What type of hair loss do I have? (photo)

Question

I have been to a dermatologist who said its not androgenic alopicia and another hair loss specialist whom also advised it wasn't androgenic alopicia.ny hair loss has been occuring since October 2018. I'm so worried. Please advise what it appears to be.

Jason Emer, MD · Answer

Thank you for your question, This needs an in-person evaluation. I suggest seeing a hair loss expert now to evaluate and go over your condition and provide you information about your best treatment options. There are great non-invasive options like prp/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

Serkan Aygin, MD · Answer

From the pictures you have sent, it seems like you may be experiencing Chronic Telogen Effluvium. Although some women with Female Pattern Hair Loss (FPHL) exhibit bitemporal recessions, Chronic Telogen Effluvium (CTE) patients have bitemporal thinning without associated thinning of the “top-scalp”. Close inspection of FPHL reveals miniaturized hairs of varying short lengths and decreased caliber, while in CTE there is a general absence of miniaturized hairs.
Excessive, alarming diffuse shedding coming from a normal looking head with plenty of hairs and without an obvious cause is the hallmark of CTE, which is a distinct entity different from Female Pattern Hair Loss. 
The exact pathogenesis of CTE is not known, but it is theorized that it is due to reduction in the duration of anagen growth phase without miniaturization of hair follicles. Also, the etiology of CTE is unclear and it is diagnosed after excluding other causes of chronic diffuse hair loss. Obvious diffuse thinning is not a feature of CTE, though many of these women do notice 50% reduction in the volume of their ponytail thickness. Moderate to severe bitemporal recession may also be seen.
Apart from complete blood count and routine urine examination, levels of serum ferritin and T3, T4, and TSH should be checked in all cases of diffuse hair loss without a discernible cause, as iron deficiency and thyroid hormone disorders are the two common conditions often associated with diffuse hair loss, and most of the time, there are no apparent clinical features to suggest them. CTE is often confused with FPHL and can be reliably differentiated from it through biopsy which shows a normal histology in CTE and miniaturization with significant reduction of terminal to vellus hair ratio (T:V < 4:1) in FPHL.

Jeff Rapaport, MD · Answer

In  my opinion you need to visit a hair loss expert for an in person consultation. They will do a history, examination with magnification and woods lamp, blood work and possibly biopsy. The main  differential diagnosis includes telogen effluvium, androgenic alopecia and scarring alopecia. Good luck.
Jeff Rapaport MD
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Jeff Donovan, MD, PhD · Answer

A physician would need to examine the scalp up close and review your entire story from A to Z to say what’s going on. I can not say that you don’t have androgenetic alopecia. If there is any doubt, I would encourage you to get a biopsy (from mid scalp or crown depending on which is thinner). Provided the biopsy is submitted to an expert dermatopathologist and evaluated by horizontal sections- it’s pretty easy to figure out if any component of your hair loss is due to androgneetic alopecia. I think what is important here is being open to the possibility more than one hair loss condition might be present in addition to possible AGA (especially telogen effluvium effluvium and traction).

William Rassman, MD (retired) · Answer

I am assuming that you are female. IF that is the case, you should be examined and if you have genetic hair loss can have the hair placed back there with hair transplants

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