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telogen effluvium
Etiology:
- psychococial stress
- childbirth (common) [3]
- seborrheic dermatitis
- psoriasis
- iron deficiency anemia, blood loss
- thyroid disease [3]
- weight loss [3]
- pharmacologic agents
1) ACE inhibitors
2) levodopa
3) beta blockers
a) metoprolol
b) propranolol
4) oral contraceptives
5) lithium
6) bromocryptine
7) cimetidine
8) anabolic steroids [3]
9) antithyroid agents [3]
10) anticonvulsants [3]
11) retinoids [3]
12) wafarin [3]
Pathology:
- abrupt arrest of hair follicle maturation in response to stress
- in telogen effluvium, 30-60% of hairs are telogen hairs
- in anagen effluvium, 100% are telogen hairs
- normally only 10-15% of hairs are telogen hairs
Clinical manifestations:
- diffuse hair loss after stressful event (childbirth is common)
- the stress generally occurs 2-3 months prior to onset
- hairs may fall out at hair root when hair is combed [3]
- full recovery is usual
* images [4,5]
Laboratory:
1) complete blood count (CBC) [absence of anemia]
2) iron studies (serum iron, TIBC, % transferrin saturation)
2) thyroid-stimulating hormone
3) serology
a) antinuclear antibodies (ANA)
b) RPR
Management:
1) no intervention needed
2) reassurance
3) high-dose B vitamins & calcium (reports of benefit)
Related
hair pluck test
telogen hair
General
alopecia (hair loss, balding)
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 916-18
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 28-29
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18
American College of Physicians, Philadelphia 2012, 2015, 2018.
- Hughes CEW, Elston DM (image)
Medscape: Telogen Effluvium
http://emedicine.medscape.com/article/1071566-overview
- DermNet NZ. Telogen effluvium (images)
http://www.dermnetnz.org/hair-nails-sweat/telogen-effluvium.html