When the Rug Gets Pulled Out from Under You: Dealing with the Unpredictable Nature of Some Types of Hair Loss

“I Feel Like the Rug Just Got Pulled Out From Under Me”

There are so many expressions that capture the frustrations of hair loss. Every language has these expressions.

In the English language, there is an expression that captures both the shock and frustration and despair that happens when someone’s stable plan or stable situation suddenly gets altered in a dramatic manner that they wish did not happen.

“I feel like the rug was just pulled out from under me”

Patients with all types of hair loss can report this from time to time but there are a few situations where it is more common.

Example 1: In chronic telogen effluvium, many patients go through periods where hair shedding really slows down. Sometimes hair shedding even stops for days or weeks or months. The world seems brighter and air tastes better. Suddenly out of the blue the intense hair shedding is back. It is completely unpredictable and makes no sense to the patient. “I feel like the rug was pulled out from under me.”

Example 2: In alopecia areata, many patients go through periods where patches of hair loss stop forming and hair grows well. Hair loss may stop for days or weeks or months or even years. The world seems brighter and air tastes better. Suddenly out of the blue a patch or two of hair loss starts forming. It is completely unpredictable and makes no sense to the patient. “I feel like the rug was pulled out from under me.”

Example 3: In scarring alopecia, many patients go through periods where hair shedding reduces to a normal level and scalp symptoms dissipate. New areas of hair loss stop forming. The world seems brighter and air tastes better. Suddenly out of the blue a patch or two of hair loss starts forming. The itching and burning comes back. It is completely unpredictable and makes no sense to the patient. A once stable course now takes a new turn. “I feel like the rug was pulled out from under me.”

Example 4: In treating the scalp dysesthesias, many patients go through periods where the life-altering scalp pain or scalp burning or scalp itching settles down and maybe even stops completely for days or weeks. The world seems brighter and air tastes better. Suddenly out of the blue, the intense symptoms are back. It is completely unpredictable and makes no sense to the patient. “I feel like the rug was pulled out from under me.”

Conclusion

As healthcare providers, we need to recognize the frustration that patients feel when the rug was pulled out from under them. Some patients can stabilize themselves and get back on their feet until the time that the world again feels brighter and the air again tastes sweeter. But many need our help during these tough times when the patterns of scalp symptoms or the patterns of hair loss or hair shedding defy all logic and make no sense.