Skin Care

John Olerud, MD
George F. Odland Professor, Department of Medicine;
Head, Division of Dermatology
Adjunct Professor, Department of Orthopaedics, Sports Medicine
University of Washington, Seattle WA

Skin Cancer Prevention
Male Pattern Baldness

SKIN CANCER

Nearly half of all new cancers are skin cancer. More than one million new cases of skin cancer will be diagnosed in the United States this year. Almost all skin cancers arise from cells in the outer layer of skin called the epidermis. Basal cell cancers and squamous cell cancer (which account for approximately 80% and 16% of skin cancers respectively), arise from the cells that form the skin barrier to keep water in the body and bacteria out. These cancers have better than a 95% cure rate if treated early. Melanoma accounts for 4% of skin cancers and arises from the pigment cell that gives skin its color (including a tan). Melanoma is by far the most serious skin cancer and accounts for more than 77% of skin cancer deaths. One person dies each hour from melanoma. One in 39 Americans have a lifetime risk for developing melanoma. (Source: American Cancer Society’s 2003 Facts and Figures). For more information about skin cancers including what they look like visit the American Academy of Dermatology web site at http://www.aad.org .

SKIN CANCER PREVENTION

By far the most important steps for skin cancer prevention are sun protection and sun avoidance. Ultraviolet (UV) radiation is a proven cause of skin cancer. Like smoking and lung cancer, the link between UV radiation and skin cancer is clearly established. People who sunburn easily are at the highest risk of skin cancer. UV radiation from the sun is most intense when the sun is directly overhead (when your shadow is shorter than you are). Choosing to be outdoors for recreational activities before 10 AM or after 4 PM avoids the peak UV radiation. Protective clothing, broad brim hats, sunscreens with an SPF of 15 or higher, and choosing shady areas when sitting outdoors are all helpful for protecting skin from UV radiation. It should be pointed out that sunscreens alone have not been shown to be protective for melanoma. The annual rate of melanoma has continued to increase even in the years when sunscreens have been available. Thus the full range of sun avoidance and sun protective behaviors are recommended in addition to sunscreens.

MALE PATTERN BALDNESS

Approximately 50% of men experience some degree of male pattern hair loss by age 50. Male pattern baldness runs in families. It can be inherited from the mother’s side or the father’s side. The hairs in the central portion of the scalp become very small and fine under the influence of one of the male sex hormones, dihydrotestosterone (DHT). The hair on the sides and on the back of the scalp is not subject to the same hormonal influence as the central scalp. Thus, the hair on the sides and back of the scalp appears normal even in people who have full expression of male pattern baldness. When hair from the back of the scalp is transplanted into the central scalp it continues to retain its normal size (free of the influence of DHT).

TREATMENT

Three treatments have the most medical evidence to support their effectiveness.

1). Topical treatment with minoxidil twice daily has been shown to result in at least moderate re-growth of hair in 20-40% of those using the treatment for 48 weeks. The 5% solution was shown to be more effective than 2% solution, but caused somewhat more irritation. When treat­ment is stopped the hair that has regrown becomes fine and small again.

2). Finasteride™ (a 1 mg pill taken daily) lowers the level of DHT in the follicles and allows some follicles to resume growing normal hair in the central scalp. At one year, approximately 30% of patients observed slightly increased hair growth, 20% moderately increased growth and 3% greatly increased growth. The 2-year percentages using the same categories for assessing hair growth were even better totaling 66%. The safety profile for this product is acceptable. However, sexual dysfunction including decreased libido, ejaculation disorders and erectile dysfunction occurred more commonly in patients treated with finasteride (3.8%) compared with placebo (2.1%) over 2 years in the 1879 men studied. Five-year studies are now available and show similar benefit and safety profiles.

3). Hair transplanta­tion from the back of the scalp where hair is not affected by DHT to the center of the scalp gives the most consistent and dramatic benefit. Recent improve­ments in techniques with minigrafting and micrografting methods (smaller plugs) have improved the cosmetic out­come significantly. The treatment is considered a cosmetic procedure and it is not covered by insurance.

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