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 Dr. Alan J. Bauman is the Founder, Medical Director and Chief Surgeon of the Bauman Medical Group, P.A. located in Wharfside at Boca Pointe in Boca Raton, Florida. His practice is dedicated exclusively to treating male and female pattern hair loss. Dr. Bauman uses state-of-the-art medical and surgical techniques to help his patients maintain and/or restore their scalp hair.
robert engel
2004-02-13
Strange hair loss
Dear Dr. Bauman,I am a 21 year old male. Back in late August-early September I came down with a case of montezumas revenge which is rare to pick up in the states. it went on for a month, high fever everyday, constant throwing up, bathroom troubles as well as a trip to the er for cat scans in which iv's didn't take the pain away. shortly after that; like probably a month; not 2-3; i saw that my hair was coming out in huge wads. all over my hands, sink, shower, room, anywhere that i looked their was hair. i went to a dermatoligst and he diagnosed mpb without me giving him to much info, it was like a 1 second exam, put me on propecia. for a month i took it and then saw another dermatologist who immediatly told me to get off it insisting i had TE. It started to get quite a bit better but a few weeks after this it has begun again, not quite like before but constant shedding. it's not huge clumps unless i gel my hair and then shower; then i still get tons but i can pull at it easily and it comes out but now more so like 1-5 or so but i could do it all day so im still losing at least 200 hairs or so a day and it seems more like shedding and not thinning. it's been almost 4 months now since this started; and it came real fast and now i can see thinning in the frontal area and along the sides of the hair line. the rest of it is thinning to but that is where i see the scalp. it sounds like almost a dose of te followed by a transition to androgenetic alopecia. my fam has little hair loss, a great grandpa on my moms side and 2 cousains on my ma's side; is it possible with te to have alot of shedding follwed by alot less but still a good deal of shedding?? another thing is it possible to have te if their is thinning in the front as a male? dermatologists cannot seem to understand the difference; so they go the majority, 95% androgenetic alopecia. im not convinced, after this huge illness i know i had te; but what i need to know is do you think it is more? only scalp can be seen in the frontal area but it is somewhat thin else where; i know aa is typical of thinning in the front but can it still be te and only just te? should i see a third dermatolgist?? the second guy is specialized in just hair loss disorders, it took me a while to see him and he insisted it was te and that my hair would get back to normal soon; it's still shedding more then it should. your advice would be so helpful, thank you. "
Robert,
Thank you for emailing me the details regarding your hair loss situation. You are correct in saying that the majority of hair loss we see is due to genetic male pattern hair loss (aka androgenetic alopecia). Of course without examining you personally, I can only get some 'clues' to your situation from the information you provide. Heavy shedding as you describe is NOT typically seen in androgenetic alopecia, so the diagnosis of TE (telogen effluvium) makes a little more sense--especially in light of the fact that you had a pretty severe illness (fever and GI problems) for an extended length of time. Remember, high fever is a known cause of shedding (TE) and add to that the fact that you were likely in a poor state of nutrition. I'll bet you lost some weight during your illness (or at least some muscle mass). Poor nutrition (especially low protein intake), or poor absorption of nutrients, leaves your body 'starving' for food and this can result in hair loss. The body will use what nutrition is available for more 'vital' body functions. Hair shedding or hair loss after illness can occur anywhere from 30-90 days from the 'insult' to the body.
Also, from your family history it does seem like there IS a risk of androgenetic alopecia (male pattern hair loss) as well. This hair loss or TE episode may have 'uncovered' a tendency toward genetic hair loss that you have, but just did not yet notice. That would mean that perhaps Propecia is not such a bad idea. It is safe, effective medication that will halt the progression of male pattern hair loss (5 out of 6 men will stop losing hair, 2 out of 3 will regrow some hair) using the daily prescription pill.
In the short term, why not also add in Minoxidil 5% twice daily to the scalp? This is another method to get your existing follicles to 'wake up' and make some more hair. Hopefully, within 10 months or so, any hair shed from the illness will rebound and begin to give you more coverage up there--provided your nutritional status is normal. Remember that hair shedding never completely stops--actually 100-200 hairs/day is considered within normal limits, and is due to the continued cycling of hair follicles through their growth and resting phases.
As you can see, I prefer a multi-therapy approach to hair loss. The only other non-invasive treatment I might recommend to you would be laser phototherapy. Laser phototherapy is an emerging technology that is beginning to show promise as a way to enhance the hair you have. It is a non-chemical, non-invasive way to 'crank-up' those failing follicles. The LaserComb or laser-hood treatments are quick and pain-free.
Unfortunately, if any follicles were damaged 'beyond repair' they will not respond to this non-invasive regimen, the only solution thereafter would be to opt for hair transplantation. If you send me some photos of your scalp (mailto:doctorb@baumanmedical.com), I can get a better idea of how well you might respond to the various therapies. Good luck and let me know if I can help further.
Sincerely,
Dr. B.
Alan J. Bauman, M.D.
Bauman Medical Group, P.A.
www.baumanmedical.com
State-of-the-Art Hair Restoration for Men & Women
This info is not designed to diagnose, provide treatment, or replace an in-person evaluation by a qualified physician.
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