Male (and Female Pattern) Baldness

Male pattern baldness is a hereditary condition in which fewer new hairs grow to replace those that shed. It is passed down from generation to generation in our genes. Male pattern baldness can be inherited from the father or the mother. The gene that causes male pattern baldness was identified in 2008, raising hopes that a cure may be found in the not too distant future. Drug companies are currently spending billions trying to discover a cure. Male-pattern baldness is the commonest type of hair loss. Its medical name is androgenic alopecia.
As well as affecting men, it can sometimes affect women (female-pattern baldness). It affects about one third of the population. It can start early, sometimes in the teens and early 20s. Pattern baldness only affects the scalp; it does not affect hair on other parts of the body.

Male pattern and female pattern baldness is caused by hair follicles becoming oversensitive to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone. The follicles react to DHT and eventually shrink. The hair becomes thinner and grows for a shorter length of time than normal. The balding process is gradual because different follicles are affected at different times.

Treatment for male pattern baldness

There is no cure for male pattern baldness however there are some treatments which can slow down its progression or stimulate hair growth. Examples include minoxidil, tretinoin and zinc (which I will discuss again in my blog).

A low dose of a drug called finasteride can prevent hair loss and cause re-growth in male pattern hair loss. It works by stopping the conversion of testosterone to dihydrotestosterone (DHT). The strength of finasteride used to treat male pattern baldness approximately 1.25mg which is not available in Ireland. Finasteride 5mg tablets are only available in Ireland and is licensed to treat benign prostatic hyperplasia (enlarged prostate) in men. The brand Propecia^® is available in many countries such as the UK and US. Propecia^® contains finasteride 1mg and is specifically licensed to treat male pattern baldness; however it is not available in Ireland. Therefore, consultants in Ireland prescribe finasteride 1.25mg as an unlicensed indication for male pattern hair loss and pharmacists split the 5mg tablet in quarters so the patient has the correct strength (1.25mg). There is a good success rate from finasteride with about 2 out of 3 men experiencing hair re-growth. One in three men experience no hair growth from finasteride however it does stop further hair loss. It can take up to 6 months to notice results from finasteride and up to 2 years for full hair growth. Side effects are rare at the low dose used for male pattern baldness but it can cause loss of libido (sex drive) in about 2 in 100 patients. It should not be used by women. Because finasteride is not licenced at a low dose in Ireland, a specialist will only prescribe the low dose version if he/she feels the benefits outweighs the risks.

Techniques such as hair transplantation, scalp flaps, and other procedures may be considered. Success rates vary, specialist advice is needed if surgery is considered and they are generally expensive.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

 This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar

The difference between a Chartered Physiotherapist and a physical or massage therapist

Since launching our chartered physiotherapy service last year, a question posed to Whelehan’s staff is, what is the difference between and physiotherapist and a “chartered physiotherapist”? There is a difference. Unlike other medical professionals such as doctors, nurses and pharmacists, up until recently there has been no protection in Irish law for the title of physiotherapist in Ireland. This meant that in essence, anyone such as a “massage therapist” or “sports therapist” has been able to assume the name of a “physiotherapist”.

There has been many therapists practicing in the Republic of Ireland in many different settings including sports and leisure using the term “physiotherapists”/ “physio”/”physical therapist” but who have not completed the required courses recognised by the only governing body in the Republic of Ireland called the Irish Society of Chartered Physiotherapists. Protect yourself by ensuring you always check that the person pertaining to be a physiotherapist is a Chartered Physiotherapist. A Chartered Physiotherapist will have the letters MISCP after their name. Recently, after many years of campaigning, the Physiotherapists Registration Board was established. This will require all physiotherapists working in Ireland to be registered and will ensure that only registered physiotherapists can use the title and treat patients.

Why confusion can sometimes arise?

The confusion arises because in many countries including the UK and the US, the titles “physiotherapist” and “physical therapist” are protected, and may be used only by therapists with the appropriate qualifications such as four-year full-time degrees. In Ireland, however, physical therapists or sports therapists generally do not have the same qualifications as a physiotherapist, and often gain their qualifications through part-time programmes. A simple way of checking if a physiotherapist is a Chartered Physiotherapist is by going to the ISCP website (www.iscp.ie); by clicking on the section, “Is your physiotherapist chartered?” and when you type in the name of your Physiotherapist, if he/she is a Chartered Physiotherapist, it will confirm this as well as their county of practice. 

 What are the differences?

A Chartered Physiotherapist, physiotherapists must have completed a three- or four-year university degree programme. This training includes three core areas of muscular skeletal, neurology and cardiorespiratory. By choosing a Chartered Physiotherapist, you are choosing a professional who has scientific approach to the assessment, diagnosis and treatment of your complaint. Chartered Physiotherapists are recognised and covered by VHI, Laya Healthcare, AVIVA and other health insurance schemes

A physical therapist, on the other hand, can complete a course on a part-time basis, from 15 months to a three- year term, so the levels of experience and qualifications do differ. Moreover, training for a physical therapist typically only focuses on muscular-skeletal areas and does not take into account other body functions and processes. While the work undertaken by a physical therapist may be legitimate, the ISCP argues that it is essential that the patient should understand exactly what experience and training the person treating them has obtained. Thanks to physiotherapist Sinead Brogan from FlexPhysio Physiotherapy clinic at Whelehans for info for this article

 

 

 

Whelehans physiotherapy service with our Chartered Physiotherapist Sinead Brogan runs on Wednesdays, Fridays and Saturdays. We offer reduced physiotherapy rates for over 60’s and affiliated sport clubs. Book a physiotherapy appointment by calling Sinead at 083 1722171.

 

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This article is shortened. More detailed info sheets is available in Whelehans

Heavy Sweating and its management (medically known as hyperhidrosis)

Hyperhidrosis is where a person suffers from excessive sweating. Excessive sweating is not considered a serious health problem, but can be a source of embarrassment and anxiety and can affect confidence. 

Types

Hyperhidrosis can sometimes only affect specific area of the body, generally the armpits, face, hands or feet. If hyperhidrosis affects the whole body, it is referred to as generalised hyperhidrosis. Generalised hyperhidrosis may be due underlying medical condition like overactive thyroid gland or a side effect of medication such as an anti-depressant. In the case of hyperhidrosis that affects the armpits primarily, there is usually no obvious cause. This is referred to as primary hyperhidrosis.

Treatment

Lifestyle changes

Certain changes to daily routine can improve symptoms including: Specialised antiperspirant sprays (rather than deodorants); Soaps may irritate the affected skin. If so, use a bland soap substitute such as an emollient (moisturiser) ointment or cream (eg) Aqueous Cream, Emulsifying ointment; Get to know triggers that make your sweating worse. Common examples include spicy foods and alcohol; Tight, restrictive clothing and man-made fibres like nylon or lycra make sweating worse so should be avoided; Black or white clothing mask signs of sweating better than other colours; Armpit shields can be used to absorb excessive sweat; Thick and soft socks made of natural fibres can absorb moisture better (eg) Cotton.Avoid socks made from man-made fibres and change socks regularly (more than once daily if required); Wear shoes made from natural material like leather or canvas rather than man-made material; Aternate pairs of shoes daily to allow them to dry fully; Avoid wearing trainers or boots as they tend to be less breathable than normal shoes; Use absorbent foot powder twice daily if sweating of the feet is an issue.

Aluminium chloride antiperspirants

Strong aluminium chloride antiperspirants work by plugging or blocking sweat glands. Aluminium chloride antiperspirant needs to be applied at night just before bed (as sweat glands are less active at night). Wash the aluminium chloride off the next morning. Mild skin irritation, itching and tingling in the areas where applied are the most common side effects of aluminium chloride. Brands available in pharmacies include Anhydrol Forte^® and Driclor^®. When it comes to using aluminium chloride antiperspirants, less is more; they are less effective if too much is used at each application. It should be used once every one to three weeks for best effect. It can take a few weeks initially to build up its effect.

Iontophoresis

Iontophoresis is only done under a specialist and works best for hands and feet. Hands and feet are placed in water and weak electric current passes through the water; the electric current has the effect of helping block the sweat glands. Iontophoresis is not painful but the electric current can cause a slightly uncomfortable sensation and skin irritation. Each treatment of iontophoresis takes about 20 to 40 minutes and person normally gets two to four treatments each week. Improvement occurs after about two weeks and it should be continued for a month after improvement is seen. 80 to 90% of people notice improvement in symptoms due to iontophoresis.

Botulinum toxin

Botulinum toxin (botox for short) blocks signals from the brain to sweat glands thus reducing sweating. Botox injections work particularly well for armpit sweating. It is not recommended for sweating of the palms and face due to the risk that botox may block nearby small muscles. Costs of this treatment depend on the part of the body being treated. Treatment needs to be repeated every 4 to six months. Botox is only effective for between two and twelve months so treatment must continually be repeated.

Anti-cholinergic drugs

Anticholinergic drugs include prescription drugs such as oxybutynin hydrochloride and glycopyrronium bromide. They only control generalised hyperhidrosis. Their success is variable so they are not used very often. Side effects can include drowsiness, dry mouth, dry eyes, blurred vision and constipation.

Surgery

Surgical options are available if the above options fail. They include Video-assisted thoracic sympathectomy (VATS), Shelley's procedure (removing sweat glands), Retrodermal curettage, Laser sweat ablation (LSA) and Body jet liposuction. Contact Whelehans for more details on surgical options.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar