Shedding from Minoxidil
Minoxidil lotion and foam are FDA approved for treating androgenetic alopecia (AGA) in men and women. This type of hair loss is also called male pattern balding and female pattern hair loss. A common concern among individuals who are deciding whether or not to use minoxidil is the potential for them to develop an increased amount of daily hair shedding in the first 6-8 weeks of starting minoxidil. This is known in the public as the "dread shed." Medically, the term is "immediate telogen release." This type of shedding is not to be confused with the shedding that happens when people with androgenetic alopecia incorrectly stop using minoxidil. (One must never stop treatment if they have androgenetic alopecia or else new hair growth will be shed and all benefits will be lost).
The 'dread shed' can be frightening when it occurs but is generally mild for most. Understanding why this occurs is important to help individuals decide whether this treatment is right for them to start or not.
Immediate telogen release: Understanding shedding with minoxidil
The increased shedding that accompanies starting minoxidil needs to occur for most people. It's not something that is really all that abnormal - it just looks abnormal. When you look closely at the scalps of men and women with androgenetic alopecia (especially early stages of AGA), one will notice that a higher than normal proportion of cells are in the shedding phase. These hairs are waiting their turn to shed. Hairs generally need to wait in line 2-3 months before they are shed. That's just the rule of the nature. That's what it means to be human.
When minoxidil is applied to the scalp, a signal is sent to all hairs that are waiting in line to be shed. The message that is relayed is that the hairs no longer need to wait 2-2 months in that line. Rather any hair that is waiting in line to be shed is welcome to shed now. The mandatory 2-3 month waiting period has been temporarily waived. And so what the patient then experiences is an increased amount of hairs coming out on a daily basis once they start minoxidil. What is being shed is hairs that were destined to come out anyways:
Instead of coming out tomorrow, a hair comes out today
Instead of coming out in 2 weeks, a hair comes out in tomorrow
Instead of coming out in 4 weeks, a hair comes out in 1 week
Instead of coming out in 6 weeks, a hair comes out in 2 weeks
This is what the 'dread shed' or 'immediate telogen release is all about.
For more information on the dread shed, readers might consider reviewing other articles.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887