Figure 1.1
Diffuse hair loss as can been seen in advanced telogen effluvium
Androgenetic alopecia: Commonly referred to as “male pattern baldness,” androgenetic alopecia can occur in female patients as well, and can be seen in younger age groups. Male pattern is typically more over the bitemporal region and vertex, whereas female pattern preserves the anterior hairline and begins as widening of the part, progressing to diffuse thinning over the top of the scalp. Thyroid function, iron status, and vitamin D levels should be assessed and optimized. The etiology of androgenetic alopecia is thought to be multifactorial, with components of genetics, hormone levels, and environmental factors playing a role. Onset is usually insidious and progressive.
Further Workup
The patient’s family is asked to return to the waiting room, so that the doctor can perform a private examination. Her mother is initially resistant but later acquiesces. The pediatrician then takes the opportunity to spend a few more minutes on the patient’s history, and asks if anything particularly stressful has occurred in the last several months. The patient denies anything out of the ordinary. Her doctor then asks if she is sexually active, and the patient breaks down in tears. She admits to having a boyfriend of which her parents are not aware, as they are quite controlling and resistant to dating, and states that she had protected sexual intercourse for the first (and only) time 3 months ago. She has been feeling incredibly guilty and anxious since that event, to the point that her boyfriend broke up with her last week.
A serum vitamin D level, CBC, iron studies, and TSH are all found to be within normal limits. Beta-HcG and ANA are negative.
Diagnosis
Telogen effluvium
Conventional Treatment Options
Time: The natural course of telogen effluvium is resolution, typically within 3–6 months, although some cases can become chronic (particularly if the patient has underlying androgenetic alopecia which becomes unmasked). Most often, however, if the inciting factor was an isolated event or occurrence, then full resolution without intervention is typical.
Counseling: If telogen effluvium is secondary to (or accompanied by) severe stress or anxiety, referral for professional counseling may help break the vicious cycle.
Minoxidil: Topical minoxidil is available in 2 and 5 % formulations, and while the approved indication is for androgenetic alopecia, may help promote hair growth in telogen effluvium as well (use is off-label). One caution with minoxidil is that, for androgenetic alopecia, cessation of treatment leads to shedding of any regained hairs—this phenomenon, however, is not clear-cut in acute telogen effluvium but remains a possibility of which patients should be aware. Additionally, minoxidil is available in solution and foam formulations, and many patients report irritation with the former (likely from the propylene glycol in the vehicle).
Integrative Treatment Options
Avoidance of products containing parabens, sulphates, and phthalates: To generally support healthy hair and discourage breakage of newly growing strands, it is advisable to use hair care products that are as free of potential irritants and carcinogenic or endocrine-disrupting chemicals as possible.
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