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July, 2012:

Information on Telogen Effluvium & Tips on How to Deal with Hair Loss

Her Hair Loss Help has an outstanding Discussion Forum specifically for women with telogen effluvium and other forms of hair lossTelogen effluvium (TE) is the second most common form of hair loss most dermatologists see. When a woman is actively shedding hair during an effluvium (meaning ‘outflow’), it can be exasperating, depressing, and scary.

Sometimes a TE shed, as our forum members frequently call their thinning hair loss, can last for months or even years. Occasionally, it will appear as if the shedding occurs along with your menstrual cycle (cyclical shedding). Women with TE never completely lose all their scalp hair, but the hair can be noticeably thin in severe cases. Whatever form of hair loss your telogen effluvium takes, it is fully reversible.

Things that can help minimize a telogen effluvium shed (or hair thinning):

  • Sometimes skipping a shampoo for a day will make it seem as though more hair comes out the next time you wash. Many of our forum members say it helps to shampoo your hair every day.
  • Use an apple cider vinegar hair rinse once per week.
  • Blot your hair dry with a towel instead of vigorously rubbing your hair.
  • Apply a light conditioning cream to your hair after towel drying to protect it from unnecessary breakage.

Things that can help boost volume and give the illusion of thick hair:

  • Visit a professional hair salon professional in your area and request a cut that will give your hair more bounce and move lightly (generally just below the chin and lightly touching the shoulders). Highlights and lowlights using foil can also give the illusion of thicker, fuller hair.
  • Use a gentle hair care product that has thickening properties. Some of our forum members’ favorites include: Tigi Bedhead Superstar Sulfate Free Thickening Line, WEN Lavender Conditioning Cleanser, WEN Sweet Almond Conditioning Cleanser, Aquage Sulfate Free Shampoos and Conditioners, and Aquage Thickening Style Gel.
  • Loosely piling your hair up on top of your head and then piecing random pieces of hair with a good hair texturizer makes thinning hair look healthy and thick.

Supplements
Supplements can be a controversial topic in matters of hair loss. Many women who have recovered from telogen effluvium agree that you should steer clear of unnecessary supplements unless you have had blood tests to diagnose any vitamin deficiencies that can contribute to your hair loss. For example, if you are iron deficient or anemic, you should take a doctor recommended amount of iron supplements. Iron deficiency is known to cause or aggravate hair loss.

It’s important to remember that one supplement that worked for one woman may not work for you. Our bodies are unique and unnecessary supplements and medicines may do more harm than good.

Finding a Good Dermatologist (or Doctor in General)

doctorFinding a good dermatologist or doctor can prove to be one of the most difficult things to face when you are experiencing hair loss…

  • A good physician will say, “I’m sorry. This must be hard for you to understand.”
  • He/she will give you the address of the National Alopecia Foundation or other support organizations and tell you about the information they provide.
  • He/she will tell you there are others with this same condition and the medical field just doesn’t understand what’s going on.
  • He/she will understand that you have NEVER heard of this condition and that you are scared.
  • A good physician won’t scoff at your questions or minimize your concerns. He/her will appreciate your questions and will be willing to learn with you as much as possible about the condition.

SIGNS OF A BAD DERMATOLOGIST!!!

  • Inappropriate Commentaries
  • Disbelief
  • Cruelty
  • Callousness
  • Impatience

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The craft of the physician may be judged by the thoroughness of the history and physical examination. The following list provides a schematic of some of the things that a physician should do, or consider doing, when first examining a patient with alopecia. Subsequent visits may be shorter but the physician should always be vigilant to the appearance of other autoimmune conditions, of which, thyroid disease appears to be the most common.

History
The initial part of the history is aimed at providing a background to the patient’s condition and allowing the physician to focus on particular problems. Some of the initial questions include:

  1. Is the hair coming out by the roots or is it breaking off?
  2. Is the loss slowing down or getting worse?
  3. Is your hair becoming thinner or do you have totally bald spots?
  4. Do you color, bleach or straighten your hair?
  5. Do you shampoo or condition the hair?
  6. Do you blow dry your hair or use a hot comb?
  7. Is your father’s, mother’s, sister’s or brother’s hair thinning?

The physician then documents all alopecia episodes including age of onset, duration, remissions, patterns of hair loss, relieving or exacerbating factors, treatments, and associated systemic diseases (autoimmune diseases, allergic rhinitis, asthma, atopic dermatitis, connective tissue disease, bowel disorders involving malabsorption, endocrine abnormalities, chromosomal disorders, or cancer). Some of the questions include:

  1. Do you have anorexia nervosa?
  2. Do you have a thyroid disorder?
  3. Have you gained or lost weight?
  4. Are you anemic?
  5. Are your mentrual periods heavy?

The history should date any medication and events within the past 6 months before the first and subsequent episodes of alopecia. The drugs include aminosalicylic acid, amphetamines, bromocriptine, capatopril, carbamazepine, cimetidine, coumadin, danazol, enalapril, etretinate, levodopa, lithium, metoprolol, propanolol, phenytoin, pyridostigmine, and trimethadione. Other pertinent questions include:

  1. Do you take vitamins?
  2. Do you take separate vitamin A tablets?

An inventory of stressful life events and psychiatric disorders. Specific questions will include:

  1. Did you have a baby?
  2. Have you started or stopped oral contraceptives?
  3. Have you gone through menopause?
  4. Have you had a high fever, the flu, been hospitalized or had major surgery?
  5. Have you been on a crash diet? Are you a vegetarian?
  6. Have you had any major stresses during this time?

Physical Exam of the entire cutaneous surface, oral cavity, nails, and sweating. Some of the special exam maneuvers are individualized and not done in every patient but include:

  1. Scalp examination to determine the patterns of hair loss and associated lesions. The presence or absence of hair follicles and sebaceous glands.
  2. Hair Pull Test where 50-100 hairs are pulled in several sections of the scalp. Normally 2-5 telogen hairs will be obtained in this manner, depending on when the last shampoo and styling were done. An active telogen effluvium condition will produce 3-4 times the normal amount of hair pulled; androgenetic alopecia or resolving telogen effluvium has a slight to moderate increase in the number of hairs shed.
  3. Quantitative Analysis of Hair Shedding – The patient is asked to collect ALL hairs shed daily for 7 days in individual plastic bags. The hair is then counted and averaged per day. Normal daily loss is 50-100 hairs. Patients with active telogen effluvium have a 10-40% greater loss.
  4. Density determination – By shaving a small area of the scalp, marking with a skin punch and ink pad, the hairs are counted per square centimeter (normally 150 hairs/cm). The growth rate is measured one month later (normally 1.0-1.2 cm/mo).
  5. Microscopic Hair analysis looking for telogen bulbs, broken hairs (exclamation point hairs), anagen hairs, hair diameter (a high variability in diameter of the hair shaft is evident in androgenetic alopecia), anagen-telogen ration, and sometimes potassium hydroxide is applied to an individual hair strand sample allowing visualization of fungal spores (blackdot ringworm) which causes broken hairs.
  6. Scalp Biopsy which will show them the following:
    • A normal 4-6 mm skin sample should contain 30 terminal hairs, sweat glands, and hair follicles. When alopecia appears to be scarring, the absence of these establishes the diagnosis.
    • The biopsy must go deep enough to include subcutaneous tissue in order to capture anagen hair bulbs. It is closed with suture to ensure proper healing.
    • Various stains are used to detect scarring, lupus, lichen planus, or a blistering disease.
    • Evidence of inflammation may be an indication for the use of steroids.
    • Amino acid and sulfur analysis may be done for certain rare genetic hair disorders.