Telogen effluvium ("TE") is a type of hair loss where individuals experience increased daily hair shedding. Instead of losing 30-40 or 50 hairs per day, the individual experiences loss of 60, 70, 80 or more hairs in any given day. The numbers can exceed 500 depending on the cause of the shedding.
Common causes of TE include low iron (low ferritin), anemias, thyroid problems, crash diets, weight loss, stress, surgery, medications (ie lithium, some blood pressure pills, retinoids (vitamin A pills)). Any significant illness inside the body (ie flu, autoimmune disease) or on the scalp surface (ie severe scalp psoriasis or severe seborrheic dermatitis) can cause a telogen effluvium.
This picture shows a typical trichoscopic appearance of someone with a "TE." Numerous short pointy hairs, known as "upright regrowing hairs (URH)" can be seen.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
In the early stages of androgenetic alopecia (first few years), miniaturized hairs grow almost the same length as original hairs (not quite but close).
As time passes, and if androgenetic alopecia progresses, them miniaturized hairs grow in the scalp for shorter and shorter periods. In advanced cases, hairs affected by androgenetic alopecia grow for only a 2-3 months - and are very, very short and very, very thin. We call these "vellus-like" hairs rather than miniaturized hairs but they are a type of miniaturized hair. Over time, vellus like hairs just don't grow any more.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Most forms of alopecia areata are easy to diagnose, however one form is not. Alopecia areata incognito (which some pair together with so called diffuse alopecia areata) is the most difficult type of alopecia areata to diagnose.
A number of dermatoscopic features support a diagnosis including yellow dots, regrowing hairs, dystrophic hairs, exclamation hair and black dots. Unfortunately, all these features are not always present.
In my opinion, most cases of diffuse alopecia areata I see have a unique feature that I have traditionally called "wimpy hairs". These hairs are short and fine and refuse to grow straight up. They are very different than the strong thick pointy "upright regrowing hairs" seen in telogen effluvium. Rather these wimpy hairs twist and turn and flop over on the scalp. Many such hairs are seen in the photo.
Treatment includes potent topical steroids and steroid injections.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
There are many different forms of hair loss. We broadly classify hair loss into the "scarring" forms and the "non-scarring" forms. Patients with scarring forms (also called scarring alopecia) may experience hair loss accompanied by symptoms such as itching, burning or even scalp tenderness/bruising. Some patients, however are completely asymptomatic.
The hallmark of all scarring alopecias is the loss of the follicular openings or "pores" when examined up close. Rather these areas are replaced by scar tissue - as shown here in this photo of a patient with a scarring alopecia known as lichen planopilaris (LPP).
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Pohl Pinkus constructions or monikethrix-like constrictions are characterized by thinner areas of the hair shaft due to reduced matrix activity. This dermatoscopic finding is common is alopecia areata, and can also be seen in scarring alopecia (shown here), congenital hypotrichosis, and with some chemotherapies
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
