Hair Loss/Hair loss


QUESTION: I am a 31 year old female suffering from thinning hair. I have experienced extreme hair shedding since I can remember. My family and friends would always complain about my hair being every where on the floor and clogging the bath or shower drains. It never really did bother me since I always used to have long thick hair. It is only until this last few years that I have noticed my hair getting thinner and my hair would never grow past my mid back. That is when I have heard of miconazole nitrate, the active ingredient in a anti fungal cream, that people use for hair growth. So that is when I started to dilute this cream and applied it on my scalp. And I must say I had minimal shedding while using this and my hair grew until my waist in only like two to three months. I was ecstatic! I later just got out of the routine of applying the cream again and my hair start shedding like it use to. I later had a full tummy tuck and six months after that I became extremely ill, I couldn't eat or drink anything without having diarrhea or vomiting. So I lost like over 10 kg in less then two weeks. The doctors finally found out that I have gallbladder issues so that was removed. Because I had even more hair loss after all this stress my hair was so thin and so I decided to get micro ring hair extensions. After a month I had it removed because my head was itching like crazy and I thought maybe I just need a break and a good wash before I have them replaced. After i had the extensions removed I discovered that I have almost no hair of my own left. I have lost more then 50% of my hair. So that was when I had all my hair cut short and started using miconazole nitrate again. I apply it like twice a day and my hair looks a lot better after just two months and there is a lot of new hairs coming out.

Now I've heard of minoxidil but I'm to scared to use it to grow my hair back because I heard that once you stop your hair will fall out again. Will my healthy hair that are in a healthy hair follicle also fall out once I stop using minoxidil or is that only true for the problem ones. Or if I do decide to start using minoxidil should I be willing to use it for the rest of my life. And can I still use the miconazole nitrate with the minoxidil since it really make my hair grow fast since I heard that minoxidil takes a few months to work. So I don't want to shed all this new hair again when I stop using the miconazole nitrate.

Sorry for all the questions. I thank you in advance.

ANSWER:   I would suggest you see a dermatologist to determine if you need treatment for yeast or fungus growing on your scalp if you have found miconozole to be effective. I would use ketoconizole shampoo every other day to help control that problem. The use of Minoxidil 5% only once a day in the mornings should help and I would not worry about it causing more loss.

There are several problems going on at the same time from what you have written. You seem to have had a few episodes of Telogen Effluvium which is a shedding of hair due to stress to the body after any kind of disease or surgery. The tummy tuck and being ill for six months is a prime example of what can cause a TE. Then you lost hair due to Traction Alopecia when you had the micro ring hair extensions.
In my book "Hair Loss Answers" which you can read for free online at:

In Chapter 4 I discuss Telogen Effluvium due to 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.

And Traction Alopecia:
Hair Styling Techniques

A type of hair loss called traction alopecia can result from certain hair-styling techniques that pull tightly on the hairs, such as tight “cornrow” braids and pigtails. Modifying these styling techniques so that they are not too tight solves the problem.

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

QUESTION: Thank you so much for the quick response.

Just to be clear about something. If I do start the minoxidil will I need to use it forever to prevent hair loss again. And I'm not sure if I will need a prescription for the ketoconizole shampoo in South Africa or are there any well known over the counter shampoos that contain the ingredient.

If you start minoxidil you will stimulate hair to grow. Some of the hairs which were recently lost and dying may start to grow again. There is no way to know how many of these hairs may decide to regrow until you actually use it for six months and see what grows. Once they grow out it is your choice to continue to stimulate them to grow or let them die off again. So the answer is "Yes- you will need to use if forever" .
 More importantly is why the need for miconazole nitrate? Fungal infections can cause a similar scaly dermatitis to dandruff but the difference is the fungal infections ( Tinea Capitis ) can cause scarring of the hair follicles and no amount of minoxidil will bring them back. That was the reason I suggested you see a dermatologist.
I checked ketoconazole shampoo availability in So Africa and found Nizshampoo is available. Check with your dermatologist or pharmacist.
I do not know the requirements for getting the shampoo. This may be one of the over the counter shampoos.
 I wold check with the local internet search engines in South Africa to see what is available.

"NIZSHAMPOO® shampoo COMPOSITION Each 1 gram of shampoo contains ketoconazole 20 mg. Preservative: Imidurea 0,2% m/m

Hair Loss

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


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


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

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