Hair and Scalp Confidential Questionnaire

Occupation: Some occupations expose people to toxic chemicals: graphic artis working with dyes or pigments, auto mechanics / auto body repair who work with paints or solvents, hair stylist, office workers who are exposed to toner from copiers, etc. Or have a high stress level: layers, sales, police, and students.

Previous Surgery with General Anesthesia: (Especially recent surgery as general anesthesia or the stress of the surgery may cause a shed. Important to know if a woman has had a hysterectomy which will cause some hormonal shift even if she is on hormone replacement therapy

 

 -Congestive heart failure, Irregular heartbeat, Coronary Artery disease are all cardiac issues that may require permission from their cardiologist before treatment, especially if they are going to use a higher strength minoxidil.

*Minoxidil was originally used to lower blood pressure, and as a side effect was found to help hair growth. It is a linear dose drug SO the higher the strength, the better it works.

-Anemia and Thyroid disease (hypothyroid and hyperthyroid) may cause hair loss.

-Diabetes - diabetics usually take longer to heal and if not controlled, may also cause poor circulation.

-Depression and liver disease effect general health and medications given to treat these conditions may cause hair loss.

-Stress is a big factor in hair loss, especially for women and may cause telogen effluvium. This condition even with treatment may take up to 16 weeks to reverse.

 

 

PLEASE NOTE- CLIENTS SHOULD NEVER STOP MEDICATIONS WIHTOUT CONSULTING THEIR DOCTOR!

 

Many medications may cause hair loss as a side effect. Most common are anti-coagulants such as heparin, warfarin (Coumadin), Anti-depressants, hormones (birth control as well as HRT), some thyroid medications, and statins (cholesterol lowering drugs.

 

 

Men who have enlarged prostate or are being checked (PSA) for enlarged prostate, need to let their doctor know they are taking an "anti-androgen" saw palmetto (XTC's Supplements) or PropeciaTM/Finasteride as they may cause the PSA to have lower value than it really is.

The doctor may suggest he discontinue taking the supplement for a week or two, prior to having this test performed for a more accurate reading of their level.

Diet is particularly important for healthy hair. An adequate protein intake is essential.

 

How much a person needs per day is based on body weight at .8g per kilogram (2.2lbs).

The only contraindication on this is a person who needs to restrict protein intake such as someone with kidney disease.

-Vegetarians who do not eat any kind of animal protein will have a difficult time with adequate protein as there are two types of protein- complete (animal based such as meat, fish, and poultry which includes dairy products and eggs) and incomplete (nuts, legumes, soy, etc)

-Fruits and vegetables are important, and people should eat a variety of colors for the best nutritional value.

-Caffeine (coffee, tea, colas, chocolate, energy drinks) interferes with how your body processes B vitamins SO excessive use should be avoided.

-Anyone who has lost a lot of weight in a short period of time (diet, gastric bypass, or bariatric surgery) will lose hair

 

 

 

Hair Loss Facts 

-Some of this information you will notice when you examine the scalp. Dandruff may be a sign of an allergic reaction or an excessively dry scalp.

-Redness, bumps, raised areas or itching may be a sign of an infection (bacterial or fungal) as well as insect bites or more serious problems such as melanoma.

-Any raised rash, scaly areas (raised white scaly areas may be psoriasis) or open cuts/wounds should be referred to their physician or a dermatologist.

There may also be chemical (perms, strong chemicals) or physical scaring (heat, accident) where regrowth may not be possible.

Occasionally a person with Trichotillomania will come for treatment. These people pull out their hair, eyebrows, eyelashes and may benefit from counseling to find out the cause of this abusive type of behavior. If they continue to pull out their hair, the loss may become permanent

 Normally approximately 10% of the hair is in the growth stage and a person may lose 50 to 100 hairs per day. 

 It is when people see hair all over their pillow, sink and clothes that there is real concern, and they seek treatment. People like animals, do occasionally shed and is not cause for alarm as long as they are replacing those hairs which would be visible with the capilloscope.

What kind of shampoo do you use? Shampoos without sodium laureth sulfate (SLS) or DEA are safer and healthier. SLS may cause irritation and DEA when it sits on the shelf in a cosmetic product may react with other ingredients to form a potent carcinogen called nitrosodiethanolamide (NDEA).

These ingredients are added to shampoo because they emulsify the product and provide a rich lather that people think necessary to have "clean" hair.

 

Patchy areas on scalp, eyebrow, facial hair (men), may be alopecia areata. This is usually a sudden hair loss that may progress to Totalis (all the scalp hair) or universalis (all body hair. It is thought to be an auto immune disease and usually happens to someone under increased stress. It may only be an allergic reaction, but the cause is not really understood. Hair loss may be a symptom of a disease such as lupus and / usually recommend that people with alopecia areata see their doctor to rule out a serious auto immune disease.

Another cause of patchy loss would be scaring alopecia. This is usually seen as a red area that may have some drainage. When it heals, it is very smooth with no hair. A diagnosis of scaring alopecia is usually done by biopsy of the area by a dermatologist. There are no follicles in the scarred areas and regrowth is not possible. The hairs around these areas may be strengthened with treatment and may make these areas easier to hide with other hair.

*Hair may be damaged with excessive heat using irons and blow dryers.

-Wet hair is more vulnerable and thinner, weak hair may be damaged when vigorously rubbed.

Hereditary: 

 

If someone indicates they have no family history of hair loss, ask how far back they are going. Har loss may skip a generation, and is carried on several genes so it may randomly show up in family members or carry down from generation to generation on a regular basis.

 

 

I agree to be evaluated and I understand I will first undergo a comprehensive preliminary evaluation by an experienced consultant. All other checkups are included with the program's cost, which includes monthly and/or quarterly digital and microscopic pictures, for which I give my consent. I further understand results will vary depending on a large number of factors. I acknowledge that it is my responsibility to the company for any changes in my condition, no matter how slight. I understand some general recommendations will be made based on the initial consultation