Hair Loss/massive and sudden hair loss
QUESTION: Dear Melanie, I have been shedding for a few years now,I never really thought much of it,I figured it's just stress,but this February the shedding became so massive and sudden that by the end of the month I could see my scalp on the crown area,I shed more on that month than I had all those years combined.Now I understand this is indicative of TE but what worries me is that although the shedding is throughout my entire head,the part hit the worst is the crown area (an androgenic area)surprisingly the temples (yet another androgenic area)have not been hit so hard,I also at times have a "pins and needles" sensation on my top/crown area,perhaps due to scalp irritation,which may be a result to losing so much hair but other than that there is no redness or visible inflammation on my scalp.It has been 5 months and there is no regrowth of he lost hair,is this because hair doesn't grow during the telogen phase? I would really like to think it is only TE but is it possible that I may have underlying AGA as well? I had some lab work done I am now awaiting results.Thank you in advance for your answer.
ANSWER: It is possible for a massive shed from telogen effluvium, as you describe, to unmask early androgenetic alopecia. This is referred to as superimposed telogen effluvium. When the center part is widened (in a christmas tree-like pattern) it may indicate telogen effluvium superimposed on androgenetic alopecia. If this is the case, once the telogen effluvium resolves, the androgenetic alopecia will become less noticeable.
It is possible for severe and long lasting telogen effluvium to appear more prominently in certain areas. I've encountered several women who were pretty sure they had androgenetic alopecia along with telogen effluvium, but when their telogen effluvium resolved there were no signs of androgenetic alopecia.
Pins and needle sensations (trichodynia) can occur with AGA or TE or Alopecia areata.
Telogen hairs do not grow. They are in the resting stage of the hair growth cycle. During the three months that the telogen hair is resting, there is a new hair forming underneath, from the same follicle.
With telogen effluvium the follicle does not remain empty. The hair that is lost is replaced with a newly growing hair. When telogen effluvium is long-lasting and severe the new growth may not be able to catch up with the rate of loss. This may be why you believe there is no regrowth at all. You should have some newly growing hairs. The newly growing hair has to make its way up the follicle, then permeate the scalp. After that it will only grow one half inch per month. So although you may have some new growth, it will take some time for it to grow long enough to add to the volume of your existing hair.
The best thing to do is to identify and address the underlying issues of your telogen effluvium in order to restore the hair growth cycle back to normal. Using essential oil scalp treatments may help stimulate new, faster healthy hair growth, but it is still important to treat the underlying cause(s). If androgenetic alopecia does become apparent, essential oils, diet, etc, can help slow the progression and minimize the effects.
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QUESTION: Melanie thank you very much for your response.Luckily I do not see a x-mas tree pattern but does this fact rule out AGA or is it still possible to be TE superimposed on AGA? I have not yet reached the 6 month mark,when TE would be considered chronic TE,you said that during the 3 month resting phase new hair is forming underneath,does this apply also to TE that lasts longer than 3 months too,I mean does this newly formed hair usually permeate the scalp at 3 months (right after it forms) or does it take an additional amount of time before becoming visible,in other words,does hair regrow while it is still in the TE phase, or does it halt growth until after the phase is over?
Telogen effluvium does not halt hair growth. Hair still grows during telogen effluvium. Because the hair loss of telogen effluvium is diffuse and there are no bald areas, it can be hard to detect new growth.
If telogen effluvium is due to nutritional deficiency, malabsorption, or certain other causes, the new growth may be light, thin, fragile and weak.
I would not worry about AGA right now. Once your telogen effluvium ends and the new growth start to fill in, you will better be able to tell if there are any signs of AGA.
Sincerely, Melanie Vomzabuesnig