TE - Intermediate hairs?

Telogen effluvium, alopecia areata, hair shaft disorders, etc.
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Joined: Mon Mar 31, 2014 8:30 am

TE - Intermediate hairs?

Post by telagain »

Hi Tom,

I thought I'd start a new thread on 'intermediate' hairs, which I've seen described on this site a couple of times and which, I believe, I have.

First off, I'm a 25yo male. After an allergic reaction to Sertraline (an SSRI anti-depressant) in Jan 2013, I experienced a bout of TE in March of that year. I didn't specifically notice more shedding, it was more like a sudden realisation that my hair was much thinner. Perhaps I'd been distracted by other things…

The thinning was very diffuse at first, though I noticed some recession on the left hand side (which has progressed), and my entire scalp was quite painful - almost a burning or itching kind of pain. From what I've read this is quite common. There seemed to be little recovery until around July/August when a fine fringe of hairs appeared over my entire scalp. These hairs were very prickly, almost of beard consistency, and I wasn't able to see them in a mirror. After about 3 months, there was no further progress and I decided to see a Trichologist. Using a microscope he reassured me that the tiny hairs were in fact there. They were short and white (unpigmented, I've attached an image - sorry it's a little blurry), and covered my entire scalp. The Trichologist reassured me that these hairs would grow into healthy terminal hairs, and so I left feeling some hope for a recovery.

Fast forward to April 2014 and it's been over a year since the TE, and over 6mo since these hairs appeared. I still feel a burning sensation on my scalp, though it seems to come and go. I've noticed more thinning on the left hand side than right, and this is the side on which the hairline is more receded. There is also a thinning around my crown though luckily I did have a quite a thick & healthy head of hair, and so the thinning is fairly well hidden at this stage - except obviously to me.

I have a few questions, but I'm also aware that they may not be answerable. I haven't seen this described anywhere and so figured that at the very least it could serve to open a discussion. Before that I'll mention that I'm otherwise healthy, exercise regularly, and try to eat well. I've also just started doing some of your scalp exercises, though it's too early to tell if that's having any effect.

1) Do these sound (or look) like intermediate hairs to you?
2) Do intermediate hairs typically take less (or more) time to shed than healthy terminal hairs, or can I look forward to years of them?
3) Are there any good ways to reduce the burning sensation? Currently I've switched to a tea tree oil shampoo, and find that washing daily seems to mitigate it slightly.

Anyway, thanks for reading this.

Big Thumb, Tiny (almost invisible) Hairs
Big Thumb, Tiny (almost invisible) Hairs
TinyHair3.jpg (108.29 KiB) Viewed 12246 times
Tom Hagerty
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Re: TE - Intermediate hairs?

Post by Tom Hagerty »

an allergic reaction to Sertraline (an SSRI anti-depressant) in Jan 2013
You had an allergic reaction to Sertraline (Zoloft) but you may also have experienced some of the side effects listed for this drug too. Hair loss is not one of the side effects. But still your hair loss could be attributed to loss of appetite, itchiness, and other of the many listed side effects. I don't know what your specific psychological problem is. I think, however, if I had a depression-related problem, I'd try cognitive behavioral therapy before I'd get into a pill regimen.

I've reduced the size of the image you attached because the original one took up the whole page. I could not determine from the image if these were intermediate hairs although they probably are. Your trichologist assured you "these hairs would grow into healthy terminal hairs..." Intermediate hairs or vellus hairs do not "grow into" terminal hairs. Hairs do not change size or texture once they have left the hair canal. The only time change takes place is in the early anagen stage of the next hair cycle. In other words, the intermediate hairs (if that's what they are) have to fall out and be replaced (hopefully) by terminal hairs - ones thick in diameter and ones that will grow six inches or more.

I'm not sure if intermediate hairs take a long time to shed. Many of the papers I've read on the subject suggest that these hairs do shed in about six months. Terminal hairs shed in about six years.

You are trying to reduce the burning sensation in your scalp by shampooing your hair every day. Tea three oil shampoo might work but I doubt it. I think the burning sensation is coming from sub-clinical inflammation perhaps in and around the hair follicles. (In damaged hair follicles there is almost always an inflammatory infiltrate.) Shampooing every day might just aggravate what's causing the burning sensation. I shampoo once a week using a clarifying shampoo - one with just a detergent cleansing agent - no excess gunk in the ingredient list. But this is just my hair cleaning regimen. You'll have to do some research to find out what's best for you. Everyday shampooing, though, is probably not the answer to your problem.
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