Chronic Telogen Effluvium: Photos don't help with Diagnosis

Chronic telogen effluvium (CTE)

Chronic telogen effuvium remains one of the most poorly understood and confusing of all the hair loss conditions. First, this is a hair shedding condition whereby women experience intervals in their life where massive shedding occurs followed by intervals whereby things feel pretty normal again.

CTE is frustrating because the scalp may look normal. I’m often asked by prospective patients if they can email me a photo to me so I can tell them what I think. This can work well for some types of hair loss - but not chronic telogen effluvium! Photos do not help in confirming the diagnosis of CTE! For patients with CTE, the scalp looks quite normal and so does the hair! Granted the patient may feel they once had double or triple the amount of hair on their scalp - but the patients still walks through the door looking as though they have fairly full hair.

How do we diagnosis CTE?

CTE is diagnosed by listening to the patient’s story and by examining the scalp up close to exclude other mimickers. The patient’s story is important because the patient reports episodes of increased hair shedding. The hair loss occurs from all over the scalp. There may be symptoms like burning, creepy crawly feelings sometimes and tenderness. These are all part of the so called trichodynia that some patients experience.

Examination of the scalp shows bands of regrowth as evidence of previous sheds but also shows that there is no miniaturization of hairs that would otherwise be consistent with androgenetic alopecia. There is no loss of ostia and evidence of scarring that would point to a diagnosis of cicatricial alopecia.

Biopsy is seldom necessary but can be used to confirm that the patient does not in fact have genetic hair loss, scarring alopecia or alopecia areata as the cause of their hair loss.

Conclusion: Photos don’t help in the diagnosis of CTE

Patients with CTE don’t usually look like they have hair loss. The patient with CTE certainly HAS hair loss - but they don’t look like they have hair loss to someone who has never met them before. The patient with classic isolated CTE will be told by family and friends that they look fine - despite the fact that that patient is frustrated with all the shedding they have and frustrated by amount of hair they have lost.