Can a dandruff shampoo cause recipient site shed at 5 months post-op?

[Ernie]

I'm currently at 5 months post-op, and I recently bought a bottle of Head and Shoulders shampoo. I've used it once, and I've noticed that there was a nickel sized amount of hair in my shower drain. Yesterday, looking in the mirror I noticed to myself: "Hmm... my HT at 5 months looks much thinner / see-through now than it did just a few days ago"....

 

... Then, to confirm that suspicion I saw the nickel (coin) - sized dollop of hair in my shower drain. I haven't seen hair in my drain in 15 years, as I'm very stable on Finasteride for 17 years and counting

 

I won't be using H&S shampoo again -- my recipient site (frontal third) looks thinner now. FYI, my prior shampoo was just Axe shampoo -- bought it just cuz it was cheap, but it's not a dandruff shampoo.

 

------

 

QUESTIONS:

 

1. Will the hair that shed grow back?

2. Why did only "new" HT hair shed?

3. Has anyone else ever had this experience?

[Dr Blake Bloxham]

Hey Ernie,

 

What was the active ingredient that made it "head and shoulders dandruff" versus just regular "head and shoulders?" I think a lot of our patients use the regular "head and shoulders" -- Dr Feller is a fan -- and I haven't heard of any complaints before. But there could be some other "active ingredient" here.

 

As to your other questions:

 

1) I see no reason why it wouldn't.

 

2) If you did shed, it probably was from everywhere. But it's likely that you're only noticing it in the recipient because: A) that's where you're looking, and B) the donor and non-transplanted areas are naturally thicker, so they don't appear "thinner" even if they are shedding. Think about it this way: you have to hit about 40 FUs/cm^2 before thinning is noticeable. And let's say this new shampoo caused a 20% shed all around. If your non-transplanted donor is 100 FUs/cm^2, it loses 20% and is now 80 FUs/cm^2. The human eye won't be able to really pick up the difference and it won't look thin. Now let's say your transplanted hair is around 45 FUs/cm^2; you lose 20% of that, you are now at 36 FUs/cm^2, which is below the threshold for noticeable thinning.

 

3) Some shampoos do contain ingredients that may cause an initial shed. However, the transplanted follicles are very, very strong, and I would be shocked if everything didn't come back completely normal. In fact, the anti-dandruff shampoo may decrease the general inflammation in your scalp and improve the quality of any native hairs in the area too (as we now know certain types of inflammation do play a role in androgenic alopecia)

 

Altogether, I think you're good.

 

Hope this helps!

[Ernie]

active ingredient is "pyrithione zinc" and pics of the culprit are below.

[Ernie]

Great answer, thx doc... All from switching shampoos (gross picture below). Crazy

Edited July 18, 2016 by Ernie

[mav23100gunther]

active ingredient is "pyrithione zinc" and pics of the culprit are below.

 

I wouldn't use the one with Old Spice scent in it, I imagine that's just another harsh chemical in it. I know Dr Rahal is not a big fan of Head & Shoulders due to harsh chemicals (per the post-op instructions). I personally use Nizoral twice a week, and then use Loreal Vive Pro for Men or Aveda Pure Abundance the other 5 days a week.

[Ernie]

I wouldn't use the one with Old Spice scent in it, I imagine that's just another harsh chemical in it. I know Dr Rahal is not a big fan of Head & Shoulders due to harsh chemicals (per the post-op instructions). I personally use Nizoral twice a week, and then use Loreal Vive Pro for Men or Aveda Pure Abundance the other 5 days a week.

 

Considering that's the most hair I've seen in my drain in almost 20 years, you can bet I will choose my shampoo wisely from now on

[Dr Blake Bloxham]

Ernie,

 

It could be the zinc.

 

I've actually seen this active ingredient used many times in patients with seborrhoeic dermatitis. Those patients shed a lot from the flaking itself, so I never really associated it with the pyrithione zinc.

 

However, topical zinc is also used -- by some -- as a hair loss therapy; and almost all of these preventive topical treatments can cause an initial shed.

 

So I think there are a few possible explanations here. However, I still feel confident it will reverse if it was truly transplanted hair.