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Hair Loss/Telogen effluvium

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QUESTION: Hi Doctor,
I am a 20 year old girl who recently megadosed on pantothenic acid.I took about 2grams of the vitamin for 6 months over a year ago.I noticed my hair falling out and the remaining hair on my head becoming finer during the second month of taking this vitamin,so I know it was caused by this because it happened so suddenly and is not some genetic problem.It has been a year since I stopped overdosing on  this vitamin and most of my hair has grown back and it has stopped falling so much.However my hair still has a finer texture than I had before I megadosed on this vitamin,when I had really coarse hair .Is there a chance I will regain my old hair texture in the next few years?
Would eating more protein and vitamins help?

Thanks and sorry for the long explanation.,
Christine

ANSWER: Christine,
 Most of the time when you take in more vitamins than your body needs it just gets eliminated in your urine.  In the case of pantothenic acid the most likely result would be diarrhea. There are only a few anecdotal reports of people taking excess amounts and rarely if ever does it leave any permanent side effects.  Hair grows steadily at the rate of 1/2 inch per month for 5 years unless something disturbs the growth cycle. If there is a disturbance to the actively growing hair the follicle gradually moves up and sheds the hair four weeks later. I suggest you do not attempt to help your hair grow by taking more vitamins. A normal diet will supply all you need.  The loss you experienced last year may have been due to the megadose pantothenic acid or something else which stressed you either physically or emotionally. That stress leads to a shed called a Telogen Effluvium. I would expect your hair to gradually feel thicker since the ones which fell out last year are less than 6 inches long and your hair is perhaps a foot long and it would take two years to reach that length.

In Chapter 4 of my book "Hair Loss Answers" I deal with causes of hair loss:
http://www.hairdoc.com/hair-loss-anwers/chapter-4-other-hair-loss-causes/
Nutritional Deficiencies

Nutritional deficiencies are rarely a cause of hair loss despite the marketing of a wide variety of nutritional supplements that claim to somehow enhance hair growth or hair health. Of the possible nutritional deficiencies that can cause thinning hair, iron deficiency anemia is most common, and when it occurs it is more frequently seen in women. Iron deficiency anemia is a result of a decreased amount of red blood cells in the blood because of inadequate iron reserves in the body.

There are several causes for this condition, including inadequate consumption of iron-containing foods, poor absorption of iron in foods or supplements, and loss of blood.

The main sources of iron in a typical western diet include meat, egg yolks, poultry, fish, legumes (lentils, dried peas and beans), whole grains, iron-fortified cereal products and iron-containing multivitamin tablets. Poor absorption of iron can result from disease conditions or from certain medications that interfere with iron absorption. Low red blood cell count from periodic blood loss can contribute to anemia because the body normally recycles the iron in worn out red blood cells. If the blood is lost, the iron in those cells is lost as well. Menstruation is the most common cause of blood loss-induced iron deficiency anemia; however; blood loss can also result from injury, frequent donation of blood, and internal bleeding from digestive system ulcers and various disease conditions.

The first step in determining if iron deficiency anemia as a cause of a hair loss condition is a blood test for ferritin levels. Ferritin is an iron-storing protein that circulates in the blood and reflects the body’s iron reserve level. Just taking an iron supplement is not likely to stop hair loss. If a serum ferritin blood test indicates a deficiency, the next step is to determine the cause of the iron deficiency, and to effectively treat the condition. Many doctors and laboratories assume the normal range of serum ferritin to be 10-230 grams per liter. But in the past few years it has been found that women with levels below seventy have an increased chance of hair loss. Inadequate dietary iron can be treated with iron supplement tablets however, iron absorption problems may require switching medications or injections of iron supplements, and blood loss treatments vary according to the cause. In addition to iron deficiency anemia, severe “crash” diets, and psychological disorders that result in extreme nutritional imbalances such as anorexia and bulimia, can also result in hair loss. Going without food for several days, or even several weeks, will not cause hair loss. But severe swings in nutrition and body weight from “crash” diets over several months time may begin to affect hair condition.

The American Journal of Clinical Nutrition published a study of two adult hospital patients who were unable to use their intestines to digest food. The patients were fed intravenously a diet that happened to be deficient in the B-complex vitamin biotin. Biotin deficiency is extremely rare because in addition to being present in many types of food, it is also manufactured by the friendly bacteria that live in normal intestines. Because these patients had inactive intestines, their intestinal bacteria did not produce adequate biotin, and they suffered hair loss as a result. When biotin was added to the intravenous diet, hair growth resumed.

With most nutritional deficiency-caused hair loss, hair growth resumes with adequate consumption of the missing nutrient.

Prescription Drugs

There are many categories of prescription drugs that present a risk of temporary hair loss as a possible side effect. Chemotherapy drug treatment almost always causes hair loss because the drugs target rapidly dividing cells typical of cancer. See Chapter 8 and Appendix 2 for a complete discussion.

Stress

Stress can cause a type of hair loss called telogen effluvium. This condition is not caused by the general accumulated stress of ordinary interactions with people at home and at work, but rather by sudden severe emotional or physiological incidents. Severe stressful events can cause some or most actively growing hair follicles to prematurely shift into the regression phase, and then the resting phase, during which the hairs fall out easily.

There is usually a delay of a few weeks to a few months before the shedding is noticeable, but after this delay the shedding seems to occur quite suddenly. Because the shedding is delayed, this type of hair loss is often a mystery to the person suffering the condition. The stressful event that triggered it is frequently forgotten, and it is rarely thought to be connected with the “new problem.”

Examples of sudden severe emotionally stressful events include the death or terminal illness of a family member or close friend, marriage, divorce, and unexpected job loss. Severe physiological stressful events shock the body, and some examples are heart attacks, major surgery, and illnesses with prolonged high fever such as malaria, viral pneumonia, and severe cases of the flu.

In most cases of telogen effluvium, the hair follicles recover and soon shift back to the regular growth cycle.

However, repeated instances of telogen effluvium can result in premature hair loss in people predisposed to lose their hair late in life. The average growth cycle of a hair follicle takes about five years, but each follicle is “genetically programmed” for only a limited number of growth cycles. For example, if a particular hair follicle were “genetically programmed” for only ten growth cycles, after about fifty years that follicle would stop producing new hairs. When all the follicles at the hairline or crown of the head are “genetically programmed” this way, a receding hairline or bald spot appears after all the growth cycles for the follicles in those areas have been cycled through.

Each incidence of telogen effluvium uses up one “life” of the affected hair follicles. So instead of having a receding hairline or bald spot at age fifty, the hair loss may occur a few years earlier. This is not a significant issue if telogen effluvium occurs once or twice in a lifetime; however, accelerated hair loss can result from repeated severe stressful events, if each instance triggers a new round of telogen effluvium.

I had a patient who was totally bald when I met him at age seventy, and he had lost all his hair by age twenty-two. He had worked on the Panama Canal fifty years earlier, and for two straight years starting when he was twenty he suffered repeated bouts of severe fever from episodes of malaria. Each time he suffered from malaria induced fever he experienced telogen effluvium, lost what hair he had, and his hair follicles lost another “life.” After ten or fifteen malaria stress cycles, at the age of twenty-two, he had the hair he would have had at age seventy. Which unfortunately for him was no hair at all.

---------- FOLLOW-UP ----------

QUESTION: Thank you for answering my previous question in such detail ,Doctor!
However,I don't think you answered my question about change in texture of hair(from coarse and thick to fine)due to telogen effluvium.
Have you heard of anyone in a similar predicament who regained the old texture they had before hairloss?
Can I still expect to see improvements in growth and texture even though it has been a year since my TE episode?

Thank you,
Christine

Answer
Some patients do experience changes in texture ( coarse to fine and curly to straight or straight to curly) after taking certain medications or after an illness.
 Most of these texture changes develop after having a Telogen Effluvium- a shed which thins out the hair. You had that happen to you. Many drugs can do this but only a few people get the texture change when the hair grows back. Sometimes it is a permanent change but most people notice the hairs gradually taking on their original characteristics.
 I can not tell you what percentage of patients who have had this happen get back to their original growth. This is not that common a condition to be able to easily do a study on patients with this condition. The few I remember seeing who have had straight hair for several years after having curly hair end up laughing about how it grew back straight instead of curly and are thankful they have the hair back. I would think those patients who get normal growth and texture a few years after the TE rarely come back to show off normal hair. So there may be a good chance yours will revert to the way it was.
Last week I saw a 16 year old girl who had lost half the hair on the top and back of her head two years ago. She had dark coarse curly hair originally and the new hairs are black fine silky hairs. No one can predict they will remain that way. In your case one year is still early in the repair process of hairs going from Chronic TE to normal growth in normal anagen phase.  

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Peter J. Panagotacos, <B>M.D.</B>

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website www.hairdoc.com

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