Telogen Effluvium

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Nargess Tavakoli

Economy & Finance Health & Medicine

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Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle in genetically predisposed men and women, usually in a specific pattern distribution. Multifactorial and polygenetic etiology. Clinical features: -History of hair loss is - long standing slowly progressing reduction of hair density, diameter Miniaturization of hair Diminished anagen hair and increased telogen hair -Pattern of hair loss in male: Hamilton- Norwood type: recession of frontal hair line, latter followed by a vertex thinning with progression until top of the scalp is completely bald. -Pattern of hair loss in female: Centrofrontal hair loss with preservation of frontal hair line (Ludwig type) {figure - left} Christmas tree pattern {figure- right} -Family history of AGA often positive In female signs of hyperandrogenism should be evaluated gynecological history progesterone containing pills -To exclude other causes history should be taken regarding- Thyroid disease, Surgery, infection in last 6months to 1 year Drug history Iron deficiency Smoking UV exposure Hair color, cosmetics use. Allergic contact dermatitis Treatment: Androgenic alopecia is naturally progressive , so main strategy is to prevent progression and increase hair density. 1.Topical minoxidil: 2% for female and 5% spray for male 1 ml twice daily or half cup foam once daily. There is transitory telogen shedding within first 8 weeks observed. Response should be assessed after 6 months. If response occurs, will be continued as main stay of treatment. 2.Finasteride oral ad Dutasteride oral 1 mg finasteride per day prevents progression of AGA . 0.5 mg daily dutasteride is alternative. Combination of topical minoxidil and finasteride is good option Response evaluated after 6 months . not indicated in women. Contraindicated in pregnant and child bearing female. 3.Antiandrogen and estrogenic drugs: Given in hyperandrogenism in female. Not indicated in male. Spironolactone 100-200 mg daily Cyproterone acetate can be used 4.Hair transplantation 5.Low-level laser therapy 6.Miscellaneous: low level of evidence. Platelet rich plasma therapy and microneedling Herbal preparations Topical melatonin Nutritional supplement of- biotin, copper, zinc, aminoacids, micronutrients

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• In recent years, the usefulness of trichoscopy (scalp dermoscopy) (videodermatoscopy) has been reported for diagnosing hair loss diseases. This method allows viewing of the hair and scalp at X20 to X160 magnifications. Characteristic trichoscopy features of alopecia areata are black dots, tapering hairs (exclamation mark hairs), broken hairs, yellow dots, and short vellus hairs. In androgenetic alopecia (AGA), hair diameter diversity (HDD), perifollicular pigmentation/peripilar sign, and yellow dots are trichoscopically observed. In all cases of AGA and female AGA, HDD, more than 20%, which corresponds to vellus transformation, can be seen. In cicatricial alopecia (CA), the loss of orifices, a hallmark of CA, and the associated changes including perifollicular erythema or scale and hair tufting were observed. Different hair shafts variation such as vellus, terminal, micro-exclamation mark type, monilethrix, Netherton type, and pili annulati hairs can be seen . The number of hairs in one pilosebaceous unit can be assessed. Healthy Hair follicles variation healthy, empty, fibrotic ("white dots"), filled with hyperkeratotic plugs ("yellow dots"), or containing dead hair ("black dots"). Abnormalities of scalp skin color or structure include honeycomb-type hyperpigmentation, perifollicular discoloration (hyperpigmentation), and scaling are also seen with the help of trichoscopy.

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Telogen effluvium (TE) is the common cause of diffuse nonscarring hair loss. TE is caused by any disruption of hair cycle resulting in increased, synchronized telogen shedding. In children, TE has been reported to be responsible for only a minority of cases with hair loss. The functional mechanism of shedding in majority of these cases is immediate anagen release. A male child of age seven years presented the out-patient department of DVL, RIMS Kadapa, with the history of shedding of hair on head and eyebrows. He is a known congenital heart disease (ventricular septal defect) for which he has undergone ventricular septal defect closure surgery. After a period of six months, shedding of hair on the head and eye brows was noticed. After examining the patient, the dermatologist diagnosed as Telogen effluvium and prescribed Mometasone furoate (synthetic corticosteroid with anti-inflammatory activity), betamethasone, ferrous fumarate (used to treat anaemia not enough red blood cells in the blood) and isotretinoin. Based on the pathogenesis of TE, potential therapeutic options include inhibition of catagen (so as to prolong anagen); induction of anagen in telogen follicles; or inhibition of exogen (to reduce hair shaft shedding). Differentiating TE from other causes of diffuse nonscarring hair loss can indeed be a daunting task. A number of factors have been implicated in the causation of TE, however, clear evidence in their support is lacking. Possible treatment options for TE, especially the chronic form, are not many. Treatment for TE is primarily reassurance and counselling

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