Keywords:alopecia
I have been expereincing diffuse hair loss for over a year. This started quite suddenly (I know the exact day) during a period of serious emotional stress. The loss has been fairly even over the entire scalp. A rough estimate of the rate of loss would be 250 hairs/day. The scalp has no scaring, although it does hurt infrequently during times of stress. I have has several blood tests (thyroid, gerneral chemistry, testosterone, etc.) and they have been normal, although my cortisol is at the high end of the scale. There is no significant history of hair loss in either side of my family. Most male relatives have more hair than would be expected given their age. I have one maternal uncle that has slightly above average thining at age 50. I am a 23 year old male.
I have seen several doctors about this. The first diagnoses were all telogen defluvium. The most recent doctor I have seen insists that this must be androgenetic (male pattern) but has not really said why she beleives this. I have used rogaine, proscar, and aldactone, each for 2 months on her recomendation. None of these have had any effect on the rate of active loss.
At this point, I have resigned myself to being completely bald by age 25; however, I am frustrated because I can not get an explanation that seems plausible. Any ideas ? Any sugestions no mater how general would be appreciated.
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Answered by Eliot Mostow, M.D. (xx103@ofcn.org)
It sounds like you have been to more than one dermatologist and that your answers, while not especially satisfying to you, may be correct.
Androgenetic alopecia is more or less a diagnosis of exclusion (that is, if it's not a, b, or c, then it must be d). Everyone has some component of thinning hair as we age, but the severity of that loss seems to be programmed by our hairs' responses to hormones (androgens) and heredity (genetics). Hence, androgen + genetic = androgenetic. Alopecia, as I'm sure you already know, just means hair loss.
Telogen effluvium is a very common diagnosis that follows a stressful event by 1 to several months and lasts about 2-6 months. Instead of the normal 10% of hairs in resting phase, 25% or more may go into resting phase after/during a stressful event (e.g. surgery, post-partum, emotional stress). The hairs start falling out only when new hairs start growing...that is why there is a lag time between the event and the hair loss. People usually recover from it fairly well, especially if the cause is identifiable, but I tell my patients that the caveat with that recovery is that coincident androgenetic alopecia is less predictable. My experience is that many people seem to move ahead several years in their thinning after a bout of telogen effluvium.
Finally, normal hair loss is about 100 hairs per day. One thing that has not been done yet is a biopsy. That may only show androgenetic alopecia changes, but it may help you feel comfortable that there is nothing else being missed. Now try asking your dermatologist why she said androgenetic alopecia. A biopsy should rule out diffuse alopecia areata, which might be even more difficult to treat, but might respond to other types of medications such as allergens or steroids. Hope this helps.
Eliot Mostow, M.D.
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Dermatology Online: Served by Eliot N. Mostow, MD, MPH
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