Background: Distinguishing chronic telogen effluvium (CTE)-from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient. Observations: One hundred consecutive patients with hair los...Background: Distinguishing chronic telogen effluvium (CTE)-from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient. Observations: One hundred consecutive patients with hair loss who were clinicall y diagnosed as havingCTE, AGA, AGA+CTE, or remitting CTE. Patients washed their hair in the sink in a standardized way. All shed hairs were counted and divided “blindly”into 5 cm or longer, intermediate length (>3 to < 5 cm), and 3 cm or shorter. The latter were considered telogen vellus hairs, and patients having a t least 10%of them were classified as having AGA.We assumed that patients shedd ing 200 hairs ormore had CTE. The κstatistic revealed, however, that the best c oncordance between clinical and numerical diagnosis (κ=0.527)was obtained by se tting the cutoff shedding value at 100 hairs or more. Of the 100 patients, 18 wi th 10%or more of hairs that were 3 cm or shorter and who shed fewer than 100 ha irs were diagnosed as having AGA; 34 with fewer than 10%of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having CTE; 34 wit h 10%or more of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having AGA +CTE; and 14 with fewer than 10%of hairs that we re 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having CT E in remission. Conclusion: This method is simple, noninvasive, and suitable for office evaluation .展开更多
A 16-year-old girl presented with a 12-month history of generalized hair shedding from the scalp. The onset of shedding coincided with the development of Hashimoto’s thyroiditis and iron deficiency. At the time of in...A 16-year-old girl presented with a 12-month history of generalized hair shedding from the scalp. The onset of shedding coincided with the development of Hashimoto’s thyroiditis and iron deficiency. At the time of initial presentation, the Has himoto’s thyroiditis had been treated with Neo-Mercazole and she was euthyroid. Her iron stores were low, with a ferritin level of 13 μg/L. As she was vegetarian, oral iron replacement therapy was commenced without further investigation. On follow-up 6 months later, her iron stores were normal (ferritin, 36 μg/L),but the hair shedding had continued. On examination, there was a positive hair pull test from both the vertex of the scalp and the occipital scalp. There was mild bitemporal recession, but no widening of the central part, and she appeared to have a full, thick head of hair (Fig. 1). Additional investigations at that time revealed normal thyroid function and negative antinuclear antibody (ANA) and syphilis serology. She was on no medication other than Neo-Mercazole. Serum testosterone, dihydroepiandosterone sulphate(DHEAS) and sex hormone binding globulin (SHBG) were normal. Two 4-mm punch biopsies were taken from the vertex of the scalp; one was sectioned horizontally and the other vertically. The vertical section was unremarkable. On the horizontal section, there were 32 hair follicles in total, 30 of which were terminal hairs and two of which were vellus hairs. One hair was in telogen. The ratio of terminal to vellus hairs was 15 : 1. A diagnosis of chronic telogen effluvium was made. The condition was explained to the patient and she was reassured that chronic telogen effluvium is not a progressive condition and does not lead to baldness. No treatment was recommended. At follow-up 12 months later, the hair loss had obviously progressed and the patient was assessed as having Ludwig Stage 1 and rogenetic alopecia with widening of the central part (Fig. 2). Repeat blood tests showed normal iron studies, thyroid function, and hormone parameters. Three 4mm punch biopsies were taken from the vertex of the scalp and all were sectioned horizontally. The terminal to vellus hair ratios were 1: 1, 2.6: 1, and 1.9: 1. A diagnosis of and rogenetic alopecia was made and she was commenced on oral spironolactone, 200 mg/day.展开更多
文摘Background: Distinguishing chronic telogen effluvium (CTE)-from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient. Observations: One hundred consecutive patients with hair loss who were clinicall y diagnosed as havingCTE, AGA, AGA+CTE, or remitting CTE. Patients washed their hair in the sink in a standardized way. All shed hairs were counted and divided “blindly”into 5 cm or longer, intermediate length (>3 to < 5 cm), and 3 cm or shorter. The latter were considered telogen vellus hairs, and patients having a t least 10%of them were classified as having AGA.We assumed that patients shedd ing 200 hairs ormore had CTE. The κstatistic revealed, however, that the best c oncordance between clinical and numerical diagnosis (κ=0.527)was obtained by se tting the cutoff shedding value at 100 hairs or more. Of the 100 patients, 18 wi th 10%or more of hairs that were 3 cm or shorter and who shed fewer than 100 ha irs were diagnosed as having AGA; 34 with fewer than 10%of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having CTE; 34 wit h 10%or more of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having AGA +CTE; and 14 with fewer than 10%of hairs that we re 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having CT E in remission. Conclusion: This method is simple, noninvasive, and suitable for office evaluation .
文摘A 16-year-old girl presented with a 12-month history of generalized hair shedding from the scalp. The onset of shedding coincided with the development of Hashimoto’s thyroiditis and iron deficiency. At the time of initial presentation, the Has himoto’s thyroiditis had been treated with Neo-Mercazole and she was euthyroid. Her iron stores were low, with a ferritin level of 13 μg/L. As she was vegetarian, oral iron replacement therapy was commenced without further investigation. On follow-up 6 months later, her iron stores were normal (ferritin, 36 μg/L),but the hair shedding had continued. On examination, there was a positive hair pull test from both the vertex of the scalp and the occipital scalp. There was mild bitemporal recession, but no widening of the central part, and she appeared to have a full, thick head of hair (Fig. 1). Additional investigations at that time revealed normal thyroid function and negative antinuclear antibody (ANA) and syphilis serology. She was on no medication other than Neo-Mercazole. Serum testosterone, dihydroepiandosterone sulphate(DHEAS) and sex hormone binding globulin (SHBG) were normal. Two 4-mm punch biopsies were taken from the vertex of the scalp; one was sectioned horizontally and the other vertically. The vertical section was unremarkable. On the horizontal section, there were 32 hair follicles in total, 30 of which were terminal hairs and two of which were vellus hairs. One hair was in telogen. The ratio of terminal to vellus hairs was 15 : 1. A diagnosis of chronic telogen effluvium was made. The condition was explained to the patient and she was reassured that chronic telogen effluvium is not a progressive condition and does not lead to baldness. No treatment was recommended. At follow-up 12 months later, the hair loss had obviously progressed and the patient was assessed as having Ludwig Stage 1 and rogenetic alopecia with widening of the central part (Fig. 2). Repeat blood tests showed normal iron studies, thyroid function, and hormone parameters. Three 4mm punch biopsies were taken from the vertex of the scalp and all were sectioned horizontally. The terminal to vellus hair ratios were 1: 1, 2.6: 1, and 1.9: 1. A diagnosis of and rogenetic alopecia was made and she was commenced on oral spironolactone, 200 mg/day.
