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Dr. Andrew Rynne

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Could toxins and scalp sweats cause hair problems?

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Dr. Kalpana Pathak

Dermatologist

Practicing since :2006

Answered : 2015 Questions

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Posted on Mon, 2 Dec 2013 in Skin Hair and Nails
Question: I have been having issues with my hair. It seems to me that most of the trouble is in the area where the most of my weight touches my pillow when I sleep at night. Could this be from toxins that escape when my scalp sweats? Or from circulation issues? It doesn,t fall out exactly, it just seems to die. It feels frizzy and the roots are not strong. It sticks out or straight up and wetting it down only helps a little temporarily. Because it does not feel right, I find myself pulling at it and it pulls out easily without pain. Usually in patches or following a line. The hair does grow back, but when it gets a few inches long it starts all over again. Right now it seems to be in the area where my head touches the pillow. It has happened in other spots though. The hair eventually grew back and seems to be acting better in some spots,but I don't know if it will continue or if it is going to start doing the same thing again when it gets a certain length.
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Answered by Dr. Kalpana Pathak 2 hours later
Brief Answer: Please read a detailed answer below Detailed Answer: Hi, Thanks for writing to us. As you have mentioned that you have undergone chemotherapy due to cancer, the weak or falling hair could be telogen effluvium where the hair suddenly goes in to resting phase and falls off. As hair becomes weak, it is easy to pull it off. Having said this I feel that due to stress, you might be having trichotillomania, where a person pulls at hair present over accessible sites of scalp. There is a sudden irresistible urge to pull hair and persons suffering from it usually complaint of having pain or increased sensitivity of hair roots. In telogen effluvium, hair fall is diffuse while in trichotillomania its patchy and focal. I would appreciate if you could attach an image of concerned area, so that I can identify your problem and comment further on treatment required for your hair problem. Hoping to hear from you soon. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kalpana Pathak 12 hours later
In my original question, I told you that I was having this problem before the chemo and also that there is no pain when I pull at my hair. In fact, there was a period of time before the chemo, that I had to part my hair on the right to cover the bare or very thin hair on the top left. The hair I pull at does not feel healthy to begin with that is why I pull at it and it doesn't take much of a pull. Most of my hair looks and feels healthy and I don't pull at the healthy hair. If I did, it would hurt. Usually I reach up and touch my hair unconsciously, and feel it sticking up and then I pull it. Unfortunately, I have to look in the mirror every day. If I didn't touch my hair,or pull at it I would still be able to see the areas that the hair sticks out, or straight up even when it is soaking wet. And/or looks frizzy (but only in the problem areas) Sometimes it feels like skin or something is growing over it ..like gluing it down to my scalp, usually going up (the wrong direction). When I pull at it, I can't tell if I am pulling it out, or just pulling it out from underneath the "glue" (Similar to ingrowing hair) Previously the spot that bothered me was on the high left towards the back, right now that is the longest healthiest hair I have. After that it was at the crown of my head (back, top) Currently the top looks good. The left side looks good. The back on the left looks good. The right side, especially at the back center is the worst spot. Some days I think it is getting better, other days it seems worse. I have new hair growing back but I still have trouble with the longer hair feeling like it is dying and radiating out to the outer edges of the "bald spot" (approximately 2 1/2" inches wide by 3" up and down, but low enough that I can cover most of it with the hair above. I am worried that if it doesn't stop soon I will not be able to conceal the area. I wouldn't know how to get a picture in here even if I could get one I don't know how to get it in my computer much less into this discussion area. I do not use hair spray, XXXXXXX or blow dry my hair. I have not had a permanent. I do not use a curling iron. I don't know what else to say.
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Answered by Dr. Kalpana Pathak 29 hours later
Brief Answer: Please read a detailed answer below Detailed Answer: Hi, Thanks for writing back. I would still keep my differential as trichotillomania and weaker hair roots due to telogen effluvium. Both the conditions possibly induced by stress, cancer and chemotherapy. Now let me summarise your skin concern as per my understanding- "Bald patches of scalp due to hair pulling behaviour at sites where you feel hair root has become weak and hair growth is defective with frizzy lifeless hair. Also wherever the hair is pulled, you feel it grows healthy." Now this is not due to friction from pillow, circulation problem or sweat collection. As I mentioned earlier also trichotillomania is defined as a condition where a person pulls at hair voluntarily. The patient always complains of defective hair, sense of tension, headache etc which is relieved by hair. Telogen effluvium is a diffuse and acute loss of hair that you have already had post chemotherapy. Telogen effluvium takes six to nine months to resolve. So weaker hair root can be contributed to your chemotherapy and cancer. Having said this patchy hair fall points more towards trichotillomania. Firstly I would stress that you stop tugging at your hair. If you feel that the hair is defective , lifeless and sticking out abnormally, please meet a dermatologist to get your hair examined. The more you pull your hair, the more damaged it becomes. To treat your dull dry hair, use warm olive oil once in a week. use minoxidil solution 2 percent 1 ml two times in a day. Minoxidil will improve your hair texture, increase hair growth and strengthen hair root. if still the hair pulling behaviours continues, you may have to take drugs like fluoxetine or sertraline to control behaviour. Other possibilities for patchy hair loss is fungal infection and alopecia areata. But these two conditions need treatment and do not improve merely by pulling the hair For further discussion, I need the images. The same can be uploaded by clicking on upload report/ image icon, which us on right side of query page. Warm Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kalpana Pathak 13 hours later
So what caused the patchy hair loss before chemo? Chemo treatment was in 2010 Radiation XXXXXXX and Feb 2011 What is the procedure for the warm olive oil treatment once a week? Before you shampoo or after? Before conditioner or after or instead Of? How much olive oil? Full strength or not? Do you leave it on or rinse it out? Do you think that I will always have to do something like this, or should my hair eventually get back to normal?
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Answered by Dr. Kalpana Pathak 3 days later
Brief Answer: Please read a detailed answer below Detailed Answer: Hi, Thanks for writing back. Firstly I apologise profusely for sending a delayed response. As I mentioned earlier also I would need to see the images to comment further as without seeing your hair and scalp its difficult to pin point a single diagnosis and appropriate management. As your basic problem is dry lifeless hair that stick out from scalp, I would suggest that you apply warm extra virgin olive oil( as has best hydrating property) two hours prior to rinsing with shampoo and then using a good conditioner atleast two days in a week. Apply minoxidil 2 percent solution 1 ml twice in a day over scalp. These two steps would ensure good and healthy hair growth. Also improve your diet include proteins, green vegetables, nuts and fresh fruits in your diet. Once your hair gets back to normal, you may stop minoxidil but should maintain a good diet and oil your atleast once For specific management as I said earlier please post the pics or consult a dermatologist nearby. Hope this helped. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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