NIAMS
(AR050487).
RESULTS
RESULTS
INTRODUCTION
Figure 3. Cross-Section Trichometry (CST) of surgical
silk. (a) Correlation between the number of 5-0 strands
and Hair Mass Index (HMI). (b) CST of mixed silk
strands of different types/diameters. (c) Correlation
between HMI, the number of strands, and bundle weight.
c
87
79
72
64
57
50
49
35
30
25
21
16
11
0
10
20
30
40
50
60
70
80
90
100
HMI
ba
2
11
21
29
38
51
55
63
0
10
20
30
40
50
60
70
0 20 40 60 80 100120140160180
HMI
Number of Silk Strands
r=0.9969
31 34
40 43
50 55 58
65.3
80.282.8
88.6
97.499.4
105.3
0
20
40
60
80
100
120
80 90 100 110 120 130 140 150 160
HMI
Number of Silk Strands
Weight(0.01g)
r=0.9953
r=0.9656
Type
Number of Surgical Silk Strands
3-0 80 60 40 20
4-0 20 40 60 80 60 40 20
5-0 20 40 60 80 60 40 20
6-0 20 40 60 80
Figure 4. Cross-
Section Trichometry
of bundles of cut
human hair using the
HairCheck® device.
Shown is correlation
between the HMI, the
number of hair
strands, and bundle
weight.
23 24 25 27 28 29 30 31 32
48.2
50.9 52.3
55.2 55.8 57.4
59.1
62.0
64.7
0
10
20
30
40
50
60
70
310 320 330 340 350 360 370 380 390 400 410
HMI
Number of Hair Strands
Weight(0.01g)
r=0.9959
r=0.9874
Applications of Cross Section Trichometry:
• Early detection of non-visible hair loss.
• Progression of hair loss.
• Evaluation of response to hair loss treatments (drugs,
devices and over-the-counter products).
• For hair transplantation, CST in the donor area during
initial consultation will help develop realistic
expectations.
• Assess hair breakage.
a b
c
d
e
mm
0 1 2 3 4 5
Figure 1. For assays of hair
density, any hair with a diameter
of greater than 30µm is counted
as one hair without consideration
of the variation in hair diameter.
But for conditions such as
androgenetic alopecia, the hair
diameter varies greatly (left).
• Currently, most dermatologists use simple, non-
quantitative methods to evaluate alopecia, with an
emphasis on hair density alone.
• Small decreases in hair density are not easily detected
by the naked eye, e.g., in global photographs.
• In addition to density, the diameter of hair fibers also
contributes greatly to the appearance of hair mass.
Figure 2. The HairCheck® System consists of a locating
strip (a,b) attached to a pair of eyeglasses (a) and the
measuring device (c,d). A four-legged template is
placed on a numbered tab of the locating strip (b) to
mark the sample site, and the tab number is recorded to
allow return to the same site for future measurements.
The measuring device is hand-held and transmits a pre-
determined load to a bundle of hair (at least 2.5 cm [1
inch] in length) captured by a J-slot (c, d, e). The hair
can be of any type, from super fine to very coarse.
Obtaining the Hair Mass Index (HMI): Bundles of
surgical silk or cut human hair were placed in the J-slot
of the measuring device (c). When the lever arm is
squeezed (d), the cross sectional area of the bundle is
instantaneously displayed as the HMI on the device’s
LED screen and expressed as: mm2 of hair per cm2 of
scalp x 100, rounded up to the closest integer.

CLINICAL APPLICATIONSCLINICAL APPLICATIONS
Tracking the Hair Mass IndexTracking the Hair Mass Index
HMIHMI

BASELINEBASELINE
No treatmentNo treatment
49497575 6161
18 MONTHS LATER18 MONTHS LATER

BASELINEBASELINE
START = FIN, MNX, LASERSTART = FIN, MNX, LASER
IRON SUPPLEMENT, ETCIRON SUPPLEMENT, ETC..
49497575 8686

BASELINEBASELINE
REDUCE FINASTERIDEREDUCE FINASTERIDE
TO HALF DOSAGETO HALF DOSAGE
49497575 7575
WORKS JUST AS WELLWORKS JUST AS WELL

BASELINEBASELINE
NEW DRUG,NEW DRUG,
UNKNOWN SIDE EFFECTSUNKNOWN SIDE EFFECTS
4949
7575 6060
NEW DRUG,NEW DRUG,
MIGHT CAUSE HAIR LOSSMIGHT CAUSE HAIR LOSS

PRE OPPRE OP
HAIR TRANSPLANTATION
49493333 6363

6 MONTHS AFTER6 MONTHS AFTER
CHILDBIRTHCHILDBIRTH
49495555 7777
18 MONTHS AFTER18 MONTHS AFTER
CHILDBIRTHCHILDBIRTH

MALE with EARLY BALDINGMALE with EARLY BALDING
Vertex = 50% LOSS = VISIBLEVertex = 50% LOSS = VISIBLE
Mid scalp = 12% LOSS = NOT VISIBLEMid scalp = 12% LOSS = NOT VISIBLE
(86/98 X 100 = 88%)(86/98 X 100 = 88%)
8686 9898
4949

FEMALE with HAIR LOSSFEMALE with HAIR LOSS
(occiput & mid scalp are about equal)(occiput & mid scalp are about equal)
CONCLUSION = Hair Loss is DIFFUSE not PATTERNCONCLUSION = Hair Loss is DIFFUSE not PATTERN
7474
7777

BASELINEBASELINE
Start treatmentStart treatment
49496565 7575
““Doc, thisDoc, this
treatment’s not working.”treatment’s not working.”

BASELINEBASELINE
Start treatmentStart treatment
49496565 6565
““Doc, thisDoc, this
treatmenttreatment reallyreally works!”works!”

CROSS SECTION TRICHOMETRYCROSS SECTION TRICHOMETRY
• Measure the amount of hair in an area of scalpMeasure the amount of hair in an area of scalp
• Measure and track shedding (effluvium)Measure and track shedding (effluvium)
• Measure and track thinning (pattern balding)Measure and track thinning (pattern balding)
• Measure the efficacy of a device or drugMeasure the efficacy of a device or drug
• Measure response to iron Rx, thyroid, etc.Measure response to iron Rx, thyroid, etc.
• Measure HT resultsMeasure HT results
• Determine if a drug causes hair lossDetermine if a drug causes hair loss
• Detect balding many years in advanceDetect balding many years in advance
• Technology was developed at UM DermTechnology was developed at UM Derm
• Used by approximately 300 physicians internationallyUsed by approximately 300 physicians internationally

CAN THE DEVICECAN THE DEVICE
BE USED TOBE USED TO
MEASUREMEASURE
HAIR DAMAGE?HAIR DAMAGE?

If youIf you
PERM, DYE, HEAT DRY & SUN EXPOSEPERM, DYE, HEAT DRY & SUN EXPOSE
actively growing hair over a period of timeactively growing hair over a period of time
TheThe DISTALDISTAL shaft will receive more insultsshaft will receive more insults
thanthan thethe PROXIMALPROXIMAL shaft, andshaft, and
BREAKAGEBREAKAGE will occur inwill occur in DISTALDISTAL shaft.shaft.

THEREFORETHEREFORE
We can incrementally measureWe can incrementally measure
the bundlethe bundle’s X-section along its length’s X-section along its length
to detect the absence ofto detect the absence of
DISTALDISTAL hair shafts.hair shafts.

BUNDLE OF BROKEN HAIRBUNDLE OF BROKEN HAIR
X-sect = 1.73 sq mmX-sect = 1.73 sq mm
Skin surface
2 cm
5 cm
7 cm
10 cm
Unbroken hairs

If the X-section is 1.73 mmIf the X-section is 1.73 mm22
at 10 cmat 10 cm
and 4.54 mmand 4.54 mm22
at the skin surface…at the skin surface…
1.73 divided by 4.54 = .381.73 divided by 4.54 = .38
WE CAN CONCLUDEWE CAN CONCLUDE
THERE IS 38% HAIR BREAKAGETHERE IS 38% HAIR BREAKAGE
@ 10 CM FROM THE SCALP@ 10 CM FROM THE SCALP

 The size of the bundle has no relevance. No scalpThe size of the bundle has no relevance. No scalp
demarcating measurement is required.demarcating measurement is required.
 Performance of aPerformance of a HAIR DAMAGEHAIR DAMAGE measurementmeasurement
takes about 2 minutes.takes about 2 minutes.
 Hair may be wet or dry.Hair may be wet or dry.
 No training or experience is required.No training or experience is required.

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