ALAN J. BAUMAN M.D., A.B.H.R.S.
Alan J. Bauman, M.D.
Bauman Medical Group – Boca Raton, FL
ISHRS Annual Scientific Meeting 2013
DIFFICULT CASES
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.”• Chief Complaint: “I’m losing hair all over for many years… My dermatologist’s treatments did not work.”
• Hair Loss Genetic Hx: + father, + mother, + paternal grandfather
• Allergies: bacitracin, neo/polysporin,
• Medical Hx: skin cancer, breast cancer, HPV, chronic eczema, anemia• Surgical Hx: 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: MVI, D, Omega3, Calcium
ALAN J. BAUMAN M.D., A.B.H.R.S.
“LAURA M.” – 70F
ALAN J. BAUMAN M.D., A.B.H.R.S.
LABS / DIAGNOSTICS• CBC & Chem20: wnl
• Ferritin: 84
• Thyroid panel: wnl
• CAG repeat: 25 (Low Androgen Sensitivity)
• HairCheck 10/2/12
Occiptial (tab#34): 50 HMI
Vertex (tab#20): 40 HMI
Frontal (tab#11): 30 HMI
L-temple (tab #10.5x6L):19 HMI
Frontal 60x
Vertex 60x
ALAN J. BAUMAN M.D., A.B.H.R.S.
ASSESSMENT / PLAN• Diffuse Hair Loss w/ Weak HMI & Poor Coverage in frontal, temples and vertex
• Weak occipital HMI – poor donor quality
• ? Misdiagnosis / failed treatment with intradermal steroids and OTC minox
• 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 DERMOSCOPYFr
onta
lVe
rtex
T = 0 days (baseline) T = 90 days
ALAN J. BAUMAN M.D., A.B.H.R.S.
MINOXIDIL “FORMULA 82M”• Minoxidil 5%
• Retinoic Acid 0.01%
• Fluocinolone 0.001%
• Oleanolic Acid (olive leaf extract)
• Algae extract
• Phytantriol
• Vitamin E
• Propylene Glycol-free
• DOSAGE: apply 1ml (~30 drops) to scalp q12hr
ALAN J. BAUMAN M.D., A.B.H.R.S.
LOW LEVEL LASER THERAPY• 224 divergent / non-collimated / wide-angle laser diodes
• 5mW / diode, 650 nm, 80% duty cycle
• 30 min, every other day over 575cm2
• Dosage
224 * 0.005 W * 1800 sec * .80 / 575cm2 = 2.8 J/cm2
• 575cm2 = ½ area of a sphere with circumference of 60cm
LASERCAP
ALAN J. BAUMAN M.D., A.B.H.R.S.
HMI TRACKING
ALAN J. BAUMAN M.D., A.B.H.R.S.
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 DAYSJULY 2013
ALAN J. BAUMAN M.D., A.B.H.R.S.
270 DAYSOCT 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
• Medical Management Works
• Diagnosis
• Follow-up
• Tracking
• Compliance
• Formula 82M Minoxidil
• Finasteride/Dutasteride
• LaserCap
• Platelet Rich Plasma
• Nutritionals
Non-Surgical Treatment Options
Thank You!!
Follow @DrAlanBauman on [email protected]
ALAN J. BAUMAN M.D., A.B.H.R.S.
THANK YOU!
• Follow @DrAlanBauman
• www.baumanmedical.com
