I have recently had some distressed young patients visiting me for hair loss – a fairly common problem probably poorly understood and more vast in etiology than one thinks..
Hair is essential to our identity so losing hair is a matter of great concern for all individuals irrespective of age and sex.
I will discuss diffuse hair loss – where no scarring of the scalp or visible abnormality of the scalp is found. The most common cause for diffuse hair loss is telogen effluvium.
Telogen effluvium is a non scarring diffuse hair loss from the scalp that occurs 3 months or around there after a triggering event. Hair loss is usually less than 50 percent of the scalp.
A wide variety of potential triggers can cause this : febrile states (fevers)- e.g. TB, HIV ,MALARIA and TYPHOID.; stress; starvation ;haemmorage;major surgery; difficult labour; crash diets; drugs e.g. oral contraceptives, anti thyroid drugs, B- Blockers, Amphetamines, oral retinoids; Thyroid dysfunction (hyper or hypothyroid), renal failure, liver failure, iron deficiency anaemia, acquired zinc deficiency, malnutrition , syphilis, systemic lupus erythematosis and hair dye application .
In terms of the febrile states – severe febrile states can also cause this i.e. if the person had an illness accompanied by fever and were seriously ill.
The kind of hair loss in telogen effluvium frequently presents with bitemporal recession – hair loss from the sides of the scalp or temples.
The hair pull test can be applied and is strongly positive in telogen effluvium.It is done by grasping 40 -60 grouped hairs btw the thumb and index finger and pulling. Normally only 2- 3 hairs are pulled out but in this case more than 10 % of hair comes out.
A a detailed history and examination should be able to pinpoint the cause of tellogen effluvium but if not then a minimum of tests can be done. These include A thyroid test, urine analysis, Antinuclear antibody title and serum zinc level swell as ferritin level. 2 common conditions associated with T.E are thyroid conditions and iron deficiency even if these conditions are not apparent prior to the blood tests.
Treatment
The most important aspect of treatment is counseling. Hair shedding takes 3 – 6 months to cease after which regrowth can be noted 3- 6 months after removal of trigger. .Substitution for zinc and iron deficiencies can be initiated.Iron therapy should be given for 3 – 6 months until supplies are replenished.. The condition however is usually self limiting lasting lasting for 6 months.
