Chronic telogen effluvium: A study of 5 patients over 7 years

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Chronic telogen effluvium is said to be self-limiting in the long run; the natural history of this condition, however, has not been investigated prospectively. Four women, aged between 18 and 64 years and diagnosed with chronic telogen effluvium between 1996 and 1997, were followed up prospectively for a minimum of 7 years. One (previously reported) woman diagnosed in 1998 developed female pattern hair loss confirmed on biopsy specimen within 18 months that was partially reversed by spironolactone. The remaining 4 women continued to experience chronic diffuse telogen hair shedding that fluctuated in severity. However, serial photography demonstrated no visible reduction in hair density, and serial scalp biopsy specimen showed no follicular miniaturization. Although 4 out of 5 of our patients showed no tendency toward development of female pattern hair loss or to spontaneous improvement, further work is required to define the natural history of chronic telogen effluvium and the relative risk of developing female pattern hair loss.

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Case 1

A 54-year-old woman presented in 1995 with an 18-month history of continuous excessive hair shedding. The hair shedding began suddenly and she was able to collect between 40 and 150 hairs per day (Fig 1). She estimated the thickness of her ponytail had decreased by 50% during the preceding 18 months. Her father had died at the age of 40 but was Hamilton stage IV at the time of his death. There was no other family history of FPHL; however, her sister had experienced a single patch of alopecia

Case 2

A 64-year-old woman presented with a 6-month history of diffuse hair shedding. She had collected 450 hairs in a single day. The loss was increased with hair washing, and consequently she now only washed her hair once every 2 weeks. There was no family history of androgenetic alopecia. She had a history of hyperthyroidism treated with radioactive iodine. She subsequently developed hypothyroidism and has been on thyroxine replacement therapy for more than 25 years. Investigation by her referring

Case 3

A 19-year-old woman presented with an 8-month history of chronic diffuse hair shedding, reduction in the volume of her ponytail, bitemporal recession, but no widening of her central part. The hair shedding had started suddenly; no precipitant event was identified on questioning. Thyroid function tests, iron studies, and hormone parameters all revealed normal findings. She took no medications. Scalp biopsy specimen was consistent with CTE (Table I). On review at 6 months, 12 months, 2 years, 4

Case 4

A 27-year-old woman presented with a 4-year history of increased hair shedding, loss of volume of her ponytail, bitemporal recession, but no widening of her central part. No trigger for the hair shedding was identified on history. Thyroid function tests, iron studies, and hormone parameters all revealed normal findings. Scalp biopsy specimen was consistent with CTE (Table I). On review at 6 months, 12 months, 2 years, 4 years, and 8 years, the hair shedding had continued, but the magnitude

Case 5

This case has been previously reported.4 A 16-year-old girl presented with a 12-month history of generalized hair shedding from the scalp. The onset of the shedding coincided with the development of Hashimoto's thyroiditis and iron deficiency. At the time of initial presentation, the Hashimoto's thyroiditis had been treated with neomercazole and she was euthyroid. The iron stores were still low with a ferritin of 13 μg/L and because she was a vegetarian, oral iron replacement therapy was

Discussion

Although most women who present with chronic diffuse telogen hair shedding with no visible reduction in scalp hair density will be found on biopsy specimen to have FPHL, approximately 40% will have normal scalp biopsy specimen and be diagnosed with CTE.5

The pathogenesis of CTE is unknown, but it is theorized that CTE is caused by a reduction in the duration of the anagen growth phase without hair follicle miniaturization.1., 8. A reduction in the duration of anagen also occurs in FPHL, and it

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This supplement is made possible through the generous support of Stiefel Laboratories for the American Academy of Dermatology.

Funding sources: None.

Conflicts of interest: None identified.

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