Chronic Telogen Effluvium

Chronic telogen effluvium

  • Joana Calvão Serviço de Dermatologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-1161-269X
  • Rui Oliveira Soares Serviço de Dermatologia do Hospital Cuf Descobertas, Lisboa, Portugal
Keywords: Alopecia, Hair Diseases, Hair Follicle

Abstract

Chronic telogen effluvium can be defined as a hair loss greater than the physiological one (above 150-200 hairs / day) for a period of more than six months, without an evident cause. Although common, it is often underdiagnosed, and raises several questions of a practical nature that the literature still has some difficulties in answering, from its etiopathogenesis to therapy. In this article on Continuing Medical Education, we intend to help answer these questions, reviewing the definition, pathophysiology, clinical / tricoscopic / histological characteristics and the therapy of the chronic telogen effluvium.

Downloads

Download data is not yet available.

References

Rebora A. Telogen effluvium : a comprehensive review. Clin Cosmet Investig Dermatol. 2019; 12:583-90.

Kligman AM. Pathologic dynamics of human hair loss. I. Telogen effuvium. Arch Dermatol. 1961; 83:175-98.

Headington JT. Telogen effluvium. New concepts and review. Arch Dermatol. 1993; 129:356-63.

Whiting DA. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women. J Am Acad Dermatol. 1996; 35:899-906.

Werner B, Mulinari-Brenner F. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - Part II. An Bras Dermatol. 2012; 87: 884-90. doi: 10.1590/s0365-05962012000500012.

Miot H, Penna G, Ramos A, Penna ML, Schmidt SM, Luz F, et al. Profile of dermatological consultations in Brazil. An Bras Dermatol. 2018; 93: 916–28. doi: 10.1590/abd1806-4841.20188802.

Trüeb R. Serum biotin levels in women complaining of hair loss. Int J Trichology. 2016; 8: 73-7. doi: 10.4103/0974-7753.188040.

Ozturk P, Orhan FO, Ozer A, Akman Y, Kurutas E. Evaluation of Anxiety and Levels of Serum B12, Folate, TSH, ferritin, and zinc in telogen alopecia patients with trichodynia. Int J Trichology. 2012; 4: 251-4. doi: 10.4103/0974-7753.111208.

Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The role of vitamins and minerals in hair loss: a review. Dermatol Ther. 2019; 9:51-70. doi: 10.1007/s13555-018-0278-6.

Banihashemi M, Nahidi Y, Meibodi NT, Jarahi L, Dolatkhah M. Serum Vitamin D3 level in patients with female pattern hair loss. Int J Trichology. 2016; 8: 116-20.

Freinkel RK, Freinkel N. Hair growth and alopecia in hypothyroidism. Arch Dermatol. 1972; 106:349-52.

Dawber RP, Connor BL. Pregnancy, hair loss, and the pill. Br Med J. 1971; 4:234.

Rebora A. Telogen effluvium revisited. Ital Dermatol Venereol. 2014; 149:47-54.

Rebora A. Proposing a simpler classification of telogen effluvium. Skin Appendage Disord. 2016; 2: 35-38. doi: 10.1159/000446118.

Rebora A. Intermittent chronic telogen effluvium. Skin Appendage Disord. 2017; 3: 36-8. doi: 10.1159/000455882.

Guarrera M, Rebora A. Exogen hairs in women with and without hair loss. Skin Appendage Disord. 2017; 3: 193-6. doi: 10.1159/000460300.

Koch PJ. Desmoglein 3 anchors telogen hair in the follicle. J Cell Sci. 1998; 111:2529-37.

Bardelli A, Rebora A. Telogen effluvium and minoxidil. J Am Acad Dermatol. 1989; 21:572-3.

Hatakeyama S, Hayashi S, Yoshida Y, Otsubo A, Yoshimoto K, Oikawa Y, et al. Retinoic acid disintegrated desmosomes and hemidesmosomes in stratified oral keratinocytes. J Oral Pathol Med. 2004; 33:622-8.

Cutrone M, Grimalt R. Transient neonatal hair loss: a common transient neonatal dermatosis. Eur J Pediatr. 2005; 164:630-2. doi: 10.1007/s00431-005-1707-y.

Van Neste D. Maintenance of optimised hair growth from viable terminal scalp hair follicles at baseline with oral finasteride in male pattern hair loss and first evidence of a "drug dependency" and a post-finasteride "rebound effect". Skin Res Technol. 2019; 25:712-9. doi: 10.1111/srt.12707.

Guzmán-Sánchez D, Asz-Sigall D. Alopecias due to drugs and other skin and systemic disorders. Curr Probl Dermatol. 2015; 47:97-106.

Rebora A. Alopecia areata incognita: a hypothesis. Dermatologica. 1987; 174:214-8.

Shashikant Malkud. Telogen Effluvium: A Review. J Clin Diagn Res. 2015; 9): WE01-3. doi: 10.7860/JCDR/2015/15219.6492.

Chave TA, Mortimer NJ, Hutchinson PE. Agranulocytosis and total scalp alopecia following acitretin. Br J Dermatol. 2003; 148:1063-4. doi: 10.1046/j.1365-2133.2003.05333.x.

Umlas J, Harken DE. Warfarin-induced alopecia. Cutis. 1988; 42:63-4.

Mercke Y, Sheng H, Khan T, Lippmann S. Hair loss in psychopharmacology. Ann Clin Psychiatry. 2000; 12:35-42.

Aziz A, Hamed S, Gaballah MA. Possible relationship between chronic telogen effluvium and changes in lead, cadmium, zinc, and iron total blood levels in females: a case-control study. Int J Trichology. 2015; 7: 100–6. doi: 10.4103/0974-7753.167465.

Rebora A. Trichodynia: a review of the literature. Int J Dermatol. 2016; 55(4):382-4.

Baldari M, Guarrera M, Rebora A. Thyroid peroxidase antibodies in patients with telogen effluvium. J Eur Acad Dermatol Venereol. 2010; 24:980-2. doi: 10.1111/j.1468-3083.2010.03589.x.

Seleit I, Bakry O, Badr E, Hassan E. Vitamin D Receptor Gene Polymorphism in Chronic Telogen Effluvium; A Case-Control Study. Clin Cosmet Investig Dermatol. 2019; 12:745–50. doi: 10.2147/CCID.S227232.

Kovacevic M, Goren A, Shapiro J, Sinclair R, Lonky N, Situm M, et al. Prevalence of hair shedding among women. Dermatol Ther. 2017; 30: e12415. doi: 10.1111/dth.12415.

Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R. Telogen effluvium: a review of the literature. Cureus. 2020; 12:1-7.

Rattanakaemakorn P, Suchonwanit P. Scalp pruritus: review of the pathogenesis, diagnosis, and management. Biomed Res Int. 2019; 2019: 1268430.

Sinclair R. Chronic telogen effluvium: A study of 5 patients over 7 years. J Am Acad Dermatol. 2005;52:12-16.

Horenstein MG, Bacheler CJ. Follicular density and ratios in scarring and nonscarring alopecia. Am J Dermatopathol. 2013; 35:818-26.

Kang H, Kang TW, Lee SD, Park YM, Kim HO, Kim SY. The changing patterns of hair density and thickness in South Korean women with hair loss: clinical office-based phototrichogram analysis. Int J Dermatol. 2009; 48:14-21.

Rakowska A. Trichoscopy (hair and scalp videodermoscopy) in the healthy female. Method standardization and norms for measurable parameters. J Dermatol Case Rep. 2009; 3: 14-9. doi: 10.3315/jdcr.2008.1021.

Shin S, Kim DY. Suprabulbar thinning of hair in telogen effluvium. Yonsei Med J. 2017; 58: 682-3.

Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Rudnicka L. Dermoscopy in female androgenic alopecia: method standardization and diagnostic criteria. Int J Trichology. 2009; 1: 123-30.

Torres F, Tosti A. Female pattern alopecia and telogen effluvium: figuring out diffuse alopecia. Semin Cutan

Med Surg. 2015; 34:67-71.

Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012; 67:1040-8. doi: 10.1016/j.jaad.2019.12.056.

Dhurat R. Phototrichogram. Indian J Dermatol Venereol Leprol. 2006; 72:242-4.

Kang H, Kang TW, Lee SD, Park YM, Kim HO, Kim SY. The changing patterns of hair density and thickness in South Korean women with hair loss: clinical office-based phototrichogram analysis. Int J Dermatol. 2009; 48:14-21. doi: 10.1111/j.1365-4632.2009.03795.x.

Martínez-Velasco MA, Vázquez-Herrera NE, Maddy AJ, Asz-Sigall D, Tosti A. The hair shedding visual scale: a quick tool to assess hair loss in women. Dermatol Ther. 2017; 7: 155-65. doi: 10.1007/s13555-017-0171-8.

Guarrera M, Cardo PP, Rebora A. Assessing the reliability of the Modified Wash Test. G Ital Dermatol Venereol. 2011; 146:289-94.

Rebora A, Guarrera M, Baldari M, Vecchio F. Distinguishing androgenetic alopecia from chronic telogen effluvium when associated in the same patient: A simple noninvasive method. Arch Dermatol. 2005; 141:1243-5. doi: 10.1001/archderm.141.10.1243.

Addor F, Donato L, Melo C. Comparative evaluation between two nutritional supplements in the improvement of telogen effluvium. Clin Cosmet Investig Dermatol. 2018; 11: 431-6. doi: 10.2147/CCID.S173082.

Guo E, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept. 2017; 7: 1-10. doi: 10.5826/dpc.0701a01.

Glynis A. A Double-blind, placebo-controlled study evaluating the efficacy of an oral supplement in women with self-perceived thinning hair. J Clin Aesthet Dermatol. 2012; 5: 28-34.

Stamatas GN, Wu J, Pappas A, Mirmirani P, McCormick TS, Cooper KD, et al. An analysis of gene expression data involving examination of signaling pathways activation reveals new insights into the mechanism of action of minoxidil topical foam in men with androgenetic alopecia. Cell Cycle. 2017; 16:1578-84. doi: 10.1080/15384101.2017.1327492.

Paus R, Heinzelmann T, Schultz KD, Furkert J, Fechner K, Czarnetzki BM. Hair growth induction by substance P. Lab Invest. 1994; 71:134-40.

Fischer TW, Slominski A, Tobin DJ, Paus R. Melatonin and the hair follicle. J Pineal Res. 2008; 44:1-15.

Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2020 (in press). doi:10.1016/j.jaad.2020.06.1009.

Perera E, Sinclair R. Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study. F1000Res. 2017; 6: 1650.

Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol. 2020; 82:252-3. doi: 10.1016/j.jaad.2019.08.060.

Ashley PF, Frank LA, Schmeitzel LP, Bailey EM, Oliver JW. Effect of oral melatonin administration on sex hormone, prolactin, and thyroid hormone concentrations in adult dogs. J Am Vet Med Assoc. 1999; 215:1111-5.

Oliveira-Soares R, E Silva JM, Correia MP, André MC. Finasteride 5 mg/day Treatment of Patterned Hair Loss in Normo-androgenetic Postmenopausal Women. Int J Trichology. 2013; 5:22-5. doi: 10.4103/0974-7753.114709.

Shapiro J, Ho A, Sukhdeo K, Yin L, Sicco K. Evaluation of platelet-rich plasma as a treatment for androgenetic alopecia: A randomized controlled trial. J Am Acad Dermatol. 2020; S0190-9622(20)32170-8. doi: 10.1016/j.jaad.2020.07.006.

Garg S, Manchanda S. Platelet-rich plasma — an ‘Elixir’ for treatment of alopecia: personal experience on 117 patients with review of literature. Stem Cell Investig. 2017; 4:64. doi: 10.21037/sci.2017.06.07.

Finner AM. Nutrition and hair: deficiencies and supplements. Dermatol Clin. 2013; 31:167-72.

Cheung EJ, Sink JR, English JC. Vitamin and mineral deficiencies in patients with telogen effluvium: a retrospective cross-sectional study. J Drugs Dermatol. 2016; 15:1235-1237.

Glynis A. A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2012; 5: 28-34.

Mysore V, Parthasaradhi A, Kharkar RD, Ghoshal AK, Ganjoo A, Ravichandran G, et al. Expert consensus on the management of Telogen Effluvium in India. Int J Trichology. 2019; 11: 107-12. doi: 10.4103/ijt.ijt_23_19.

Published
2020-12-19
How to Cite
Calvão, J., & Oliveira Soares, R. (2020). Chronic Telogen Effluvium. Journal of the Portuguese Society of Dermatology and Venereology, 78(4), 311-319. https://doi.org/10.29021/spdv.78.4.1254
Section
Continuous Medica Education