what is inflammatory disease on scalp ?? Is it different from male pattern baldness? I get lots of itching on my scalp…and directly entering norwood class 6… but my doc saw my hair under some glass which looks like a huge magnifying glass and said its male pattern baldness…

Inflammatory scalp disease is when there’s an inflammatory process occuring in your scalp causing hair loss. There will be macrocyte and other white blood cells releasing histamine and other chemicals to cause the inflammatory process. The diseases which can cause skin inflammation are psoriasis, alopecia areata, eczema, a variety of autoimmune problems, or infections. This is different for male pattern baldness (MPB), because MPB is caused by DHT attacking the follicles through growth interference and not by an inflammatory process. Some forms of inflammation do not cause hair loss, so you will need a doctor to help confirm your diagnosis, which sounds like what your doctor was trying to do for you.

Hi, in regards to this man’s question from your site: Hair Grew Back After Many Years

Did he ever send you pictures? I know names are kept confidential, but if what he says is true, there may be something closely related to my problem, which I consider extremely serious but no one else does.

When I was 22 had testicular cancer, right testicle removed, then 2 years later it spread to my lungs. I had 4 cycles of first line chemo, the most you can get, and afterward my hair grew back completely normally – no hair thinning, loss, recession – it was like it was always, a complete head of hair. But a few months later, the cancer showed up again, so I went on HIGH DOSE chemotherapy for 4 months. It’s been about 1 year since then, and since, my hair looks like I’ve been balding for decades. 4 months and I go from a complete head of hair to visible balding at the back of my head. The strange thing is, the follicles are completely miniaturized, but all over my head, and even my underarm hair and pubic hair are thinned out. The fact that it won’t grow on top is killing me however. I have very little family history of this, my dad is 50 and his hair isn’t budging.

Anyway, I’m not expecting you to give me solutions, just answers, or at least an intelligent hypothesis. I cross-referenced a list of the American academy of dermatologists and the New Yorker’s list of top 50 doctors to find a specialist, and here’s what he told me: “sometimes after chemo the texture of the hair can change. What’s happening with you is, male-pattern-baldness is probably affecting it somewhat but it’s at a right angle to your problem, it’s most likely a mixture of different things.” This was supposed to be the cream of the crop. He refused to do tests, scalp biopsies, anything, saying they would show nothing so why do them.

I know a decent amount about this after obsessing about it for a year over internet research. I know chemotherapy has nothing to do with dht, and right now my oncologists want me to go on testosterone supplements because my levels are low, so I know that this is not a straightforward problem.

Please, give a poor guy at the end of his ropes a break, don’t cast me out as one of the millions of hopeless cases. I’ve done this a hundred times, and have been disappointed with responses like “sorry, can’t help.” Can you at least take a hypothetical stab at an explanation, or put me in contact with that guy who’s hair grew back with chemotherapy?

In regards to the patient you mentioned whose hair grew back — unfortunately, there were no pictures supplied in his email.

Your hair loss is likely a result of your chemotherapy (you knew that). Your hair texture and growth cycle does change after chemotherapy (you knew that). A biopsy will not help, because we already know the cause of your hair loss (you knew that too, but it wasn’t explained to you in the right way). It takes time and everybody is different (again, you knew that). A year is a long time, but there is nothing except time on your side before you can see if your hair will grow back (you should know this too).

It seems you have done your homework and want a solution, but sometimes there is nothing more than what you already know. In the mean time, you should follow your oncologist’s advice.

My son who is 21 completed a 4 cycle chemo treatment in May 05. Today his hair is still very thin, fine and spots of balding. I have left a message today with his doctor for some advise when I saw your web page. Any suggestions? I know hair growth takes a while but it is going on 10 months now. Thanks!

Hair loss during and after chemotherapy is one of the most distressing side effects. Hair loss occurs because chemotherapy targets all living cells in the body including hair follicle cells. Simply put, chemotherapy is poison to all living cells. It is a medical balancing game where the cancer cells are killed before the chemotherapy kills you.

Hair follicle cells have three phases of growth:

1. Growth phase (Anagen phase) which lasts anywhere from 2 to 6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
2. Transitional phase (Catagen phase) which lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
3. Resting phase (Telogen phase) which lasts about 1- 2 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.

During chemotherapy, hair in the growth phase is most affected due to the active nature of the hair follicle. Ideally, hair lost during chemotherapy should start to grow after 3 to 6 months. Unfortunately, new hair may grow thinner, slower, or with different texture or color.

Your son’s hair growth seems to be returing, but at a much slower rate than you have anticipated. This may be due to the 4 cycles of chemotherapy. This may also be due to the fact that your son’s body is recovering at a different rate than expected. It may just be a normal recovery pace for your son. Ultimately, if your son is healthy and is in remission, that is the most important priority. Neverthess, hair loss is certainly the most visible and distressing side effect of chemotherapy and a stigmata of cancer. There are a number of support groups and wigs available to chemotherapy patients, which are sometimes even covered by insurance companies. Finally, topical creams or Propecia would not be of benefit for hair loss from chemotherapy.

By Dr. Jae Pak and Dr. William Rassman

[Note: This blog entry has been answered by Dr. Jae Pak, who has been working with Dr. Rassman for the past 9 years developing new surgical instruments and hair transplant procedures.]