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Telogen effluvium is the most common form of diffuse
alopecia. It is often diagnosed from a history of an
initiating event 3 months before the onset of shedding.
Causes include childbirth, sustained high fever, surgery,
systemic disease exacerbation, crash low protein diets,
severe emotional stress, and drug reactions. Pull tests are
positive all over the scalp. Bitemporal recession is a
useful diagnostic sign in women. The acute form normally
subsides in 3 to 6 months. In true telogen effluvium, the
hair invariably regrows within a short time.
Postpartum telogen effluvium
This condition is associated with postpartum hormone-related
changes that temporarily prolong hair resting phase. It is
most commonly seen 2 to 4 months postpartum.
Anagen effluvium is drug or toxin-induced and may mimic
diffuse alopecia areata. Chemotherapy is the most common
Trichotillomania is the manifestation of a psychogenic
behavioral pattern of frequent hair-pulling by the patient.
It is frequently related to obsessive-compulsive disorder
and can be seen in males and females of all ages, but most
commonly in preadolescent and early adolescent girls. The
disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas
of functioning. The bald area manifests as a distinct,
unnatural geometric shape. Hair may be pulled from a
secondary site, such as the eyelashes, eyebrows, underarms,
body, or pubis. Assess for other psychosocial factors and
disorders and refer for counseling as indicated.
Diagnostic and Statistical Manual-IV (DSM-IV) Criteria for
Recurrent pulling out of one's hair, resulting in
untreatable hair loss
Increasing sense of tension immediately before pulling out
the hair or when attempting to resist behavior
Pleasure, gratification, or relief when pulling out the hair
The disturbance is not better accounted for by another
mental disorder and is not due to a general medical
condition (e.g., a dermatologic condition).
Alopecia areata is an inherited autoimmune condition of
varying severity. In some patients, hair loss is confined to
one or more small oval patches; in others, the scalp is
essentially denuded except for a few tufts of hair. It may
involve the entire scalp (alopecia totalis) or the surface
of the whole body (alopecia universalis). The condition is
marked by exacerbation and recovery with high variability
Tinea capitis is a contagious fungal infection of the scalp
mostly seen in ages 4 to 14 years. There are fine, scaly,
circumscribed areas that are frequently itchy and inflamed.
Hair is dull and brittle, breaking off at scalp. In more
extensive cases, there may be fever and cervical
lymphadenopathy. In the United States, over 90% of cases are
from the nonfluorescent Trichophyton fungus. Potassium
hydroxide (KOH) examination shows hyphae. Antifungals such
as terbinafine, fluconazole, itraconazole, or griseofulvin
are used for treatment.