Shrivastava Shyam Behari
Department of Dermatology Venereology and Leprosy, Dr Baba Sahib Ambedkar Hospital, Delhi, India.
Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):20-7; quiz 27-8. doi: 10.4103/0378-6323.45215.
Telogen effluvium (TE) is the most common cause of diffuse hair loss in adult females. TE, along with female pattern hair loss (FPHL) and chronic telogen effluvium (CTE), accounts for the majority of diffuse alopecia cases. Abrupt, rapid, generalized shedding of normal club hairs, 2-3 months after a triggering event like parturition, high fever, major surgery, etc. indicates TE, while gradual diffuse hair loss with thinning of central scalp/widening of central parting line/frontotemporal recession indicates FPHL. Excessive, alarming diffuse shedding coming from a normal looking head with plenty of hairs and without an obvious cause is the hallmark of CTE, which is a distinct entity different from TE and FPHL. Apart from complete blood count and routine urine examination, levels of serum ferritin and T3, T4, and TSH should be checked in all cases of diffuse hair loss without a discernable cause, as iron deficiency and thyroid hormone disorders are the two common conditions often associated with diffuse hair loss, and most of the time, there are no apparent clinical features to suggest them. CTE is often confused with FPHL and can be reliably differentiated from it through biopsy which shows a normal histology in CTE and miniaturization with significant reduction of terminal to vellus hair ratio (T:V < 4:1) in FPHL. Repeated assurance, support, and explanation that the condition represents excessive shedding and not the actual loss of hairs, and it does not lead to baldness, are the guiding principles toward management of TE as well as CTE. TE is self limited and resolves in 3-6 months if the trigger is removed or treated, while the prognosis of CTE is less certain and may take 3-10 years for spontaneous resolution. Topical minoxidil 2% with or without antiandrogens, finestride, hair prosthesis, hair cosmetics, and hair surgery are the therapeutically available options for FPHL management.
休止期脱发(TE)是成年女性弥漫性脱发最常见的原因。TE与女性型脱发(FPHL)和慢性休止期脱发(CTE)一起,占弥漫性脱发病例的大多数。在分娩、高烧、大手术等触发事件后2 - 3个月,正常杵状毛突然、快速、普遍脱落表明为TE,而中央头皮变薄/中央发缝变宽/额颞部后缩导致的逐渐弥漫性脱发表明为FPHL。外观正常、头发浓密且无明显原因的过度、令人担忧的弥漫性脱发是CTE的特征,CTE是一种与TE和FPHL不同的独特病症。除了全血细胞计数和尿常规检查外,对于所有无明显原因的弥漫性脱发病例,都应检查血清铁蛋白、T3、T4和TSH水平,因为缺铁和甲状腺激素紊乱是常与弥漫性脱发相关的两种常见情况,而且大多数时候,没有明显的临床特征提示这些情况。CTE常与FPHL混淆,通过活检可可靠地区分两者,活检显示CTE组织学正常,而FPHL有毛囊小型化,终毛与毳毛比例显著降低(T:V < 4:1)。反复保证、支持并解释该病症表现为过度脱发而非实际毛发丢失,且不会导致秃顶,是TE和CTE管理的指导原则。TE是自限性的,如果去除或治疗触发因素,3 - 6个月内可恢复,而CTE的预后不太确定可能需要3 - 10年才能自发缓解。2%外用米诺地尔加或不加抗雄激素药物非那雄胺、假发、头发化妆品和毛发手术是治疗FPHL的可用选择。