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Can shedding accelerate genetic hair loss?

Accelerated Follicular Miniaturization from Prolonged Shedding (A.F.M.P.S)

It's one of the more difficult concepts to grasp in all of hair medicine. It's one of the greatest sources of disbelief from patients in terms of diagnosis.    Repeated cycles of shedding speeds up the arrival of genetic hair loss in patients who are genetically predisposed to develop genetic hair loss.

In my hair clinic, I use the term AFMPS - or Accelerated Follicular Miniaturization from Prolonged Shedding. It's a phenomenon that happens only in those who are predisposed to develop androgenetic alopecia (female pattern hair loss).  We generally see AFMPS more in women than men, but it can occur in men. 

It's a phenomenon that is frequently seen but rarely is it fully appreciated. Consider the 28 year old female whose hair does not return completely back to normal after the birth of her first child. She had massive shedding from month 3-8 and now the shedding has stopped. Her hair is 80-90 % of the original density - but not 100 %. What does she have? AFMPS. Did the pregnancy cause her to have genetic hair loss? No, but the repeated cycles of shedding sped up the process of miniaturization and sped up the age at which genetic hair loss could first be clinically appreciated and diagnosed. Without shedding, she may have first noticed genetic hair loss in the mid to late 30s, but the shedding has sped up the process of miniaturization and she now notices thinning (diagnosed as genetic hair loss) at age 28. When I examine her scalp I can appreciate miniaturization with use of my dermatoscopy - and this miniaturization is most prominent in the frontal region of the scalp.

Or what about the patient who developed shedding from health issues in her 30s, including thyroid issues and low iron and starting and stopping oral contraceptives. Her health has improved but her thinning had accelerated greatly in recent years. What is going on? AFMPS.  Did the thyroid issues, low iron and medications cause her to have genetic hair loss? No, but the repeated cycles of shedding sped up the process of miniaturization and sped up the age at which genetic hair loss could first be clinically appreciated and diagnosed. Without shedding, she may have first noticed genetic hair loss in the mid 40s, but the shedding has sped up the process of miniaturization and she now notices thinning (diagnosed as genetic hair loss) in her 30s.When I examine her scalp I can appreciate miniaturization with use of my dermatoscopy - and this miniaturization is most prominent in the frontal region of the scalp.

Or what about the patient who developed shedding at age 38 from use of a specific medication (drug induced telogen effluvium). She stopped the drug but her  hair did not quite return back to normal. What is going on? AFMPS.  Did the drug cause her to have genetic hair loss? No, of course not. But the repeated cycles of shedding sped up the process of miniaturization and sped up the age at which genetic hair loss could first be clinically appreciated and diagnosedWithout shedding, she may have first noticed genetic hair loss in her late 40s, but the shedding has sped up the process of miniaturization and she now notices thinning (diagnosed as genetic hair loss) at age 38. When I examine her scalp I can appreciate miniaturization with use of my dermatoscopy - and this miniaturization is most prominent in the frontal region of the scalp.

 

Does everyone who sheds ultimately develop AFMPS?

Not everyone with shedding issues will experience AFMPS.  Many women after pregnancy do find their density returns close to normal. Many patients after chemotherapy find their density does return to normal. And for the prototypical hair shedding disorder - chronic telogen effluvium - there are many patients with chronic telogen effluvium who DO NOT miniaturize.  In fact, AFMPS seems to actually be somewhat inhibited in those patients who truly have chronic (idiopathic) TE. In other words, it's more likely for me to find that a patient with a diagnosis of CTE does not have a second diagnose of genetic hair loss than does have a second diagnosis of genetic hair loss.  They experience shedding but the hair follicle calibre remains the same over time. Some patients shed after a trigger and the hair indeed does return back to normal. But not everyone. 

The concept of AFMPS is very important. It is critically important to limit hair shedding in those predisposed to genetic hair loss.  Everything that causes shedding - iron, thyroid issues, dieting, medications, stress, seborrheic dermatitis - must be properly managed. 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299



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