Hair growth vs. skin irritation
DEAR DR. ROACH: You recently wrote that minoxidil (Rogaine) provides some benefit for hair growth. My friend broke out in hives after using it. Would you please print the pros and cons associated with Rogaine? -- T.A.
ANSWER: Topical minoxidil is generally well-tolerated. The most common side effect was what your friend had, a local skin reaction, which can be allergic in nature or plain irritation. In most cases of people with allergic reaction, it was a separate component in the product -- a solvent called propylene glycol, not the minoxidil itself -- that caused the reaction, so some people have had success with a compounded version of the medicine made with a different solvent.
Both men and women have strong desire for even the moderate benefit in hair that minoxidil usually gives, so much so that they are often willing to put up with mild irritation.
Minoxidil taken orally dramatically lowers blood pressure, but topical minoxidil is not absorbed well enough to lower the blood pressure in people with intact skin. People with inflammation of the scalp may absorb enough minoxidil to lower their blood pressure, which could be a problem in people with some kinds of heart disease.
DEAR DR. ROACH: I have noticed most physicians are board certified in their field. Should I avoid those who are not certified? Does board certification have anything to do with qualifications? -- H.W.
ANSWER: There are several different qualifications for doctors. They need a license to practice, for one, and state licensing boards monitor their activities and education. State medical boards also require that doctors provide documentation of continuing medical education. This requirement varies from 12 hours per year (Alabama) to 200 hours per year (Washington state).
A number of national boards provide additional certification for doctors, including internal medicine, surgery, family medicine and many others -- a total of 40 specialty and 87 subspecialty boards. A doctor does not need to be board certified to practice medicine, but 87% of medical school graduates from 1997-2000 did become board certified. To do so, a doctor not only needs to pass the board examinations (not everyone does), but needs to have successfully completed the medical school internship and residency (and sometimes fellowship) needed to become certified for the board. The American Board of Medical Specialties states that board certification "offers an independent evaluation and verification of physicians' skills and expertise. It supports and encourages physicians in developing their knowledge and skills throughout their careers to meet the professional practice requirements set by their peers." Many boards, such as internal medicine, require its newer diplomates (and encourages its older diplomates) to continue to demonstrate expertise through additional educational activities and examinations to be "continuing board certified."
Doctors who finished training years ago did not become board certified as often as they do now, and some physicians never become board certified but nonetheless have great expertise in their fields. For doctors who have graduated recently, not being board certified would be a bit of a concern.
You can find out if your doctor is board certified at: www.certificationmatters.org/find-my-doctor/.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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