Help diagnosing - telogen effluvium or something else?

[jtmann]

Hello,

I am new to the forum and hoping you might provide some insight into my case. I am at a loss and hope you can provide some helpful words.

I’m 37 years old and since I was 22 my hairline has been receding at the temples. It has receded very slowly for 15 years basically, to the point where now the temples are almost half way back the top of my head (i.e., the classic M receding pattern). The receding has not bothered me too much (for the reasons below). But something has rather drastically changed over the past few months. Here’s what.

Until recently, even though I was receding at the temples, I had no bald spot or thinning at the crown, and the thickness and strength of my hair was very good – i.e., not see-through in any way. I keep my hair very short/shaved (about ½ inch in length all over). But within the past few months, the receding at the temples has accelerated (not severely, but definitely quicker) and – here’s my main concern – my hair has thinned significantly and seems to be losing all strength. There are small patches of bald on the crown/top of my head (size of two 25 cent pieces) and it seems even some small patches (size of a 25 cent piece) on the side of the head and back – note that the “bald” not right to the skin but close – there are still some hairs on the bald spots but they are thin.

And hair all over the top of my head is quite see-through in certain light levels. Even the hair on the sides and back of my head seems to be much thinner. How I began to notice this was that a few months ago my scalp (all over but especially crown and all top of the head) started to get frequent bouts of redness, heat and itching (very itchy). I have noticed there are still some red patches under the (thinner) hair and although the redness, heat and itching is not as bad as a few months ago, I still get those bouts a few times a week. And I notice that the skin is flaky at times/peeling almost like a sunburn (not flakes like dandruff – more like the skin itself is drying up at shedding like a snake).

Re: my medical history and meds, for the past 6 years I have already been taking Proscar (same active ingredient as Propecia, as you probably know). I wash with a baby shampoo, do not use a hair dryer, etc. I do have a history of eczema (but have never had it on my scalp or head). Not sure if what is on my scalp now is related to eczema, but I tried a half dozen applications of both Hydroval and Elidel. Neither helped. A couple months ago when this episode started I tried Nizoral (2%) for a few times but it didn’t’ help. I started to use 5% minoxidil but stopped after around ten days because of the drying (alcohol) and because I seems I read as many negative experiences as positive (especially shedding). I have not used Nizoral or minoxidil in two months or more.

I have been to my family doctor several times and to a dermatologist. Neither has been helpful (every time I saw them, for whatever reason the redness itch and peeling on my scalp was in remission and as a result they just kind of shrugged their shoulders. The dermatologist did hold out the option of doing a scalp biopsy – any thoughts from the forum on that?).

Here’s an added twist. About two months before this onset started (i.e., about five months ago from today) I started to go through (and still am, but much better now) a very difficult emotional time in my personal life. Loss of appetite, depression, insomnia and low REM sleep (waking every couple hours) and weight loss (down from 160 pounds to 135 in three months). I am getting much better and gaining some weight back and I am super regimented the past couple months about eating a good diet including whey protein shakes to ensure I am not protein deficient (never been a big meat or egg eater). And I have started taking Vitamin E/antioxidant supplement a couple months ago. My doctor also did a full blood workup a month ago and every single blood level was fine.

The doctor and the dermatologist I saw did not really have anything concrete or helpful to say other than it could be a case of telogen effluvium. But they also said maybe not be that…basically they were no help and glossed over my case in my opinion.

So I am turning to you fine folks for some input, hoping that there are similar cases who might shed some light on diagnosis and treatment.

Thanks and I’d be forever grateful!

[HairLossFight.com]

Hi there,

Thanks for sharing your experience and situation. Stress and emotional duress can definitely cause hair loss in the form of telogen effluvium. It's also possible that stress can cause an existing underlying condition such as male pattern or female pattern hair loss, or even alopecia areata, to become worse or to get aggravated.

Based on the fact that you are saying that you are seeing "patches" of hair loss, I would be worried about alopecia areata. I don't want to scare you though. I'm not a doctor, but I would definitely seek further help on this if your existing doctor or dermatologist isn't helping much. If you post some pictures up here that could help us guide you in the right direction, but ultimately a diagnosis from a physician, preferably one with expertise in hair loss, would be useful.

Whatever caused the emotional duress for you, if that has gone away or been reduced you may see some improvement. I speak from personal experience here.

If I were you I would take stock of my entire life. It may sound crazy, but hair loss can be used as a catalyst for you to deal with things that you otherwise may not be dealing with. Even if you are predisposed to it, like I am, you can take steps that significantly improve the appearance of your hair. Much of what you can do to make improvements to your hair will also be the same steps that you would need to take to improve your overall health. I am convinced personally that there is a psychosomatic connection to hair loss. It may be true that your genes are the ultimate determinant as to whether you will experience it, it is up to you to treat your mind and body in such a way as to not allow those genes to dictate the rate and magnitude of the hair loss.

In my own case, lifestyle changes over the years, combined with hair restoration surgery, really put me in a good spot. If I were you I would first seek to understand the cause of my hair loss by getting a diagnosis, but also in parallel with that, I would turn myself into an athlete. I literally did that and my entire life has improved immensely, including my hair. Big time. Start by dramatically reducing your starch and sugar intake. That helped me a LOT. Make sure you take the time to develop a habit of going to the gym, or performing some form of regular exercise. Use your hair loss as a catalyst to change your life.

I hope that helps.

Sam

[jtmann]

Ok I've been considering a scalp biopsy but can't seem to understand what the upside of the biopsy would be - i.e., doesn't the biopsy just point to it either being teleogen or male pattern, and the treatment options are the same anyways. Trying to understand what the additional upside I would get from having the biopsy. Any insight into that? Thanks!