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Hair Loss/Recovery from Telogen Effluvium

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QUESTION: Dear Doctor,
I am a 40 year old F and have been told that I suffered from telogen effluvium.  I first noticed hair coming out in handfuls while washing my hair. It just kept coming out in my hands as i brushed my fingers through it. my house was covered in hair, I had to cut hair out of my vacuum roller. I would wake in the night and be covered in hair, my brush would be full of hair.  This was in jan of 2010 and I had been taking or accutane since NOv 09.  Before this I had been on Aldactone, which was giving me great results, but I didn't want to take meds forever.  I stopped  accutane in march 10 as I was felt very unwell.  I was very fatigued and after many tests it was revealed that I had very low vitamin d and hypercalcemia.  I was told to take 2000 mg of vitamin d3 a day.  My levels are now normal.  My dog died in June 2011 after a long traumatic illness which was very stressful. I noticed lots of baby hairs all through scalp in nov 2011, but this seems to occur when I take a hair skin nails supplement with zinc, iron , biotin and vitamin c.  When I stopped this in early 2012 my growth seemed to slow and then accelerated again when I started again in oct 2012 after my GP said my hair looked thin.  I still have lots of baby hairs of different sizes all through scalp and derm said not genetic and my part is only slightly widened.  My hair looks and feels thicker on sides and only slightly thicker on top.lots of dark, thick hairs poking out of part. To most people I have a full thick head of hair now. Derm says part will fill in once top starts to thicken up.  Do you think that I had a chronic telogen effluvium or should I have a biopsy to confirm this? Also my temples and sides really thinned out, but are now filling back in.

ANSWER: Shelly,
 It certainly seems to me you have had ample cause to have a Chronic Telogen Effluvium. You went through the list of things that can cause a TE and you pretty much covered them all.
Stopping the Aldactone can cause a TE -- a temporary shed for a few months is common
Taking Accutane- a drug induced TE can take place for the entire time you are on it and a few months after
Vit D deficiency would lead to poor regrowth as would a low serum ferritin
Depression after a death of a pet causes TE in many people

Will it grow back? Most likely, yes. IF you do not have much inherited balding genes- look at your mother and father to see if they lost a lot of hair.  The Chronic Telogen Effluvium can lead to a much earlier onset of balding than you would have normally.
 If you do not have much in the way of family history for baldness then just forget about the temporary thinning because it will all grow back i another four months. I suggest you apply 5% Rogaine for men once a day in the morning just before combing your hair.

THIS IS FROM CHAPTER 4 IN MY BOOK  HAIR LOSS ANSWERS
http://www.hairdoc.com/hair-loss-anwers/chapter-4-other-hair-loss-causes/

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.

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QUESTION: Thank you for your kind prompt reply.  My mum has lost some hair at temples, but she is always scratching from seborrhoec dermatitis ,b ut has a full head of thick hair at 63. My dad has always had baby soft very fine hair since childhood, his hair has thinned in last 10 years or so, but he still has a fine covering of hair.  I have always had mothers hair, very thick and course and no or else in family has thing, even dads brothers have a full head of hIr and his dad did until he diesel in 80's.

I know that my hair has been thickening up, it feels thicker, temples are filling it and i see lots of new hairs stickng up inpart and when i part my hair, but when I look at top of scalp (which you never do until you have thinning!) it scares me.  I have been also seeing a trichologist who has taken progressive photos and it looks like it is filling in.  I do however get burnt in middle of part, however am from aust, so uv is extreme.  

I will attach a photo and this will probably change your previous answer completely.  My derm who i saw yesterday however, says part only slightly widened, it doesn't look like that to me.  I thought that telogeneffluvium caused no change in centre part?

ANSWER: A telogen effluvium can cause thinning and widening of the central part. With you family history it seems you should not worry about getting the hair back as the small new hairs seem to indicate regrowth and your trichologist has taken photos to prove that. Sometimes it is hard to judge which way the loss is going when you see it daily. I take photos routinely for just this reason.

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QUESTION: Thank you for kind reply, Sorry to be a pain, but the hair on the sides of my head seem to be thickening up nicely, but the hair on top still seems flat and thinner compared to the rest.  My ponytail has also thickened up.  Is this normal and will the part and top of head take longest to thicken?  Also, my shedding stopped sometime in 2011, I saw small hairs all through scalp in Nov of 2011 after taking a hair supplement, but hair seems to be very slow to grow back.  I only saw more regrowth once I started taking  the hair supplement again in October of last year after GP mentioned that my hair looked thin.  Ponytail and sides/temples have grown out some since then.  It is normal for recovery to be this slow?   My hair before the shedding was extremely thick.  I did suffer from some seborrheic dermatitis in part at back two-thirds of the top of my head and I scratched it until it bled and scabs formed, which I kept scratching off (bad I know!).  This was in October last year and under strong light you can still see red marks where sores were.  Would this have impacted the regrowth of hair in part?  

Thank you so much for your help

Answer
The thinner top compared to the sides is more in keeping with the thinning seen from aging or AGA. A Chronic Telogen Effluvium can lead to premature aging as I wrote in previous answers. I do not know how thin you would have been twenty years from now and whether what you have now is that degree of thinning. From the fairly good recovery of the sides and back it would seem that the top has indeed aged and thinned.
 Picking at you sores on the top of the head could have scarred some of the follicles. Your dermatologist and trichologist are in a better position to answer that question since they can see the scalp. You may have to accept the fact that you have regained most of what you lost and will have to live with a thinner area on top. Again, hairs only grow 1/2 inch per month and you may not feel the increased density on top for a year or two after the shedding .

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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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