Whiting D A
Department of Dermatology and Pediatrics, University of Texas Southwestern Medical Center, USA.
J Am Acad Dermatol. 1996 Dec;35(6):899-906. doi: 10.1016/s0190-9622(96)90113-9.
Diffuse loss of scalp hair is a common problem in middle-aged women. A segment of these cases represents idiopathic chronic telogen effluvium (CTE).
The purpose was to establish distinctive clinical and pathologic criteria for the diagnosis of CTE to facilitate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss.
A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hair of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair loss with both increased shedding and thinning of abrupt onset and fluctuating course and showed diffuse thinning of hair all over the scalp, frequently accompanied by bitemporal recession. Two 4 mm punch biopsy specimens were taken mostly from the mid or posterior parietal scalp of these patients. The biopsies were performed at these same areas in 412 patients with AGA (193 male, 219 female). Similar paired biopsy specimens were also taken from 22 normal control subjects (13 males, nine females). Specimens were sectioned horizontally and vertically and were examined for terminal and velluslike (miniaturized) hairs, follicular stelae, follicular units, and perifollicular inflammation and fibrosis.
In horizontal sections of 4 mm punch biopsy specimens from patients with CTE the average number of hairs was 39, the terminal/velluslike hair ratio was 9:1, 89% of the terminal hairs were in anagen, and 11% were in telogen. In AGA these values were 35, 1.9:1, 83.2%, and 16.8%, respectively, and in normal control subjects 40, 7:1, 93.5%, and 6.5%, respectively. Significant degrees of inflammation and fibrosis were present in only 10% to 12% of cases of CTE and normal controls, but occurred in 37% of cases of AGA. CTE ran a prolonged and fluctuating course in many patients.
CTE, which usually affects 30- to 60-year-old women, starts abruptly with or without a recognizable initiating factor. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from AGA by its clinical and histologic findings.
头皮弥漫性脱发是中年女性的常见问题。其中一部分病例为特发性慢性休止期脱发（CTE）。
旨在建立CTE诊断的独特临床和病理标准，以促进其与雄激素性脱发（AGA）及慢性弥漫性脱发的全身性病因相鉴别。
一组355例（346例女性，9例男性）不明原因的头皮弥漫性广泛性头发稀疏患者被归类为患有CTE并纳入研究。其特征为有脱发病史，脱发增加且头发突然变薄，病程波动，头皮各处头发弥漫性变薄，常伴有双侧颞部头发后退。主要从这些患者顶骨中部或后部头皮取两个4毫米的打孔活检标本。对412例AGA患者（193例男性，219例女性）在相同区域进行活检。也从22名正常对照者（13名男性，9名女性）取类似的配对活检标本。标本进行水平和垂直切片，检查终毛和毳毛样（小型化）毛发、毛囊柱、毛囊单位以及毛囊周围炎症和纤维化情况。
CTE患者4毫米打孔活检标本的水平切片中，平均毛发数量为39根，终毛/毳毛样毛发比例为9:1，89%的终毛处于生长期，11%处于休止期。在AGA中，这些值分别为35、1.9:1、83.2%和16.8%，在正常对照者中分别为40、7:1、93.5%和6.5%。仅10%至12%的CTE病例和正常对照有显著程度的炎症和纤维化，但37%的AGA病例存在。许多CTE患者病程延长且波动。
CTE通常影响30至60岁女性，发病突然，有无明显诱发因素均可。它可因其病程长且波动与典型急性休止期脱发相鉴别，因临床和组织学表现与AGA相鉴别。
