I've seen three dermatologists in Kansas City in less than a year. Dr. Singh was the only one to take pictures of my hair before giving a proper diagnosis of Telogen Effluvium.
Scarring Hair Loss
There are several types of scarring hair loss. They are caused by inflammation around the hair follicles that eventually heal over with ‘fibrosis’ or scar. These entities can be treated if diagnosed early. The goal of treatment is to stop the progression of the inflammation to allow the hair to regrow. However, once the scarring has begun, it becomes difficult to achieve regrowth.
Lichen Planopilaris (LPP) - For unknown reasons, LPP is typically seen in middle-aged Caucasian women. It typically leads to tender, burning, and/or itchy areas in the front of the scalp with redness, scaling, and bumps around the affected hair follicles.
Discoid Lupus Erythematosus (DLE) - DLE is an autoimmune condition that typically only affects the skin. However, rarely, these individuals can develop systemic lupus erythematosus. When DLE affects the scalp, it can cause reddish-purple or brown plaques with hair loss in the affected areas.
Scarring hair loss early intervention. Left image shows baseline, right image shows 1 month after treatment
Scarring hair loss early intervention. Left image shows 1 month after treatment, right image shows 2 months after treatment
Non-Scarring Hair Loss
Telogen Effluvium - The hair grows in three phases - 1. Anagen (growing) 2. Catagen (resting) 3. Telogen (shedding). Normally, 85-90% of the scalp hair is in the anagen phase, 2-3% is in catagen, and 10-15% is in telogen. Therefore, we should normally shed 100-150 hairs daily. However, if a stressor occurs (i.e. thyroid abnormality, iron deficiency, hormonal changes, medication change, pregnancy, hospitalization, or serious illness), up to 4-6 months later, the hair cycle can shift so that 20-40% of the scalp hair sheds or enters the telogen effluvium. This is usually manifested as significant shedding and decreased overall thickness of the hair. This entity is typically temporary, with the hair shifting back to normal cycling 6-12 months after the inciting stressor has been resolved. Rarely, telogen effluvium can be ‘idiopathic’, meaning no cause is found and may be chronic.