In approximately 30% of cases of chronic diffuse loss of scalp hair with a
duration of at least 6 months, no underlying abnormality can be found. Typi
cally this occurs in women, starting abruptly without a recognizable initia
ting factor, and involving the entire scalp area with increased shedding of
telogen hair. With the exception of bitemporal recession, hair thinning is
usually discrete, and contrasts to the great emotional overtones in this s
ituation. This may initially lead to the differential diagnosis of psychoge
nic pseudo effluvium. Due to synchronization of the hair cycle, the amount
of shed hair is greater than that in androgenetic alopecia, while miniaturi
zed hairs are not a feature of the disorder. Overlap with androgenetic alop
ecia and/or psychogeneic pseudo effluvium is not uncommon. Scalp dysesthesi
a or a sensation of "pain in the hair" (trichodynia) is an accompanying sym
ptom in a significant proportion of cases, and correlates better with emoti
onal upset than with actual hair loss. Current therapeutic recommendations
are pragmatic, and based on both experimental observations of the sheep woo
l industry and clinical experience. They include the use of L-cystine-conta
ining oral preparations and of corticosteroids. Further investigation into
the molecular controls of the hair cycle are required to find a more specif
ic form of therapy, for which the expense and risk-benefit ratio seem appro
priate for the treatment of this benign condition.