Telogen Effluvium in Children: Infections, Iron, Vitamin D and Stress Top the List of Triggers

What are the triggers of telogen effluvium in children ?

Introduction

Earlier this year, I shared a study from Dr Sibbald and colleagues outlining the potential triggers for telogen effluvium at a tertiary care centre. Systemic inflammatory diseases, infections, low iron, low vitamin D, and stress were among the top triggers.
READ: IRON DEFICIENCY, STRESS, INFECTIONS AMONG THE MORE COMMON CAUSES OF TELOGEN EFFLUVIUM IN CHILDREN.

Chen et al 2022

A new study set out to better evaluate causes and treatment approaches for children with telogen effluvium.

Chen and colleagues performed a retrospective study of pediatric patients with telogen effluvium at the University of Miami seen over the period 2009 to 2021. There were 76 patients included in the study. Age at disease onset was on average 12.3 years old. Patients consisted of 88% (67/76) female and 12% (9/76) male.

Races included African-American/Black (3%), Asian (3%), Hispanic or Latino (62%), multi-race (3%), and White (28%).

32% (24/76) of patients had other non-dermatologic conditions, including asthma (n = 7), anemia (n = 3), thyroid disease (n = 3), GI diseases including inflammatory bowel disorders (IBD) (n = 3), and attention deficit and hyperactivity disorder (n = 3)

Specific Triggers of Telogen Effluvium in Children.

67% of patients (n = 51) had an identifiable “trigger”, with the most common ones being emotional stress and acute febrile illness, followed by nutritional deficiencies (specifically low ferritin, and low vitamin D).

No trigger could be found in 42 % of children. 18.4 % had emotional stress as the trigger. 14.5 % had acute illness or febrile illness as the trigger. Micronutrient deficiencies were present in 11.9% 5.3 % had weight loss as the trigger. 12-15 % had another reason.

Treatment included addressing the trigger where possible. Observation was the most common therapeutic approach. Children were found to have similar chances of improvement regardless of the cause.

Comment

This study has many similarities to the study by Thomas et al. It indicates that stress, infection, low iron and low vitamin D are among the triggers of telogen effluvium in chilfren. It’s interesting that inflammatory bowel disease was a disease comorbidity present in some children of the Chen et al study and some children of Thomas et al study. This patient population may be a higher risk than many other pediatric groups for micronutrient deficiency related telogen efflvium (as well as some cases of drug induced telogen effluvium).

REFERENCE

Chen V et al. Etiology, management, and outcomes of pediatric telogen effluvium: A single-center study in the United States. Pediatr Dermatol. 2022 Oct 20.