Extreme Shedding: Could I be going bald?

With the exception of the obvious excitement of the arrival of a new baby, there wasn’t much that I enjoyed about pregnancy. One symptom that I did appreciate was that my hair seemed to be getting thicker and longer. I couldn’t see my toes for months but at least I had a great pony tail. Until very suddenly one day I didn’t. It was after my princess was born and around the time that I began weening. After shampooing one evening all of my beautiful pregnancy hair fell out in clumps. All at once.

Thankfully all it took was a second pregnancy to regain my long hair. Princess number two had a much more difficult time transitioning to solid food which led to a much longer period of nursing the second time around. This time I was prepared for what was to come. Surprisingly though, I did not dramatically lose all my hair in one evening and even a more gradual hair loss was not right away. But when I did start losing enough hair to build a new pet Chihuahua every day, instead of worrying that I was very quickly going bald, I was equipped with a label for what I was experiencing.

Telogen effluvium is a condition whereby some people lose hundreds of hairs in a single day (1). Aside from the extreme shedding, people are normally in good health (1). The condition may become chronic, with periods of remission followed by relapses (1). Common symptoms sometimes include loss of 100 – 400 strands of hair per day with a noticeable reduction in pony tail size (2). Interestingly, despite the obvious hair loss, total hair density remains stable (2). So how is this possible?

Hair grows in cycles. At some points in time, hair is actively growing. At other times the hair follicle enters a resting period. Eventually the hair falls out which allows the follicle to return to its active growing phase. Unlike certain animals that shed seasonally, the hair cycle in people is asynchronized. What that means is that at any given point in time, you will find different hair follicles at a different stage in the hair cycle. Thus we are always losing some amount of hair but always actively growing hair as well. During telogen effluvium, the individual hair follicles become much more synchronized, resulting in a large loss of hair at the same time. Fortunately though, those hair follicles also return to the growing phase which is how the steady hair density is maintained.

There are several different ways in which the hair follicles can become synchronized and there are even more catalysts suspected to trigger these events. Some of these will be addressed in subsequent blogs. For pregnancy however, “delayed anagen release” has been reported. Anagen is the medical term for the growth phase of the hair cycle. Pregnancy hormones encourage the hair follicles to remain in the growing phase, leading to simultaneous heavy shedding 3-4 months postpartum when those hormones subside (3,4). A similar effect is sometimes observed after discontinuation of contraceptive pills (3,5).

Putting a label on what I was experiencing helped confirm that I wasn’t imagining anything, as well as reduced my worry that all the tumble weeds rolling around my bathroom and clogging my vacuum cleaner would lead to baldness. If you are concerned, your hair loss expert can help to differentiate telogen effluvium from other common hair loss conditions such as female pattern baldness and alopecia areata.

References

1. Grover C, Khurana A. Telogen effluvium. Indian J Dermatol Venereol Leprol. 2013 Oct;79(5):591–603.
2. Sinclair R. Chronic telogen effluvium: a study of 5 patients over 7 years. J Am Acad Dermatol. 2005 Feb;52(2 Suppl 1):12–6.
3. Dawber RP, Connor BL. Pregnancy, hair loss, and the pill. Br Med J. 1971 Oct 23;4(5781):234.
4. Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol. 2005;6(3):165–73.
5. Griffiths WA. Diffuse hair loss and oral contraceptives. Br J Dermatol. 1973 Jan;88(1):31–6.

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