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GENERALIZED HAIR FALL

Diffuse hair loss usually occurs without inflammation or scarring. The loss affects hairs throughout the scalp in a more or less uniform pattern. The hair pull test is important for differential diagnosis.

Telogen Effluvium for Hair Fall

A number of events have been documented That prematurely terminate anagen and cause an abnormally high number of normal hairs to enter the resting, or telogen, phase. The follicle is not diseased but has had its biologic clock reset and undergoes a normal involutional process.

Usually No more than 50% of the patient’s hair is affected. Scarring and inflammation are absent. Resting hairs on the scalp are retained for approximately 100 days before they are lost; therefore, telogen hair loss should occur approximately 3 months after the event that terminated normal hair growth.

Common Causes

The most common causes are briefly discussed here. High fever from any cause may result in a sudden, diffuse loss of club hairs 2 to 3 months later. Hair loss begins abruptly and lasts for approximately 4 weeks. Hair pluck tests show telogen counts that vary from 30% to 60%. Full recovery can be expected.

Severe emotional and physical traumas have been documented to cause diffuse hair loss. Hair Loss has been reported to occur 2 Weeks after severe psychologic or physical trauma, but because that is too short a time for the induction of the telogen phase, the loss must have occurred by another mechanism. Some Individuals may experience increased shedding caused by idiopathic shortening of anagen (a short anagen syndrome). They have increased shedding and decreased hair length. For every 50% reduction in the duration of anagen, there is a corresponding doubling of follicles in telogen.

Chronic Telogen Effluvium for Hair Fall

i.e.

Chronic telogen effluvium (CTE) refers to a diffuse hair loss all over the scalp and persists for more than 8 months. Patients present with hair loss with increased shedding and thinning of abrupt onset and fluctuating course. There is diffuse thinning over the entire scalp, frequently accompanied by bitemporal recession. CTE usually affects 30- to 60-year-old women. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from androgenetic alopecia by its clinical and histologic findings.

CTE lasts from 6 months to 7 years. Many physicians test patients with hair loss for iron deficiency and thyroid abnormalities. Iron deficiency is commonly found in CTE but treatment for it seldom reverses the hair loss. Perform A ferritin and a transferrin saturation evaluation if iron deficiency is suspected. The long, fluctuating course is different than that seen in acute telogen effluvium. The Presence of 20% To 30% Telogen hairs and 15% To 35% Dystrophic hairs on the trichogram (plucked hair) confirms the diagnosis.

A Biopsy can support the diagnosis but is usually not necessary. CTE is distinguished from androgenetic alopecia by distribution and trichogram and a biopsy is usually unnecessary.

Postpartum Hair Fall

i.e.

The percentage of follicles in telogen progressively decreases during pregnancy, particularly during the last trimester. Diffuse But primarily frontotemporal hair loss occurs in a significant number of women 1 To 4 Months after childbirth. The Loss can be quite significant, but recovery occurs in less than 1 year. Hair growth usually returns to the pre-pregnancy state.

Drugs for Hair Fall

i.e.

Cytotoxic drugs that directly affect hair matrix cell proliferation cause profound hair loss, inducing an anagen effluvium. A large number of drugs probably cause telogen effluvia. These are listed in Anagen Effluvium.

Anagen effluvium for Hair Fall

i.e.

It is the abrupt loss of hair from follicles that are in their growing phase. PMID: 22178150 An abrupt insult to the metabolic and follicular reproductive apparatus must be delivered to create such an event. Cancer Chemotherapeutic agents and radiation therapy are capable of such an insult. The Rapidly dividing cells of the matrix and cortex are affected. The Insult causes a change in the rate of hair growth but does not convert the follicle to a different growth phase, as occurs in telogen effluvium.

High Concentrations of antimetabolites or radiation bring the entire metabolic process to an abrupt halt, and the entire hair and hair root are shed intact. The only hairs left are those in the telogen phase. These are dead, wedged into the hair canal, and unaffected by any acute event.

Stem cells i.e.

The stem cells of the hair follicles are spared because of their slow cycling, and they generate a new hair bulb. Insults of less intensity slow the mitotic rate of the bulb and cortex cells, causing bulb deformity and narrowing of the lower hair shaft. Narrow, weakened hair shafts are easily broken and shed without bulbs. Since 90% of scalp hairs are in the anagen phase, a large number Of hairs can be affected. Patients With 10% To 20% Of their hair remaining after an insult almost certainly have had an anagen effluvium. Minoxidil 2% Topical has no benefit in the prevention of chemotherapy-induced alopecia.

Loose Anagen Hair Syndrome i.e.

The loose anagen hair syndrome (in other words, LAS) is a rare sporadic or familial hair disorder that affects children but may be seen in adults. The Female to male ratio is 6:1.

LAS is due to a defective anchorage of the hair shaft to the follicle that results in easily and painlessly pluckable hair. LAS May result from premature keratinization of the inner root sheath that produces a impaired adhesion between the cuticle of the inner root sheath and the cuticle of the hair shaft. The Typical patient with LAS Is a young girl with short blond hair that does not grow long, but LAS Can affect children with dark hair.

Signs i.e.

The Signs reduce hair length, increased hair shedding, and altered hair texture. These Patients may have sparse hair that does not grow long and have patches of dull, unruly hair. Others just have increased hair shedding. The Child needs few haircuts, and the hair is difficult to manage.

Examination i.e.

Examination Shows diffuse thinning and irregular bald patches attributable to traumatic painless extraction of hair tufts. Hair is dull, unruly, or matted. Up To 300 Hairs are shed daily. Most Cases are isolated, but it can occur in hereditary or developmental disorders including coloboma, Noonan’s syndrome, and hypo hidrotic ectodermal dysplasia.

Microscopic examination i.e.

Microscopic examination shows anagen hair without sheath. The bulb is often misshapen, and its proximal portion often shows a visible ruffled cuticle. The pull test in children with LAS shows more than 3 and often more than 10 loose anagen hairs. The pull test in normal children shows one or two loose anagen hairs. The trichloramine LAS Shows at least 70% Loose anagen hairs and no telogen hairs. Most patients improve with age.