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SUMMARY
TE is one of the most common form of non-scarring alopecia.
It is a diffuse and profuse loss of hair in telogen phase lasting for more than 6 months.
It affects both males and females, with a higher incidence rate in middle-aged women.
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TIPS FOR DIAGNOSIS
The collection of the medical history is mandatory to make a diagnosis.
Laboratory testing may be helpful for identifying an etiology when the inciting factor for telogen effluvium is unknown.
Scalp biopsy is reserved for doubtful cases.
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TIPS FOR TREATMENT
The most important aspect in the management of TE is counseling the patient about the natural history and the benign course of the disease.
Minoxidil can be an option in selected cases.
Physical therapies are very useful to prolong the hair cycle.
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DON’T FORGET
TE can be a challenging disease, because numerous causes and triggering factors can be associated.
The latency between the triggering factors and the occurrence of chronic telogen effluvium may also lead to misdiagnosis.
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PITFALLS AND CAUTIONS
Main differential diagnosis is represented by androgenetic alopecia, alopecia areata diffuse and incognita anagen effluvium.
Chronic telogen effluvium usually onsets slowly and lasts long with periodic relapses and remissions.
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PATIENT EDUCATION POINTS
Chronic telogen effluvium is a condition lasting for more than six months.
The daily shedding is mild (usually less than 100 hairs daily), but the patients are very distressed and complain of progressive temporal thinning and decreased hair mass.
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Kligman, in 1961, coined the term telogen effluvium (TE),1 referring to a diffuse and profuse loss of hair in telogen phase. A normal hair cycle results in replacement of every hair on the scalp every 3 to 5 years.2 Hair remains anchored to the follicle throughout the telogen phase and is shed only when the follicle starts its growth phase again and produces a new hair.
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The diagnosis of telogen effluvium includes two separate entities: acute and chronic.
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Chronic telogen effluvium is a condition lasting for more than six months (see Chapter 26). It can involve both sexes, but it mostly affects middle-aged women, having a prolonged fluctuating course. The examination of the scalp shows hair with normal thickness with signs of shorter re-growing hair in the frontal and bitemporal areas.3 The daily shedding is mild (usually less than 100 hairs daily), but the patients are very distressed and complain of progressive temporal thinning and decreased hair mass.
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Chronic TE can be idiopathic or secondary to a variety of causes, but it can often remain unexplained since the patient doesn’t recall the causative factor.4...