Hair Loss Treatment with Dr. Shilpi Khetarpal – The Cleveland Clinic.

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Interviewer: Hello, and thank you for joining us on another installment of Theradome TV. Today, we are very fortunate to have with us Dr. Shilpi Khetarpal from the Cleveland Clinic.

The Cleveland Clinic Department of Dermatology has more than 30 dermatologists, seeing over 150 hair loss patients a week, making the Cleveland Clinic one of the largest providers of hair loss treatments in the country.

Interviewer: Hello Dr. Shilpi Khetarpal. Thank you for joining us today to discuss laser phototherapy for hair loss. Can you please introduce yourself a little bit, and tell us about your practice?

Dr. Khetarpal: Yes. Thank you so much for having me. My name is Shilpi Khetarpal, and I’m a board certified ASDS fellowship- trained dermatologist at the Cleveland Clinic. I focus on many things in my practice, but uh a topic that is really near and dear to my heart is hair loss, and all aspects of hair. I was fortunate enough to have several mentors who specialize in different aspects of hair restoration. So now, I focus not only on a medical approach to hair loss, but also combining, you know, minimally-invasive procedures.

Interviewer: Now, dermatology is a medical specialty within itself. But within dermatology, there are several specialties one can pursue. Is there a reason why hair was of interest to you?

Dr. Khetarpal: Yes, absolutely. So, I think dermatology, in general, has a lot of aspects that are very appealing in the fact that you could see, you know, men and women of different ages, races, genders. And you know, hair loss specifically, I realized very early in my career that it was a very common problem ah not only with women but also with men, and how it really impacted people’s quality of life. So, after realizing that we do have safe and effective treatments uhm not only how much improvement you can provide to someone, but also how much it affects not only their quality of life, their perception of themselves, their interactions with others. That’s really what drew me to hair loss. I found it to be incredibly rewarding and satisfying to see results in these patients.

So now, you know, I’ve been doing this for over 10 years. And each year we continue to have better therapies, and my patients continue to be happier and happier with their success

Interviewer: So, about how many patients do you think you’re seeing a week with hair loss?

Dr. Khetarpal: So, in our practice, we’re very fortunate that we have several dermatologists who treat, you know, hair and other conditions involving the scalp. I would say, you know, we see probably 100, 150 patients a week. Uhm so, that’s definitely on the higher end looking at, you know, practices around the country.

Interviewer: Wow! That’s a pretty big number. Now, that me… must make the Cleveland Clinic one of the largest providers with a focus on hair loss in the country.

Dr. Khetarpal: Absolutely! And you know, we really pride ourselves on offering patients evidence-based medicine, the latest treatments, those that are scientifically proven, uhm and able to treat all aspects of uh hair conditions and across all genders and you know all different uhm etiologies.

Interviewer: So, I… I would say that you… you see the entire spectrum of people dealing with hair loss. What percent of them would you say are women?

Dr. Khetarpal: So, generally speaking, I would say probably 90% of the patients we see are women when it comes to their hair. And I don’t think that has to do with any other reason other that; in our society, it’s really acceptable for men you know when they start to thin or bald, they just you know cut their hair really short or shave it, and that’s completely acceptable. For women, it’s really perceived that women should have this long, luscious, thick, flowing hair. So, uh women are definitely more bothered by it.

And it’s really interesting because statistics show, men are actually more often affected with hair loss. In fact, every decade of life, men experience male pattern hair loss at higher and higher rates. So, someone in their 20s, around a

20% chance versus someone in their 50s has a 50% chance of having it on the males. On the flip side with women, the… these changes typically don’t occur until after menopause, so maybe 50 to 60% of women, you know, 60 or later. So,  even though it’s more common in men, we definitely see more women I think because they’re more bothered by it and just the pressures our society creates.

Interviewer: Hmm. And you said 90% are women, that is a pretty significant difference. Is there a difference in causes or concerns with women versus your male patients?

Dr. Khetarpal: So, that’s a great question. I think for men, it really is just your straightforward like male pattern hair loss. You know, dad, brothers, grandparents had it. With women, it… it definitely varies. Now, we’re at… the inherited type of hair loss is the most common androgenetic alopecia or the female pattern hair loss uhm is definitely the most common. However, we do see many other causes for hair loss in women. Uhm I would say second to that is probably something we call telogen effluvium which is, you know, a massive amount of shedding caused by stress. Common examples are after a woman delivers or has a baby; they get massive amounts of shedding. Any rapid weight loss, crash dieting, an infection, uhmany of any major trauma or stress in the body can trigger a shed, so I would say those are probably the most common.

Uhm the good thing is that, you know, we have a lot of great treatments for them and these are non-scarring types of hair loss. So, if we identify the problem and start treatment early, we can many times you know uhm restore the hair that’s been lost and you know give them good results.

Interviewer: Hmm. Now, you mentioned several of the causes for hair loss. Now, let’s discuss the cure. How can photo or laser phototherapy help these women?

Dr. Khetarpal: Sure. So I really think the… the key to treating hair loss is combination therapy. There’s unfortunately not one treatment that solves everything, so I think just as important as what we offer in the… in the office from the medical side of things is just as important as what our patients do at home. So, one of the things I tell my patients, you know, “We’re going to come up with a treatment plan for you that encompasses medical treatments that we offer and then treatments you’re going to do at home.” I really think that’s where phototherapy is very important um you know due to different circumstances in life. Say a patient has recently had cancer or they’re pregnant or nursing, they may not be able to take certain medications; but laser phototherapy is really a great option for anyone. There’s virtually no side effects. It’s very safe and effective. It can really be combined with any treatment approach, and I really think it gets people involved in their care. You know, they see improvement when we’re doing things in the office. Then when they go home, you know a couple times a week, they’re going to do this. So, when they start to see improvement, like say they see less shedding or they see new baby hairs coming up, I think it’s really motivating to know that… that they’re making a difference.

So, um I really recommend it to all of my patients regardless of their age, their race, their gender. And the nice thing is too with this laser phototherapy that multiple people in the same household can share it. I have many people where uh you know spouses can use it; or they say my son is having some hair loss; or my daughter just had a baby, so I see a lot of times where everyone in the household is using it, making it a really safe and cost effective option.

Interviewer: So, when would be the best time for someone to take action to address their hair loss?

Dr. Khetarpal: So, of course, earlier is better. You know the early sign where they start to see some changes, whether it’s thinning or shedding, that is the best time to do it. But I tell everyone that it’s never too late to start treatment. So, not only are we going to stop things from getting worse, but we can also get some of that hair back. So, whenever it starts to bother someone, whenever they notice some changes, I think laser phototherapy is something relatively easy. They can start on their own, say while they’re waiting for an appointment to see their doctor.

Uhm and it’s definitely… I’ve had very good success with it. I have many patients who were on a treatment plan and then we did something simple like adding you know a home low-level light therapy, and they said you know “My shedding was so much better within four weeks” or “I’m seeing new hairs come up.” So, it’s definitely like another piece of the pie and just something else to offer, especially when you know in this day and age where we have you know so many other medical conditions people are being treated for, different cancers, this and that. This is really something you don’t have to worry about because there’s really… there’s not a single patient who I’ve had that is not an appropriate uhm candidate.

Interviewer: So, there are several other laser photo devices on the market. What makes the Theradome Pro LH80 the… the device of choice for you in the Cleveland Clinic.

Dr. Khetarpal: So, this is a question I get asked all the time uh not only by my patient but also by other providers. That, you know, why the Theradome? So, I think there’s a few things. I was involved about uh eight years ago when we started the initial FDA trials on these low-level light devices. So, the initial devices started as a comb. So, you know, you had to like move

it through the scalp. You had to either recharge it or use batteries, and it was very much operator-dependent. It would take a long time. They had to kind of move it around their scalp.

Then you know a few years later, they had the headbands, which were slightly better but still operator-dependent. The reason I like the Theradome is because it’s the largest treatment area out of any of the devices. Um you put it on. It covers that entire androgen-dependent area on the scalp. You push your button. It kind of walks you through your treatment, tell you… It’s also the highest power. Um so you know, looking at those bulbs it… it definitely delivers the perfect wavelength, which is um a diode wavelength which goes directly to the… the level of the follicle where we know it you know decreases inflammation, stimulates hair growth.

So, I think you really take out that user error or the you know the operator um side of things. So, you just put it on, hit a button, and you don’t have to worry about “Am I moving it fast enough? Am I covering my whole scalp?” Um it’s rechargeable so you don’t have to worry about batteries. So now, you know we’ve used all the devices over the last decade or so. And I would say probably for the last five years, our institution and all of us providers that treat a lot of hair have really favored um the… the Theradome. I think we’ve gotten that positive feedback from our patients also.

Interviewer: So, what do you tell your patients upfront? How do you set the expectations for the Theradome?

Dr. Khetarpal: So, as we talked about before, the earlier you started, the better your results are going to be. Um with hair in general, it is on a lag, meaning what we see today is the result of several weeks ago. So, I think patience is key. So, I tell people you know use it as much as you can, every other day, a couple times a week. And then, usually in the first month or so, you’ll start to see less shedding. And then after that, you’ll start to see some new hair growth and you know it just… it kind of peaks three to six months after you started. So, I just tell people to be patient, keep doing what you’re doing, and just don’t give up. And when they start to see these early signs of “Oh I’m not shedding as much when I wash my hair,” I think it’s very encouraging and they feel really motivated to continue on their… their plan.

Interviewer: Now, over the last 10 years, you’ve helped thousands of patients with hair loss. Are there any particular experiences with patients that stick in your mind?

Dr. Khetarpal: So, I think there’s a few. Um I would say, you know, there… there’s a few that stick out in my mind. I think the reason is you know their circumstances. The first was a young gentleman I had who was in his 20s, who you know he had tried really everything under the sun. And he had you know resorted to wearing a hat or you know covering his head almost every day. We treated him with you know a series of some uhm platelet-rich plasma or PRP injections. Also, got him started on the Theradome, and I would say he had about 30, 40% improvement. And you know, he came back to me as a follow-up and said you know, “This is the first time I really left my house without wearing a hat.” He’s like, “You know, I got a promotion at my job. I’m in a new relationship.” And he’s like, “I’ve never felt better.” He was able to stop his antidepressant. And you know, at that point, I realized, to us, you know if we haven’t experienced it ourselves then we just think “Okay, it’s your hair. It’s just you know it’s not a big deal.” And him being a male, I really didn’t realize how much it affected him. But it was almost like seeing a different person. His whole outlook on life and you know had changed just because we improved his hair.

Uhm another person that really sticks out in mind, a patient of mine who was in her 60s, who had undergone uhm chemotherapy for breast cancer. She had just said you know she lost a lot of her hair after her chemotherapy. Her doctor and her were really hesitant to really start any medication specifically for her hair, so she said “You know, I’m doing everything I can over the counter. What else can I do?” So, she was a great candidate for the Theradome because we knew it didn’t interfere with you know her radiation or chemo or anything else going on. And she came back probably six or eight months later and said, “You know, this is the first time I’ve grown my hair out. I was able to go to the salon and get it done because before that I was almost bald.”

So, you know, I think people don’t realize a) what an impact it has and b) how much just adding in one simple treatment can really do for someone. So, I was really touched and felt really um you know satisfied that I could really make a difference. So I… I tell people no matter where you are, what your background is, it really you know, there are options and they just need to you know seek the appropriate help and ah find a treatment plan that works for them.

Interviewer: Yeah. Wow, that’s amazing. You know you think of it as a physical condition hair loss, but there’s definitely a mental and emotional component to it as well. Uh well, Dr. Khetarpal, I’d like to thank you for joining us today and sharing both your clinical and personal experiences with the Theradome and laser phototherapy. Do you have any parting words for those who are concerned about hair loss?

Dr. Khetarpal: Um you know, absolutely. I really feel like it’s important to seek intervention early, but it’s never too late. Also make sure you find a provider who you feel comfortable discussing these things with and who has you on the same page. You know, I myself just recently being a new mother uhm about a year ago, after a delivery of my baby, I experienced that dreaded telogen effluvium, shedding so much hair. And I… I understand the emotional, physical and mental aspect of it. So, when I’m talking to others, I really feel like that you know I can relate to them. So, I think the best thing is you know start early.

It’s never too late. And just find someone, a provider who’s like on the same page as you to come up with a plan that’s going to be best for you and that you feel like is feasible to continue on with.

Interviewer: Sounds great. Dr. Khetarpal, thank you for your time today. And I know that Theradome is honored to work with you, and the team of providers at the Cleveland Clinic and pleased to play their part in the treatment therapies that you provide. As a new mother, I hope you enjoyed your first Mother’s Day. And again, thank you for all you do each and every day, and sharing some of your insights and experiences. Thank you.

Dr. Khetarpal: Great. Thank you!