CHRONIC TELOGEN EFFLUVIUM - INCREASED SCALP HAIR SHEDDING IN MIDDLE-AGED WOMEN

Background: Diffuse loss of scalp hair is a common problem in middle-a ged women. A segment of these cases represents idiopathic chronic telo gen effluvium (CTE). Objective: The purpose was to establish distincti ve clinical and pathologic criteria for the diagnosis of CTE to facili tate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss. Methods: A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hai r of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair l oss with both increased shedding and thinning of abrupt onset and fluc tuating 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 sp ecimens were also taken from 22 normal control subjects (13 males, nin e females). Specimens were sectioned horizontally and vertically and w ere examined for terminal and velluslike (miniaturized) hairs, follicu lar stelae, follicular units, and perifollicular inflammation and fibr osis. Results: In horizontal sections of 4 mm punch biopsy specimens f rom 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 anag en, 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 fi brosis were present in only 10% to 12% of cases of CTE and normal cont rols, but occurred in 37% of cases of AGA. CTE ran a prolonged and flu ctuating course in many patients. Conclusion: CTE, which usually affec ts 30- to 60-year-old women, starts abruptly with or without a recogni zable initiating factor. It may be distinguished from classic acute te logen effluvium by its long fluctuating course and from AGA by its cli nical and histologic findings.