Treatment-Induced Hair Shedding (Dread Shed) Associated with Androgenetic Alopecia Therapies

Main Article Content

Aysham Chaudry, DO https://orcid.org/0009-0005-5303-5850
Alexandra DeVries https://orcid.org/0009-0008-6576-2432
Wilhelmina Lam, DO, MPH https://orcid.org/0000-0001-6709-4281
Alec Lawson https://orcid.org/0009-0001-5147-9803
Spencer Hawkins, MD, FAAD
Matt Leavitt, DO
Mark S. Nestor, MD, PhD

Keywords

Dreadshed, Minoxidil, androgenetic alopecia, hair loss, nutraceutical, Female pattern hair loss

Abstract

Treatment-induced hair shedding, or “dread shed,” is an often discussed yet poorly defined phenomenon in androgenetic alopecia (AGA) management. Shedding was most consistently reported with topical and oral minoxidil, attributed to premature anagen induction or stress-induced telogen effluvium. Evidence for shedding with antiandrogens is limited, while platelet-rich plasma with microneedling and light based therapies were rarely associated. Nutraceutical trials generally showed improved hair parameters without a clear shedding phase, though early shedding may be underrecognized due to delayed efficacy assessments. Despite its prevalence in social media, “dread shed” remains underrepresented in literature, highlighting the need for further research to guide patient counseling.

References

1. Nohria A, Desai D, Sikora M, Mandal S, Shapiro J, Lo Sicco K. Combating "dread shed": The impact of overlapping topical and oral minoxidil on temporary hair shedding during oral minoxidil initiation. JAAD Int. 2024;15:220-224. Published 2024 Mar 25. doi:10.1016/j.jdin.2024.03.005

2. Gubelin Harcha W, Barboza Martínez J, Tsai TF, et al. A randomized, active and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014;70(3):489-498.e3. doi:10.1016/j.jaad.2013.10.049

3. Stojadinovic O, Morrison B, Tosti A. Adverse effects of platelet-rich plasma and microneedling. Journal of the American Academy of Dermatology. 2020;82(2):501-502. doi:10.1016/j.jaad.2019.07.109

4. Ablon G, Kogan S. A Randomized, Double-Blind, Placebo-Controlled Study of a Nutraceutical Supplement for Promoting Hair Growth in Perimenopausal, Menopausal, and Postmenopausal Women With Thinning Hair. J Drugs Dermatol. 2021;20(1):55-61. doi:10.36849/JDD.5701

Most read articles by the same author(s)

1 2 3 > >>