Dr Julius Parker: Dramatic hair loss and discoloured toe nails

Q My first baby was born three months ago. I am breastfeeding her and am in good health except for a dramatic loss of hair. Normally my hair is thick and curly but now it is fine and lacklustre. I know it’s normal to lose a certain amount of hair after birth but at the rate mine is falling out I’m worried I will end up with bald patches. What do you suggest?

A This is a well-recognised symptom two to three months after childbirth, and although the often dramatic hair loss can be alarming, it will almost certainly return to normal.

The medical term for this condition is telogen effluvium. In a healthy scalp, about 85% of hair follicles are actively growing, and 15% are “resting”. Hair follicles remain growing for between two to seven years, which is why we need a regular haircut.

After about three months in the resting stage (called telogen) the hair is shed and a new hair follicle regrows. During pregnancy an increasing proportion of hair follicles enter the resting stage, probably as a result of hormonal influences. Once the baby is born their growth returns to normal and over the next two to three months many women notice a significant diffuse loss of hair over the whole scalp.

This hair loss is noticeable when brushing and in the shower and your hair will feel finer and thinner.

Although dramatic, it is very unusual for hair growth not to settle back to normal, although this may take up to six months. You shouldn’t need to take any medication or supplements, especially as you’re breast-feeding. If you see your GP they may check your iron and thyroid hormone levels, but unless these are abnormal you don’t need any specific treatment.

In short, this will almost certainly resolve and it’s not predictable; it may not occur if you decide to have another baby.

Q Summer is coming and I’m dreading showing my toes. About ten years ago I got a fungal infection by sharing towels while on holidays, which has left me with unsightly discoloured and misshapen toe nails. Is there anything I can do?

A Unsightly and discoloured toe nails are known as nail dystrophy.

It’s often embarrassing but usually can be improved. As you say, the commonest explanation is a fungal nail infection. Typically this starts with one nail, but spreads to others

The nail becomes yellowish, thickened and brittle. Minor trauma causes fragmentation. Often the skin by the cuticle becomes reddened and painful. The first step is to confirm the diagnosis.

Your GP can arrange for nail clippings, ideally together with debris collected from under the nail, to be sent for microscopy and culture in the lab. If negative, it is worthwhile repeating the sample.

Most GPs won’t prescribe oral treatment, such as terbinafine, without a positive result because of rare, but serious, side-effects. Terbinafine has a high cure rate but needs to be taken for at least three and often six months.

Not all dystrophic nails are the result of fungal infection. Sometimes the nails become thickened and distorted as a result of previous trauma, or, for example, tight footwear.

Occasionally the nails are affected by other skin conditions, such as psoriasis or eczema, and treating these effectively can improve the nail disease as well

If your nail disease can’t be treated by medication I’d recommend seeing a podiatrist, who may be able to improve the shape and appearance of your nails and advise on healthy foot care.


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