Transcript of Chronic Telogen Effluvium

[Music] welcome to the hair loss show Dr Russell nudson and Dr Vikram J aprakash discuss issues relating to hair loss and the medical and surgical treatment of hair loss in both men and women [Music] hi everyone and welcome back to the hair loss show my name is Dr Vikram jayaprakash and I'm Dr Russell nuns welcome hey good good to have everyone here and thanks again for watching please remember to like And subscribe to the channel and also please keep your questions coming we really love to get your feedback on what you're liking and what you want to hear more of on the channel in future episodes so today I want to talk about a problem that we see sometimes in our practice predominantly in women it's kind of interesting where they come in complaining of a long-term increase in shedding so what I want to try and break this down to you you can call it a chronic malt if you like the technical term for only is chronic telogenal servium it's a well-recognized condition so acute means lasting less than six months chronic means lasting more than 12 months and there's many many causes of acute malts you know fever pregnancy drug therapy sudden weight loss surgery is any number of them that can cause increase in shedding for a short period of time and they all fall under the banner of stress yes it's called stress well actually acute stress is a cause yes because the stress or hormones do shorten the growth Haze of the hair Cyclone therefore increase the shedding but again I would remind the people that shedding and hair loss are not the same thing that shedding is a normal process every hair on the head has to fall out according to your genes it can be anything from two to six years at the growth cycle on the scalp and that will determine what the normal rate of shedding is but the way to think about it I think is is to think of its own all right you know so if we just draw a conventional clock um basically you should see the shedding as the growth Goes Around the Clock like this for a certain period of time and when it gets to the end here again the hair is shed okay and so your genes control how quickly the clock moves as this thing from a conventional clock so for example I'm being making a generalized statement here women would have a longer cycle Around the Clock hence why women can grow their hair longer men have a shorter well some men some men I mean the world the world record for um for hair growth is an Indian man they're 26 feet and four inches which would take about 60 years to get to that length so it didn't cut his hair for 60 years so think of it as a clock so things can accelerate the clock so there is seasonal changes but those games these are in the in the acute you know short things but there is this peculiar condition where predominantly women come in and complain and increase setting that goes on and on and on and the really interesting thing about it is they shed their long hairs now long hairs by definition are healthy hairs right unhealthy hairs do not grow long so if you're shedding long hairs you're shedding healthy hairs but it doesn't mean there's a disease process going on because if the clock's sped up the shedding rate would increase but the hair would still be growing back three months after it after it's shed and that's the interesting finding we don't see thinning in these patients right we just see this sudden increase and it's a mysterious thing because it comes out of the blue with not necessarily A trigger cores that we can identify it lasts for two three four five years or whatever and then it can suddenly stop and so the the what I wonder is whether there's some inflammatory trigger that set it off and that it just keeps going and then somehow spontaneously the inflammatory sugar settles down and the reason I say that is because often when people go through accelerated shedding they they express symptoms of inflammation so they talk about tenderness burning itch right or flaking which are all inflammatory symptoms or signs so I think this is an important thing to understand that it may be just an inflammatory process so one of the things we try to do in these patients you see if we can settle some inflammatory reactivity down in the scalp with anti-inflammatory shampoos right there are a lot of claims about therapeutic effects from shampoos in the marketplace which don't stack up but there are proven remedies that exist within pharmacies exactly uh that that so we have things that have zinc parathione in them for example which is Head and Shoulders we have things that have selenium in them which is cell Sun we have things which have a anti-fungal Ketoconazole in them which is an often there's Nizoral around the world these are all proven remedies for inflammatory conditions of the scallop so you can have psoriasis of the scalp you can have ordinary dandruff of the scalp you can have seborrheic dermatitis to the scalp these are on inflammatory conditions of the scalp they can come out of nowhere we don't really know why they happen they become chronic they can affect part of the scalp or all of the scalp it's really quite curious yeah how this occurs but but I do think that this condition of chronic molting worries the women that come to see me about it really incredibly and and some of them really are symptomatically suffering as well yes and so we try very hard I mean you can get to a shampoo that actually has Cortisone and and so these are things that you can do but that's what we're talking about here it's not a hair loss per se it's just a speeding up of the clock so it's a mystery condition that no necessarily why it starts don't know necessarily why it finishes sure but it's but it does it's not damaging that's right and and you know we get Look hair loss for anyone is uh is a stressful you know condition and that could also that could be a self-perpetuating thing as well because the the act of losing hair can also increase the psychological stress which can also make negative feedback correct can make it even worse so the point being that the telogen of fluvium or t will shed longer hairs and especially essentially speeding up the clock that's fine for the first cycle but the second cycle the second pass of the clock around the you know the the hand of the Around the Clock the next cycle of hairs to be lost okay yes it could be other hairs that will be Shed from other aspects of the scalp but what if you're losing shorter hairs well that would be unusual so for example um when people say but you're speeding up the clock I understand that but if you can grow your hair to hair yeah right you've got a four year cycle yeah okay so you know yes ordinarily it would take you four years to lose every hair on your head yeah let's say the clock's fed up twice it would still take two years for that to happen and it may have stopped in that time right so we don't actually see I haven't ever seen a patient come to me that is cycled on so long with this condition that they come back reporting shorter here right okay but the thing I wouldn't emphasize to our female listeners is that one of the common things that that patients always say to me is look my ponytail is only half what it was before and I remind them that if you go through either an acute or a chronic malt the hair will only come back three months later and when you grow the centimeter per month and it'll take them 18 months to get long enough to get be collected into the ponytail so nothing is going to happen overnight in terms of that if you want to see that volume back in your ponytail or the volume back in the lower part of your scalp it's going to take years all right so so taking a step back from from a from an individual's perspective they're losing long hair all right obviously they need to look you need to look at what's the potential cause that needs to be investigated if it's something obvious then yes that needs to be treated and you need to treat the underlying cause of of that but from your side of things Russell what are the top three things that you would that you've you've found in your practice that are going to be be beneficial and I and I just want to highlight again that this is not meant to be as oh yeah take this information and go buy this over the counter you need to be assessed properly and and make sure that you've got the diagnosis correct first thing I tell them is to wash their hair regularly yeah because most people because they're the first thing they do is they're scared to wash their hair so they put a bigger interval between washes which means even more hair comes out in the wash because I'll remind people at the end of the growth cycle the hair separates from the skin that sits there waits for something to tug it out which is washing or brushing so unless you do it the more you're going to find so the first thing I do is get them to do it and there's two reasons I do it number one is to stop that artificial um you know increase in shedding that they're saying which really isn't an increase in shedding at all and secondly if they're symptomatic and complaining of inflammatory symptoms wash rushing more ready to scalp and and shampooing the scalp more regularly settles those symptoms down yeah so it has a therapeutic benefit to actually wash it more regularly and so I think that that's the main message I'd get across to our audience is that you should wash more frequently not less frequently it'll help symptomatically and also calm me down that the hair is counter-intuitive to a lot of people because they feel that that oh the act of what you know as you said the act of washing or or combing um it's causes causes further hair loss so that's the main thing that's the main thing Perfect all right so I think that's something you know chronic molting is something that we're seeing a lot of all right it can be very perturbing to uh to people that are experiencing it so again I think the take home message there if there is one is to make sure that this if you are experiencing this make sure that this is assessed properly and that you're getting good advice and how to how to manage that yes I mean this is not something for your hairdresser to address this is something for a medical opinions absolutely very good well thanks again uh it's I hope you found that useful again please remember to like And subscribe to the channel and we'll see you again on the next episode thanks guys and ladies hmm