Dermatology Book

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Telogen Effluvium

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  1. Definition
    1. Non-scarring Alopecia involving altered hair cycle
  2. Pathophysiology
    1. Altered growth cycle where Telogen phase predominates
    2. Timing
      1. Onset occurs 2-4 months after inciting event
      2. Resolves months after causative factor resolves
  3. Symptoms
    1. Increased Hair Loss with brushing or showering
    2. Loss of 100-300 hairs per day
    3. Affects scalp, axillary and pubic hair
  4. Signs: Hair pluck test
    1. Hairs in Telogen phase approach 50% (normally <15%)
    2. Consider work-up if >70% in Telogen phase
  5. Causes
    1. Endocrine disorders (e.g. Hypothyroidism)
    2. Stressors
      1. Crash dieting or significant dietary limitations
      2. Severe chronic illness or acute infection
      3. Postpartum effluvium
      4. Major surgery
      5. Serious psychological stressors
    3. Medications
      1. Heparin and other anticoagulants
      2. Heavy metals
      3. Etretinate (Tegison)
      4. Anticonvulsants
      5. Antithyroid Drugs (e.g. Methimazole, PTU)
      6. Hormonal agents
      7. Alkylating Agents
  6. Differential diagnosis
    1. Early Androgenetic Alopecia
    2. Syphilis (consider if regrowth delayed)
  7. Associated Conditions
    1. Comorbid Androgenetic Alopecia is often present
  8. Labs
    1. Thyroid Stimulating Hormone (TSH)
  9. Management
    1. Treat underlying cause
  10. References
    1. Sperling (1998) Med Clin North Am 82:1155
    2. Springer (2003) Am Fam Physician 68(1):93

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